A 72-year-old female presents to an Adelaide emergency department with bilateral eye pain and redness lasting several days. She has a history of hypertension, hypercholesterolemia and age-related macular degeneration for which she has received a range of medications. Anterior uveitis is identified as the proximal cause of the ocular pain but there are many possible aetiologies that require careful consideration. Pomegranate [Case Reports] have been developed to help Trainees rehearse diagnostic problem solving and case presentation.
 
Guests
Associate Professor Jagjit Singh Gilhotra ,FRANZCO (Queen Elizabeth Hospital; University of Adelaide)
Dr Yong Min (Shane) Lee FRACP (Royal Adelaide Hospital)
 

Host
Associate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes  ‘Desert Whispers’ by Tellsonic  and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. 

Key Reference (Spoiler Alert)

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Bilateral occlusive retinal vasculitis secondary to intravitreal faricimab injection: a case report and review of literature [Lee, Eye Vis. 2024]

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Australia has just approved a second amyloid-targeting therapy for patients with incipient Alzheimer’s dementia. Lecanemab (Leqembi) now joins donanemab (Kisunla) on the Australian Registry of Therapeutic Goods but the impact of both has been modest in Phase III trials to date. After 18 months of therapy they delay progression of disease, as quantified on neurocognitive tests, by around 5 months on average. 
 
For some, the prolonged independence and dignity will justify the $60,000 to $80,000 a year price tag for the drugs. But for the Pharmaceutical Benefits Advisory Committee “the high burden of [donanemab] treatment on both patients and the health system, combined with the risks and modest clinical impact, makes the drug unsuitable for PBS subsidy”.
 
This burden includes specialist consults, gene screening, multiple MRI and PET brain scans, and delivery of monthly or fortnightly infusions, adding up to another $20,000 in costs. Even before considering these logistical requirements, Australian memory clinics don’t have anywhere near the capacity to address the 245,000 new cases of early dementia or mild cognitive impairment every year. 

Advocates see these disease-modifying therapies as a turning point for dementia research and argue for further investment in the systems infrastructure needed to roll them out. Sceptics argue that the available evidence instead questions the importance of amyloidosis in the Alzheimer’s disease cascade.

Guests
Professor Michael Woodward AM FRACP FANZSGM FAAG FAWMA (Austin Health, Melbourne; University of Melbourne)
Dr Chrysanth Pulle FRACP (Prince Charles Hospital, Brisbane) 

Chapters
13:16 Time Saved
16:18 Costs of treatment
26:44 IMJ paper on resourcing
39:10 Scepticism and staging

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘RGBA’ and ‘Pulse Voyage’ by Chill Cole, ‘A Forest Melody’ by Tellsonic, ‘Axon Terminal’ by Out to the World, ‘Organic Textures 2’ by Johannes Bornlof and ‘Fugent’ by Lupus Nocte. Image courtesy of Wikimedia Commons and University of Pittsburgh. 

Editorial feedback kindly provided by physicians of the podcast editorial group Ronaldo Piovezan, Aidan Tan, Hugh Murray, Joseph Lee, Rahul Barmanray, Simeon Wong and Sebastian Lambooy. Thanks also to Profs Bruce Campbell, Mike Parsons and Amy Brodtmann and registrars Jamie Bellinge and Karan Singh for additional insights into research methods. 

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

ST elevation is clearly a worrying finding that can herald life-threatening conditions, such as ST elevation myocardial infarction. But not all ST-elevations are created equal, and Trainees would benefit from considering a broader number of causes for this presentation. In today’s podcast the team will discuss a case of ST elevation observed in a 65-year-old female during the routine elective procedure of atrial fibrillation ablation. A range of pathophysiologies is discussed that can help listeners work though the differentials in a systematic way. 

Guests
Assoc Prof Pramesh Kovoor FRACP FACC PhD (Westmead Hospital; the University of Sydney)
Dr Neil Warwick FANZCA (Westmead Hospital)
 
Hosts
Associate Professor Stephen Bacchi FRACP (University of Adelaide)
Dr Joshua Kovoor (Ballarat Base Hospital)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Game show music courtesy of Waderman. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by RACP physicians Aidan Tan, Aafreen Khalid, Hugh Murray and medical student Nivida Dixit.

Key Reference (Spoiler Alert)

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Metaraminol-induced coronary vasospasm masquerading as ST-elevation myocardial infarction during general anaesthesia [Br J Anaesth. 2024]

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

In this episode we put continuing professional development (CPD) under the microscope, particularly the regulatory changes on the horizon. The Medical Board of Australia is emulating shifts already made by the Medical Council of New Zealand and regulators in Canada, the U.S. and the U.K. In some cases, this 'revalidation' movement has been fiercely opposed by doctors. But where did it come from, and why is CPD even necessary after you've already done 10 to 15 years of medical training.

Guests
Professor Richard Doherty FRACP (Dean, RACP; Monash Childrens Hospital and University) 
Dr Craig Campbell, MD FRCPC (Royal College of Physicians and Surgeons of Canada; The Ottawa Hospital)

Production
Written and produced by Mic Cavazzini. Recording assistance in Ottawa from Pop-Up Podcasting. Music courtesy Gunnar Johnsén at Epidemic Sound ('Task at Hand 2', 'Task at Hand 5', 'The Sky Changes 2') and Blue Dot Sessions ('Vittoro'). Image courtesy Neil Turner at Flickr.The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP members Phillipa Wormald, Michael Herd, Rhiannon Mellor, Joseph Lee, Rachel Williams, Phillipa Wormald, Paul Jauncey, Rebecca Grainger, Philip Gaughwin and Alan Ngo. Thanks also to RACP staff Lianne Beckett, Michael Pooley, Elyce Pyzhov, Amy Nhieu, Shona Black, Abigail Marshall, Kerri Brown, Sandra Dias and Carol Pizzuti.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

An empathic connection and good communication between physician and patient can promote better outcomes. In this episode of Pomegranate Health, U.S. physician A/Prof Danielle Ofri discusses where breakdowns in doctor-patient communication occur—often in the first 10 or 20 seconds of a consultation. Dr Ofri, author of What Patients Say, What Doctors Hear, suggests ways for physicians to listen better, to be understood and promote adherence.

Some media also report a 'crisis of compassion' in healthcare. Burnout of staff is a major contributor, and palliative care physician Dr Shamsul Shah describes how to mitigate it by convening groups to reflect on the emotional challenges of the job. She recently published an evaluation of Schwartz Center Rounds® (case-based reflections) run at Auckland City Hospital in the College's Internal Medicine Journal.

Guests
A/Professor Danielle Ofri MD PhD (Bellevue Hospital, New York; New York University School of Medicine)
Dr Shamsul Shah FRACP (Auckland City Hospital)

Production
Written and produced by Mic Cavazzini. Music courtesy of Blue Dot Sessions ('Periodicals'), Sergey Cheremisinov ('Old Ally', 'Tavern'), and Loch Lomond ('A String- Instrumental'). Image property of RACP. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP members Philip Gaughwin, Michael Herd, Andrea Knox, Paul Jauncey, Rebecca Grainger, Joseph Lee, Rachel Williams, Mahesh Dhakal, and Katrina Gibson.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

As medicine becomes more sophisticated, discussions about clinical ethics become more common. It is now possible to support life in dire clinical circumstances, but physicians are not always sure if this is the right thing to do. There are questions about quality of life and best interests of the patient, questions about cognitive competence to make such decisions for oneself or questions about equitable distribution of limited resources.

This episode was recorded at the RACP Congress in May and centres around two case studies. The first describes a three-year-old boy with a severe neurodegenerative disorder whose parents are desperate to try an expensive experimental drug. The second is about a man ravaged by bowel cancer who has spent months on life-sustaining care. You'll hear a variety of physicians express their views, and members of the College Ethics Committee describe how clinical ethics services can support decision-making in such cases.

Panellists
Professor David Isaacs FRACP (Children's Hospital Westmead, University of Sydney)
Professor Ian Kerridge FRACP (Royal North Shore Hospital, Sydney Health Ethics)
Professor Paul Komesaroff FRACP (Alfred Hospital, Monash University, Centre for Ethics in Medicine and Society)
Associate Professor Jill Sewell FRACP (Royal Children's Hospital Melbourne, Children's Bioethics Centre, University of Melbourne)
Dr Linda Sheahan FRACP FAChPM (St George Hospital, Sydney Health Ethics)
Professor Cameron Stewart (Sydney Law School, Sydney Health Ethics)

Production
Produced by Mic Cavazzini. Initial interview conducted by Melissah Bell. Music courtesy of Daddy Scrabble ('Tune for Elli'), Jason Shaw ('Namaste'), and Kai Engel ('Highway to the Stars'). Image via Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP Fellows Philippa Wormald, Andrea Knox, Rebecca Grainger, Philip Gaughwin and Rhiannon Mellor.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

This is the second of two episodes about acute coronary syndrome (ACS). In part one, the discussion focused on diagnostic workup of acute coronary events. This episode deals with secondary prevention and adherence to therapy. One-fifth of people discharged with a diagnosis of ACS have another ischaemic event within six months, and the risk of dying increases the second time round.

There is an established strategy for secondary prevention of ACS that includes pharmacotherapy, cardiac rehabilitation and lifestyle management. However, 75 per cent of patients are discharged from hospital without one or more of these tools. A recently published study in the Internal Medicine Journal suggests this sets a trend for care going forward. As Professor David Brieger explains, follow-up visits to the GP are unlikely to ensure best-practice pharmacotherapy if this was not prescribed in hospital.

Cardiac rehabilitation may also not be as effective as it could be in reducing the risk of further ischaemic events. On this episode, Associate Professor Julie Redfern argues that the group exercise model is outdated, and a more personalised approach is needed to keep patients engaged.

Guests
Professor David Brieger FRACP (Concord Repatriation General Hospital, University of Sydney)
Associate Professor Julie Redfern PhD(George Institute for Global Health, University of Sydney).

Production
Written and produced by Mic Cavazzini. Music courtesy of Jason Shaw ('Minstrel'), Lee Rosevere ('Become Death'), Sergey Cheremisinov ('Pulsar') and Loch Lomond ('Listen, Lisbon'). Image courtesy of iStock. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP Fellows Joseph Lee, Michael Herd, Marion Leighton, Rachel Williams, and Mahesh Dhakal.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Chest pain and other symptoms suggestive of ACS make up the majority of presentations to hospital. 11 to 17 per cent of patients presenting to ED with such symptoms end up having the diagnosis confirmed. But follow-up studies of discharged patients show that up to six per cent of diagnoses are missed, and inappropriately discharged patients have a twofold higher mortality rate than those who are admitted.

The 2016 guidelines of the Cardiac Society of Australia and New Zealand were developed to guide the rapid differentiation of patients presenting with suspected ACS. ACS takes in STEMI and non-STEMI heart attacks, and also unstable angina. This episode outlines the investigations used to distinguish these and other differential diagnoses associated with chest pain. First, electrocardiogram recordings are used to identify the occurrence of a myocardial infarction with ST segment elevation. If STEMI is discounted, the next most important step is to rule out other life-threatening causes of chest pain. Third in the diagnostic hierarchy is to establish whether there has been myocardial infarction without ST elevation, or unstable angina. This is where high sensitivity troponin markers become useful, and can feed into stratification protocols for assessing the risk of patients suffering future acute cardiac events.

Guest
Associate Professor Louise Cullen FACEM (Royal Brisbane and Women's Hospital, University of Queensland

Production
Written and produced by Mic Cavazzini. Additional audio recording from Michelle Ransom-Hughes. Music courtesy of Jason Shaw ('Minstrel, Pioneers'), Lee Rosevere ('Become Death'), Sergey Cheremisinov ('Pulsar') and Loch Lomond ('Listen, Lisbon'). Image courtesy of Science Photo Libary. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP members Paul Jauncey, Pavan Chandrala, Rebecca Grainger, Phillip Gaughwin, Rhiannon Mellor, Alan Ngo, and Mahesh Dhakal.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

In Episode 32  we discussed cognitive error in diagnostic reasoning. On this episode, we take a look at systems pressures that increase the likelihood of medical error, crystallised by the recent prosecution of NHS paediatrician Dr Hadiza Bawa-Garba. Almost half of diagnostic errors are due to a combination of systems errors and individual cognitive error. Obvious systems effects come into play in understaffed acute care units; if a clinician is forced to see too many patients without enough time to make careful examinations or reasoned decisions, errors become more likely. The stepping stones of ordering, receiving and reviewing diagnostic tests and scans also allow much opportunity for error and delay. Guests on this episode discuss mechanisms to improve efficiency

Obvious systems effects come into play in understaffed acute care units. If a clinician is forced to see too many patients without enough time to make careful examinations or reasoned decisions, errors become more likely. And of course, long hours and fatigue will only reduce cognitive capacity. Hospital systems also include the stepping stones of ordering, receiving and reviewing diagnostic tests and scans. Missteps and delays in this cascade contribute to a large proportion of diagnostic errors. Guests on this episode discuss mechanisms to improve efficiency.

Another important step in improving health systems is capturing and reporting error rates accurately. If clinical error is wrapped in culture of blame and punishment, it will make such disclosure more difficult. This concern has been raised in response to the recent prosecution of U.K. National Health Service (NHS) paediatrician Dr Hadiza Bawa-Garba, who had her licence to practice medicine revoked for her role in the death of a young patient. Six-year old Jack Adcock died on a chaotic day in 2011 at the Leicester Royal Infirmary that involved delays in the diagnosis and treatment of his sepsis. Today’s episode examines how widespread systems errors contributed to such mistakes.

Guests
Professor Jeffrey Braithwaite FAIM, FACHSM, FAHMS, FFPH-RCP, FAcSS, Hon FRACMA (Australian Institute for Health Innovation, Macquarie University)
Associate Professor Ian Scott FRACP (Director, Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, University of Queensland)
Associate Professor David Heslop FRACGP (University of New South Wal

Production
Written and produced by Mic Cavazzini. Additional audio recording from James Milson and Jennifer Leake. Music courtesy of Kai Engel ('Memories'), Jahzarr ('Become Death'), Sergey Cheremisinov ('Now You Are Here') and Loch Lomond ('Violins and Tea'). Image courtesy of Max Pixel. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Phillipa Wormald, Katrina Gibson, Rosalynn Pszczola, Andrea Knox, Philip Gaughwin, Rhiannon Mellor and Richard Doherty. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

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Cannabis is a plant rich with potential therapeutic compounds and centuries of cultural resonance. At this moment in Australia, media accounts are full of patient stories and lab data suggesting benefit from cannabis for scores of different conditions, while politicians discuss laxer regulation of the drug and a new lucrative industr

However, only a few of the claimed medical effects of the plant have been proven by rigorous clinical trials in people. Nabiximols is the only medicinal cannabis product currently registered in New Zealand and Australia, and it's indicated only for­­ the treatment of spasticity in patients with multiple sclerosis (MS). Systematic reviews of the research note strong evidence that cannabis can also help with the pain associated with MS, the nausea induced by chemotherapy and some cases of epilepsy. But for many other conditions like post-traumatic stress disorder, irritable bowel syndrome, immune disorders and Parkinsonism, reviewers concluded that meaningful clinical recommendations could not be made—there simply aren't enough studies of good quality. 

Cannabis is complex. The flower bud contains mostly cannabidiol and tetrahydrocannabinol (THC), but there are about 100 other cannabinoid compounds. On this episode, Pomegranate Health guests explain how important it is to separate the effect of these various components in a systematic way, and why well-regulated research and prescribing will be safer for patients. 

Guests
A/Prof Peter Grimison FRACP (Chris O'Brien Lifehouse, University of Sydney)
Prof Meera Agar FRACP (UTS, USNW, IMPACCT)
A/Prof Carolyn Arnold FRACP (Monash University Alfred Health)
Prof Samuel Berkovic AC FRACP (Epilepsy Research Centre, University of Melbourne)
Prof Jennifer Martin FRACP (Australian Centre for Cannabinoid Research Excellence, University of Newcastle, John Hunter Hospital).

Production
Written and produced by Mic Cavazzini. Additional audio recording from James Milson. Music courtesy of Blue Dot Sessions (“Cloud Line”), 4T Thieves (“New Times”), Mystery Mammal (“Asylum”) and Jahzarr (“Please Listen Carefully”). Image courtesy of iStock. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP members Dr Michael Herd, Dr Pavan Chandrala, Dr Marion Leighton, Dr Rosalynn Pszczola, Dr Mahesh Dhakal, Dr Rhiannon Mellor, Dr Rebecca Grainger, Dr Philip Gaughwin and Dr Paul Jauncey, as well as Louise Hardy (Manager, RACP Policy and Advocacy) and Ms Joanna Harrison (Senior Adviser, ACRE).

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Misdiagnosis or delayed diagnosis occurs in 10-15 per cent of acute presentations, although fortunately only a tenth of these lead to serious consequences. But of concern is the fact that this figure hasn't changed in three decades, despite progress in clinical knowledge. Errors in diagnostic reasoning occur at the same rate in senior clinicians as they do in juniors, even though mistakes from poor examination or knowledge become less frequent as one gains experience. 

Compared to problems in maths or physics, diagnostic problems are thought of as ill-structured: because information isn't readily available, the problem can keep changing and often you're not certain you've reached a solution and are free to stop searching. Cognitive errors result from jumping to conclusions on the basis of intuition and incomplete information. There are a hundred different types of such bias. On this episode, the most common types will be discussed, as well as strategies to force a more considered process of diagnostic reasoning. 

In about two thirds of cases, systems problems like design and workflow contribute to diagnostic error. These will be discussed in the second episode of this series. 

Guests
Dr Nicolas Szecket FRACP (Auckland City Hospital)
Dr Arthur Nahill FRACP (Auckland City Hospital). 

Production
Written and produced by Mic Cavazzini. Music courtesy of Mystery Mammal ('To be Decided,' 'Data'), RGIS VICTOR ('Lampagisto') and Lobo Loco ('Spook Castle'). Image courtesy of iStock. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP members Dr Paul Jauncey, Dr Alan Ngo, Dr Katrina Gibson. Dr Marion Leighton, Dr Michael Herd and Dr Joseph Lee.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

'Ngā Kaitiaki Hauora' translates as 'guardians of health'. This podcast emerged from a meeting near Auckland organised by the RACP's Māori Health Committee in November 2017. Members of various medical colleges and institutions came together to share perspectives on the delivery of health care to New Zealand's population of Māori and Pacific Islander people. This conversation comes in the context of the Wai 262 claim, which is forcing a re-examination of the Crown's obligations to the Māori population under the Waitangi Treaty of 1840.

On this episode, Reverend Hirini Kaa proposes that all institutions of civil society must be committed to recognising Indigenous sovereignty not just over land, but also the natural environment, the language, and cultural practices. GP Dr Peter Jansen and oncologist Dr George Laking describe the variation in medical care that Māori and Pacific Islander patients receive on a day to day basis, and how this can emerge in part through cultural 'mismatches'. And public health physician Dr Elana Curtis describes the successes and future targets of streaming Māori and Pacific Islander students into medical school.

Guests
Dr Peter Jansen FNZCGP FRACMA (Ngāti Raukawa, Mauri Ora Associates, Accident Compensation Corporation)
Dr George Laking FRACP (Te Whakatōhea, Auckland City Hospital)
Dr Elana Curtis AFPHM (Ngāti Rongomai, Ngāti Pikiao, University of Auckland)
Rev Hirini Kaa (Ngāti Porou, Ngati Kahungunu, University of Auckland)
Mr Chayce Glass (Tumuaki, University of Otago).
Commemoration to Matua Leo Buchanan given by Dr Tuwhakairiora Williams.

Production
Written and produced by Mic Cavazzini. Music courtesy of Jason Shaw ('Autumn Sunset'), Doctor Turtle ('Making a Change') and Broke For Free ('Feel Good Instrumental'). Image of the Te Whare Tapa Whā health model by Sir Mason Durie, provided courtesy of NZ Ministry of Health: Manatū Hauora. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP Fellows Dr Katrina Gibson and Dr George Laking and RACP staff Ms Harriet Wild, Ms Nicola Fowler, and Dr Cristiana Palmieri.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
 

The World Medical Association has just updated the Physician's Oath in the Declaration of Geneva to include the clause, 'I will attend my own health, well-being, and abilities in order to provide care of the highest standard.' This is in recognition of the often reported figures about burnout, depression and suicide in the health workforce.

These rates are typically twofold higher than they are in the general population, according to studies from New Zealand, Australia and around the world. Causes often given for psychiatric distress in the medical profession are the gruelling hours, the pressure of perfection, the unforgiving culture and the stigma associated with mental health issues. This episode examines how the system might be shaped to improve physician wellbeing.

If you or someone you know is struggling with mental health issues, please seek help—call Lifeline on 13 11 14. The RACP also provides a confidential, 24-hour support program for its members. Fellows can call 1300 687 327 in Australia, and 0800 666 367 in New Zealand.

Guests
Dr Geoff Toogood FRACP (Alfred Hospital)
Dr Margaret Kay FRACGP (University of Queensland; Medical Director, Queensland Doctors' Health Program)
Dr Hilton Koppe FRACGP.

Production
Produced by Mic Cavazzini. Recording assistance from Michelle Ransom-Hughes and Rebecca Fary. Music courtesy of Kai Engel ('Highway to the Stars'), Cory Gray ('Low Rollers'), Blue Dot Sessions ('Periodicals') and Lee Rosevere ('Here's the Thing'). Photo via iStock. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP Fellows Dr Marion Leighton, Dr Alan Ngo, Dr Michael Herd, Dr Phillipa Wormald and Dr Paul Jauncey.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  
 

There is evidence that six months or more off the job leads to some loss of practical skills and knowledge and certainly, many doctors report a loss of self-confidence. People take time out from medical practice for many different reasons but career breaks to raise children are more common than ever before. Senior staff at Sydney Children’s Hospital have developed a day-long workshop to help medics brush off the cobwebs before they return to practice. It involves rehearsal of specific skills, refreshers on calculation and interpretation tasks and a high-fidelity critical care simulation. Just as importantly, there is open discussion and mentorship to support the transition back to work. The program is called Paediatric Returnees after Maternity or Extended Leave (PRAM) this podcast was recorded during a live workshop at the Kids Simulation Centre, Randwick.
 
Guests
Workshop participants:
Elodie, Eliza, Emma, April, Stephanie, Lucy and Paula.

PRAM creators:
Dr Josephine Goodyer FRACP (Sydney Children’s Hospital, Randwick)
Dr Sasha Symonds FRACP FACEM (Sydney Children’s Hospital, Randwick)
Renee Byrne (Sydney Children’s Hospital, Randwick)

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Elm Lake’ by Elm Lake, ‘Quiet Waters’ by Walt Adams, ‘Illuminations 4’ by Johannes Bornlöf, ‘Feeling Minnesota by Gavin Luke, and ‘Maybe This Time’ by Major Tweaks. Image by Maskot licenced through Getty Images. 

Editorial feedback kindly provided by RACP physicians Sasha Taylor, Stephen Bacchi,Simeon Wong, Zac Fuller, Hugh Murray, Aidan Tan, Sern Wei Yeoh, Sasha Taylor and Stella Sarlos. Thanks also to RACP staff Arnika Martus and Kathryn Smith. 

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. 

Adverse drug events cause about five per cent of admissions to a public hospital, although some studies suggest the figure could be as high as 15 per cent. That makes at least half a million patients in Australia and 55,000 in New Zealand every year. 

Drug-drug interactions make up about a fifth of these adverse events. They have become more frequent over the decades, as more medications reach the market. More than half of people over the age of 75 are on five or more prescriptions—a state referred to as polypharmacy. 

This episode examines some of the systems that have led to current rates of polypharmacy, and some strategies for deprescribing. We also discuss Professor Richard Day's recent review of drug interactions from the Internal Medicine Journal, and highlight the combinations physicians should be most concerned about.

Guests
Professor Richard Day FRACP (St Vincent's Hospital, UNSW)
Professor Sarah Hilmer FRACP (Royal North Shore Hospital, University of Sydney).

Production
Produced by Mic Cavazzini. Music courtesy of Daddy Scrabble ('Flying Pea', 'Cherry Blossom'), Doctor Turtle ('Manly Nunn Steps Out'), and Scott Holmes ('Chasing Shadows'). Photo by iStock. The production manager was Anne Fredrickson.

Editorial feedback for this episode was provided by RACP Fellows Dr Paul Jauncey, Dr Marion Leighton, Dr Rebecca Grainger, Dr Alan Ngo, Dr Phillipa Wormald and Dr Michael Herd. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

The transition from trainee to consultant marks an exciting and daunting step in a clinician's career. Suddenly you take on responsibility for everyone on the ward—both patients and other staff. And while clinical skills have been hammered in over years of training, the 'hidden curriculum' can be harder to pick up. The College has recently published How to Thrive as a New Consultant, a handbook to help navigate this period with confidence.

For today's show, guest producer Zacha Rosen spoke to four physicians who look back on their transitions, from six months on to nine years on. They capture the experience of striking out as a leader, manager and mentor to others. At the same time, one doesn't need to have all the answers. Recognising limitations and knowing when and how to seek help is all important. This is equally important in the clinic and in regards to one's own wellbeing. The speakers in this episode describe how they maintain a healthy balance within and around their careers.

Guests
Dr Marion Leighton FRACP (Wellington Hospital)
Dr Martina Moorkamp FRACP (Mercy Hospital for Women, Melbourne)
Dr Lawrence Ong FRACP (Westmead Institute For Medical Research)
Dr Ben Vogler FRACP (Cairns Hospital).

Production
This episode was produced by Zacha Rosen, with research assistance from Beverly Bucalon, and hosted by Mic Cavazzini. Recording in Wellington by Ryan Smith. Music courtesy of Lee Rosevere ('Thoughtful', 'Here's the Thing'), Chris Zabriskie ('Wonder Cycle'), and Rosie Catalano ('Waiting'); photo copyright RACP. The production manager was Anne Fredrickson.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Australia and New Zealand have relatively high rates of asthma by international measures, with a population rate of about one in nine. For years the management model has been empirical. The more serious the disease, the more the dose of controller therapy is increased. But this doesn't work for everyone. In at least 10 per cent of patients, there is an excessive symptom burden despite maximum controller therapy. 

Severe asthma is marked by frequent exacerbations that may require hospitalisation, and the chronic narrowing of the airways that can often present like COPD. A rational approach to treatment requires identifying one of three endotypes with distinct pathophysiology. Eosinophilic asthma, allergic asthma, and non-eosinophilic asthma can be differentiated by markers in blood and sputum. And targeted therapies have emerged, such as monoclonal antibodies to stages in the cytokine pathway that underlies eosinophil recruitment. It's also important to consider the co-morbidities and risk factors that contribute to the disease, and to coordinate therapy in a multi-disciplinary way. The guests for this episode published a 'Clinical Perspectives'; review in June's edition of RACP's Internal Medicine Journal.

Guests
Professor Peter Gibson FRACP (Hunter Medical Research Institute, Co-Director of the University of Newcastle's Priority Research Centre for Asthma and Respiratory Diseases)
Professor Vanessa McDonald FRCNA (Co-Director of NHMRC CRE in Severe Asthma at HMRI, University of Newcastle).

Production
This episode was produced by Mic Cavazzini. Music from Jason Shaw ('Namaste', 'Timen Passing By'), Kai Engel ('Wake Up'), Mark Neill ('Shakey'). Photo courtesy iStock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Michael Herd, Dr Joseph Lee and Dr Tessa Davis, and Dr Steven Maltby, HMRI, University of Newcastle. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Uncertainty can be frightening for patients and doctors alike, but it's an unavoidable fact of medicine in every specialty. In this two-part story, we hear from a GP, a paediatrician, a surgeon and a rheumatologist about how they navigate the grey areas of diagnosis and treatment, and maintain a patient's faith throughout. In the first episode, we examine the culture within the profession and general public that expects nothing less that perfection in medicine—technology that appears to make everything soluble, and pressure on doctors to back their hunches or to be heroic in intervention

In this final episode, we look at the stigma and disorientation experienced by patients with medically unexplained syndromes. While the definition of functional disorders still causes some debate, behavioural strategies for intervention can often have a great impact on the lives of these patients. Treatment outcomes are never guaranteed, however, and clinical outcome cannot be the only measure of success. Our guests each give examples from their specialty about how a patient's expectations can be managed from the beginning of the consultation. 

Guests
Dr Louise Stone FRACGP (Australian National University)
Professor Phil Fischer MD (Mayo Clinic, Rochester, Minnesota)
Professor Ian Harris RACS (Liverpool Hospital, UNSW)
Dr Rebecca Grainger FRACP (Wellington Regional Rheumatology Unit, University of Otago).

Production
This episode was produced by Mic Cavazzini. Music from Transient ('Vodka', 'Damascus'), Ben Carey ('Calico', 'Ghost Limb'); photo courtesy iStock. Recording assistance from Ryan Smith and Mark Flaherty. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Paul Jauncey, Dr Marion Leighton, Dr Tessa Davis, Dr Michael Herd, Dr Sherina Mubiru, Dr Pavan Chandrala, and Dr Alan Ngo. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Uncertainty can be frightening for patients and doctors alike, but it's an unavoidable fact of medicine in every specialty. In this two-part story, we hear from a GP, a paediatrician, a surgeon and a rheumatologist about how they navigate the grey areas of diagnosis and treatment, and maintain a patient's faith throughout.

In this episode, we examine the culture within the profession and general public that expects nothing less that perfection in medicine—technology that appears to make everything soluble, and pressure on doctors to back their hunches or to be heroic in intervention. We also ask whether hospital training might inadvertently shelter younger doctors from the experience of complex, chronic conditions, and how the simplicity of protocols can be misleading.

In the second episode, we look at the stigma and disorientation experienced by patients with medically unexplained syndromes. While the definition of functional disorders still causes some debate, behavioural strategies for intervention can often have a great impact on the lives of these patients.

Guests
Dr Louise Stone FRACGP (Australian National University)
Professor Phil Fischer MD (Mayo Clinic, Rochester, Minnesota)
Professor Ian Harris RACS (Liverpool Hospital, UNSW)
Dr Rebecca Grainger FRACP (Wellington Regional Rheumatology Unit, University of Otago).

Production
This episode was produced by Mic Cavazzini. Music from Transient ('Vodka', 'Damascus'), Ben Carey ('Calico', 'Ghost Limb'); photo courtesy iStock. Recording assistance from Ryan Smith and Mark Flaherty. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Paul Jauncey, Dr Marion Leighton, Dr Tessa Davis, Dr Michael Herd, Dr Sherina Mubiru, Dr Pavan Chandrala, and Dr Alan Ngo. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

It's estimated that socioeconomic (SES) factors are responsible for half of a population's health and wellbeing status. In comparison, medical services might determine only a quarter of health outcomes. Better targeting of social services and health resources is key to addressing this—but it's not just a macro-level problem, according to Professor Ross Upshur FRCPC of the Dalla Lana School of Public Health. He says that merging medical records with SES markers will help physicians manage inequity at every consultation via 'social precision medicine'. In his opening address at Congress, he also spoke about how codes of ethics in medical practice have changed over the years.

Associate Professor Sue Woolfenden FRACP is a paediatrician in the Sydney Children's Hospital Network, and spoke at Congress explaining how the biological and social determinants of health are entwined even before birth, with effects accumulating at every stage of development. Her research for the UNSW School of Women and Children's Health reveals why some culturally and linguistically diverse communities don't access antenatal services and pre-school care, and what clinicians can do to make services more accessible.

The podcast also features Dr Brett Sutton FACTM FRSPH, Deputy Chief Health Officer of Victoria, who participated in a Congress session discussing health advocacy, and dealing with issues that might conflict with political or media interests. 

Production
This episode was produced by Mic Cavazzini. Music from Comma ('Between the Sunset and The Sea'), Gillicuddy ('Adventure Darling'), Blue Dot Sessions ('Downhill Racer'); photo courtesy iStock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Philip Britton, Dr Rebecca Grainger, Dr Joseph Lee, Dr Marion Leighton, Dr Alan Ngo, Dr Phillipa Wormald, and Advanced Trainee Dr Aaron Wagen. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Patients with autism spectrum disorder (ASD) can present unique challenges for the emergency physician. As these patients often have trouble making sense of their own emotional and physical states, they can become very distressed when experiencing pain. Many are also limited in their language abilities, and therefore can’t communicate verbally what is wrong

In this episode of Pomegranate, carer Annette talks about raising her teenage grandson Aaron, who needs continual care. Consultant paediatrician Meenakshi Rattan FRACP (Campbelltown Hospital, NSW), and psychiatrist Kenneth Nunn FRANZCP FRACP (Children’s Hospital Westmead, NSW) share the techniques they use to calm distressed patients living with autism and make medical assessments. They also describe the appropriate sedation that might be used for the most agitated and aggressive cases, and how gaps in the transition of patients to adult care might be filled. 

Production
This episode was produced by Mic Cavazzini. Music from Blue Dot Sessions ('A Path Unwinding'), Loch Lomond ('From Here to Iceland', 'Violins and Tea'), Chris Zabriskie ('Out of the Skies, Under the Earth'); photo courtesy iStock.  The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Pavan Chandrala, Dr Tessa Davis, Dr Rebecca Grainger, Dr Michael Herd, Dr Paul Jauncey, Dr Joseph Lee, Dr Marion Leighton, Dr Sherina Mubiru, Dr Alan Ngo, Dr Ellen Taylor and Dr Phillipa Wormald, Advanced Trainee Dr Katrina Gibson and Mr Quentin Abraham MNZPsS. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

This episode looks at one of the biggest steps in a physician's career: retirement. It's common to avoid thinking about retirement, and the idea can sometimes come as a shock—professionally, personally, or financially. This month, we speak with physicians both in and out of retirement, as well as two psychiatrists whose research focuses on medical professionals' identity.

Guests
A/Prof Jill Sewell FRACP (Royal Children's Hospital, Melbourne)
A/Prof Carmelle Peisah FRANZCP (Consultant Old Age Psychiatrist, Conjoint Professor UNSW, Clinical Associate Professor University of Sydney)
Dr Chanaka Wijeratne FRANZCP (Prince of Wales Hospital, Conjoint Associate Professor University of Notre Dame Australia)
Emeritus Professor John Dwyer FRACP (UNSW Medicine).

Production
This episode was produced by Zacha Rosen. Music from Lee Rosevere ('And So Then', 'Quizitive'), Chris Zabriskie ('CGI Snake'), Broke for Free ('Something Elated'); photo courtesy iStock. Pomegranate is presented by Mic Cavazzini, with Anne Fredrickson as production manager.

Editorial feedback was provided by RACP Fellows Dr Rebecca Grainger, Dr Dennis Hain, Dr Paul Jauncey, Dr David McBride, Prof Barry McGrath, Dr Alan Ngo, Prof Kim Oates and Dr Humphrey Pullon. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

This is a two-part series looking at how modern genomics is changing clinical practice, and how a physician can hope to keep up with the pace of discovery and technological development. Some single gene tests and gene panels have been available off-the-shelf for years, but whole genome sequencing is becoming more accessible and affordable every day. In the first episode we discussed the differences between these technologies in terms of cost and practical utility, using diagnosis of Mendelian conditions and rare developmental conditions as examples.

The second episode begins with the question of disease risk and how to present uncertain predictive diagnoses. This is particularly relevant to research using genome-wide association studies, which is finding more and more markers with small risks of disease. This increases the likelihood of picking up diagnoses incidental to the ones a clinician might be looking for. The ethics of consenting patients to genome screening and informing them of potential markers are discussed, as well as gene-targeted treatments at the cutting edge of cancer research.

Guests
Associate Professor Kristine Barlowe-Stewart FHGSA(GenCounsel) (Director, Master of Genetic Counselling Program, University of Sydney)
Professor Leslie Burnett FRCPA, FHGSA, FCAP (Chief Medical Officer, Genome One)
Dr Michael Gabbett FRACP (Royal Brisbane and Women's Hospital)
Dr David Thomas FRACP (Director, Kinghorn Cancer Centre; Director, Cancer Division, Garvan Institute for Medical Research).

Production
This episode was produced by Mic Cavazzini. Music from Blue Dot Sessions ('Cloud Line'), Chris Zabriskie ('Is That You or Are You You?'), Alex Fitch ('Celeste'), Cory Gray ('Terminal Two'), and Kromatic ('Club Crunk for Monkeys'); photo courtesy Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Pavan Chandrala, Dr Tessa Davis, Dr Rebecca Grainger, Dr Michael Herd, Dr Paul Jauncey, Dr Joseph Lee, Dr Marion Leighton, Dr Anutosh Shee and Dr Ellen Taylor, and Advanced Trainee Dr Katrina Gibson. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

In this episode we hear about an emergency presentation to a South Australian hospital, of a 74-year-old male with shortness of breath. The curve ball is that he had undergone ablation for drug-refractory atrial fibrillation less than two weeks prior. This discussion gives an overview of developing technologies for AF treatment and developing knowledge about the possible complications. We also have some multiple choice questions to test your understanding.

Guest
Dr Shaun Evans, FRACP (Royal Adelaide Hospital; University of Adelaide)
 
Hosts
Associate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)
Jasmine Le (University of Adelaide)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by RACP physicians Hugh Murray, Aidan Tan, Aafreen Khalid, Sebastiaan Lambooy, Amy Hughes and Lauren Gomes. 
 

Key Reference (Spoiler Alert)

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Delayed cardiac tamponade from pericarditis following pulmonary vein cryo-balloon ablation [IMJ. 2020]

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

This episode goes back 200 years to tales of the early Sydney colony. The lectures featured on the program were first recorded at the 'Our Healthy Heritage' seminar series, hosted quarterly by the Australian and New Zealand Society of the History of Medicine.

Dr Fiona Starr of Sydney Living Museums retells colourful accounts of the colony's first general hospital, better known as the Rum Hospital. It was built in 1816 by Governor Lachlan Macquarie, who saw an urgent need to maintain the health of the convict workforce. Prof Peter Curson describes the worst infectious diseases that struck the colony over the 19th century—from the measles outbreak that killed over 1,000 children to the plague epidemic that caused panic and social conflict. Peter is Emeritus Professor in Population and Health at Macquarie University. Also on this episode is Dr Lisa Murray, Historian for the City of Sydney Council, discussing the perennial problem of where to bury the dead in an era of incredibly high mortality. 

Production
 This episode was produced by Mic Cavazzini. Music from Sláinte ('Banish'), The OO-Ray ('Barriers'), Studio Noir ('Alma Rubens, Clarine Seymour'), Aislinn ('Sliabh') and Jahzzar ('Notre Dame'); sound recordings from Freesound. Image courtesy of Thomas Fisher Rare Book Library, University of Toronto.  The production manager was Anne Fredrickson.

 Editorial feedback was provided by RACP Fellows Dr Bruce Foggo and Dr Michael Herd.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Sir Harry Burns and Dr Ruth Hussey OBE are public health physicians involved in 'whole-of-system change' in Britain's health and social care. They were invited to Australia in 2016 to advise NSW Health on such delivery models; this episode of Pomegranate features a special lecture presented at the RACP during their trip.

As the former Chief Medical Officer of Scotland, Sir Harry Burns has drawn worldwide attention to the social determinants of health and focused his energy on a citizen-driven scheme for 'salutogenesis.' He continues to comment on health inequalities as Professor of Global Public Health at the University of Strathclyde.

Dr Ruth Hussey was until recently the Chief Medical Officer for the Welsh Government Assembly and prior to that Medical Director for the National Health Service in Wales. In these roles she has pushed for a local approach to delivering high quality clinical services, which she calls 'prudent health care.'

Production
This episode was produced by Mic Cavazzini. Music from Jason Shaw ('Autumn Sunset, Back to the Woods') and Blank Kytt ('RSPN'); photo courtesy Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Michael Herd, and Dr Joseph Lee. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Almost three quarters of physicians surveyed in the U.S. admit to ordering at least one unnecessary test, procedure or treatment every week. In Australasia, EVOLVE is the RACP's initiative to minimise clinical practices that aren't supported by the current evidence base, and stems from the international healthcare campaign Choosing Wisely.

EVOLVE has recently published a list of the top five practices in general paediatrics that need to be pulled back. Developed in consultation with Fellows from the RACP Paediatrics and Child Health Division, its recommendations are:

1. Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection.
2. Do not routinely undertake chest radiography for the diagnosis of bronchiolitis in children or routinely prescribe salbutamol or systemic corticosteroids to treat bronchiolitis in children.
3. Do not routinely order chest radiography for the diagnosis of asthma in children.
4. Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapy.
5. Do not routinely order abdominal radiography for the diagnosis of non-specific abdominal pain in children.

This episode of Pomegranate explores the rationale behind these recommendations and some alternatives that paediatricians can adopt to improve their practice.

Guests
Prof Harriet Hiscock FRACP (Director, Royal Children's Hospital Health Services Research Unit; Director, Australian Paediatric Research Network)
Dr Sarah Dalton FRACP (President, RACP Paediatrics and Child Health Division; Clinical Leader, NSW Agency for Clinical Innovation)
Dr Hamish McCay FRACP (Paediatrics Clinical Director, Waikato Hospital).

Production
This episode was produced by Mic Cavazzini. Music from Comma ('Between the Sunset and the Sea') and Cory Gray ('Down to the Street'); photo courtesy Shutterstock. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Michael Herd, Dr Joseph Lee and Prof Peter Procopis. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

While more than half of all medical students and trainees are women, they make up only about 30 per cent of registered physicians. When it comes to clinical leadership positions it's down to single digits, and medicine's gender pay gap is worse than that of other industries

The reasons for this loss of talent, and disparities in pay, are both cultural and logistical. One significant factor affecting career progression is time taken out for child-rearing; the penalties associated with such an interruption appear to compound more in medical training than they do in other professions. But medical culture, reflecting the wider society, also contains structural biases that affect women. On this episode guests discuss the challenges for gender equity in the profession, and how role-modelling and leadership training may offer strategies to support the next generation of women doctors. 

Guests
Dr Catherine Yelland FRACP (President, RACP)
Dr Stefanie Schurer (University of Sydney)
Dr Elizabeth Sigston FRACS (Consultant Surgeon, ORLHNS, Monash Health)
Prof Helena Teede FRACP (Executive Director, Monash Partners Academic Health Sciences Centre; Director, Monash Centre for Health Research and Implementation).

Production
This episode was produced by Mic Cavazzini, with additional research from Beverly Bucalon and Dr Marion Leighton FRACP. Music from Blue Dot Sessions ('Fervent', 'Downhill Racer'); photo courtesy Sergio Santos. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Sarah Abrahamson and Dr Marion Leighton, and RACP staff member Ms Beverly Bucalon.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Crystal methamphetamine, or ice, has been sensationalised in the media over the past decade. While raising awareness of the drug, such reporting has also stigmatised its users—both on the street and in the wards. 

In this episode of Pomegranate, some of Australia's leading addiction researchers and clinicians explain how misleading the dominant narrative is and put straight some of the facts and figures behind the so-called ice 'epidemic.' They also discuss how characterising crystal methamphetamine as 'the most addictive drug ever' discredits the effectiveness of available and upcoming therapies.

Guests
Prof Alison Ritter (National Drug and Alcohol Research Centre, UNSW)
Dr Gilbert Whitton FAChAM (Bankstown Hospital, Sydney)
Prof Amanda Baker (Calvary Mater Hospital, University of Newcastle)
Assoc Prof Nadine Ezard FAChAM (St Vincent's Drug and Alcohol Service, University of Sydney).

Production
This episode was produced by Mic Cavazzini with music from Ben Carey ('Transference'), Mark Neill ('Threshold', 'Right Strafes Derision'), and David Szesztay ('Snow'); photo courtesy Sean Naber. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Michael Herd, Dr Murray Hunt and Dr David Lloyd-Jones.  This episode was produced in partnership with NSW Health.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Pyrexia, or fever of unknown origin (PUO) is a syndrome that challenges the diagnostic skills of every physician. It is defined by frequent fevers over 38.3 degrees Celsius, persisting for 3 weeks, which have eluded diagnosis by standard baseline tests.

Dr Rohan Beresford, Advanced Trainee in infectious diseases and microbiology and Professor Iain Gosbell of the University of Western Sydney, review the condition in September's issue of the RACP's Internal Medicine Journal. In a recent case series, they write, 22% of PUO cases were auto-inflammatory, 16% were attributed to infection, 7% were neoplastic, and 4% were due to drugs or other miscellaneous causes. But over 51% of patients with PUO were left with no diagnosis at all.

On this this episode, Dr Beresford explains how to rationally investigate patients with persistent fevers and manage their anxiety through the process. He is joined by paediatrician and infectious diseases specialist Dr Philip Britton FRACP (Children's Hospital Westmead), describing some of the conditions that more likely explain PUO in children, and Dr David Spriggs FRACP (Auckland City Hospital), who provides examples of the complexity of PUO in geriatric patients.

This episode was produced by Mic Cavazzini with recording assistance from Justin Gregory. Music from Chris Zabriskie ('I Am Running with Temporary Success from a Monstrous Vacuum in Pursuit'), Jahzaar ('Gramaphone', 'Aisles') and Scott Holmes ('Close to the Distance'); photo courtesy Armle. The production manager was Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Prof David Gordon, Dr Michael Herd, Dr Marion Leighton and Dr Christian Lueck.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

The National Disability Insurance Scheme (NDIS) is designed to provide better care for the 460,000 Australians who have significant and permanent disability. The NDIS supports individuals in making personalised therapy goals, accessing appropriate care, and participating in mainstream life. Since 2013 the scheme has had a staged launch across parts of Australia. This month, the NDIS will start rolling out across New South Wales and Victoria and will have complete coverage by 2019.

On this episode internal medicine physician Dr Robyn Wallace FRACP, of Calvary Hospital in Hobart, explains how the NDIS differs from past disability services, and rehabilitation specialist Dr Elizabeth Thompson FRACP shares the hopes her Sydney clients have for the personal funding. Kerry O'Kane talks of her relief at having found a secure future of care for her son in the ACT, while Dr Katherine Langdon FRACP describes the impact the scheme has had for paediatric therapy models in Perth.

 This episode was produced by Mic Cavazzini with recording assistance from Diana Darmody. Music from David Szesztay ('Farewell', 'The Hangover') and Gillicuddy ('Adventure Darling'); photo courtesy Markus Spiske. Pomegranate's executive producer is Anne Fredrickson.

Editorial feedback was provided by RACP Fellows Dr Stephen de Graaff, Dr Robyn Horsley, Dr Anne Kynaston, Dr Robert Leitner, Dr Jacqueline Small and Prof Graham Vimpa

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  ices

Life expectancy for Aboriginal and Torres Strait Islander people is a decade lower than that of the non-Indigenous population. Addressing this disparity is one of the key priorities of the Closing the Gap initiative agreed upon by the Council of Australian Governments. 

Today's speakers discuss where progress has been made and where resources are still lacking. Associate Professor Noel Hayman FAFPHM, FRACGP is Clinical Director of the Inala Indigenous Health Service in Brisbane. Ms Shannon Daly is an Aboriginal Health Practitioner who often works with Dr Joshua Francis FRACP, a paediatric infectious diseases specialist based at Royal Darwin Hospital. 

 This episode was produced by Anne Fredrickson and Mic Cavazzini, with recording assistance from Johanna Bell. Music from Doctor Turtle ('G of the Bang') and Rebecca Foon ('White Throated Sparrow'); photo copyright  courtesy of Cameron Herweynen.

Editorial feedback was provided by RACP Fellows Dr George Laking, Dr Tamara Mackean, A/Prof Ashim Sinha and Dr Catherine Yelland, and RACP staff member Ms Helen Craig.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

The World Health Organization defines 'adolescents' as anyone between the ages of 10 and 19, and 'youth' as those between 15 and 24. The RACP uses the terms 'young people' and 'adolescent and young adult' to cover the whole range of 10 to 24 years. Regardless of how it's defined, the transition from childhood to adulthood involves a range of physical, mental, and psychosocial issues. If you're a teenager with a chronic health condition, the situation can be even harder.

For physicians in Australia and New Zealand, there has been no specific training to meet the needs of adolescents—until now. Over the past few years, the RACP has been working to create an adolescent and young adult medicine curriculum, which will become a dual training program in 2017. On this episode Prof Kate Steinbeck FRACP, Dr Michelle Telfer FRACP, and Dr Bridget Farrant FRACP talk about why adolescents and young adults need targeted care and the issues they face in the current system. They also discuss the new curriculum, and how interested Fellows and Trainees can get involved.

View the RACP's curated collection on adolescent and young adult health for an expanded guide to CPD tools.

 This episode was produced by Alastair Wilson and Anne Fredrickson, with music from Podington Bear ("Now Son," "Whiplash String Swells," "Filaments"), and Kevin MacLeod ("Funkorama"); image courtesy Andy Maguire.

Editorial feedback was provided by RACP Fellows Prof Shanthi Ameratunga and A/Prof Jane Holmes-Walker, Advanced Trainee Dr Emma Mitchell and RACP staff member Ms Veronica Vogel.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Medical practice is dynamic, and continually changes with evidence and experience. But costly or prolonged treatment doesn 't always translate into better outcomes for patients. In response, the College has launched EVOLVE—a partnership with specialty societies to identify and reduce low-value care.

EVOLVE is part of a growing international movement to examine clinical and consumer decision-making about overused, inappropriate, or potentially harmful medical treatments. As a founding partner of Choosing Wisely Australia, EVOLVE represents the College 's major contribution to the campaign: helping Fellows develop and promote lists of low-value care items for their specialty. On this episode Prof Rachelle Buchbinder FRACP, A/Prof Warrick Inder FRACP, and A/Prof Ian Scott FRACP discuss why they support the campaign, the process of developing low-value lists, and how they work with patients when the best course of action is…to wait.

 This episode was produced by Anne Fredrickson, with music from Jahzzar ( 'Montmartre '), The OO-Ray ( 'Silhouettes '), Deerhunter ( 'Cryptograms ') and Delicate Steve ( 'Butterfly '); image courtesy EVOLVE. 

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Catherine Hill, A/Prof Ruth Marshall and Dr Catherine Yelland, and RACP staff members Mr Jason Soon and Ms Siobhan Marren. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

In Aotearoa-New Zealand, the proportion of doctors identifying as Māori has doubled from where it was a decade ago to over 5 percent. But there is still a long way to go before the workforce is representative of the broader population which is 17 percent Māori.

The Auckland and Otago Medical Schools have in recent years turbocharged their intake of Māori and Pasifika students but these graduates don’t seem to have trickled through to the RACP in great numbers. Just 3.5 percent of general physicians and 4.8 percent of paediatricians identify as Māori, and Pasifika doctors make up a further 1 and 2 percent respectively.

In this podcast, three Māori medics discuss how the culture of training environments can be made more welcoming to junior doctors with diverse ethnic backgrounds. This discussion takes place in light of an independent review into the clinical examination for paediatrics in Aotearoa-New Zealand which found issues with standardization, transparency and cultural safety. 2024 was a tough year for Māori Health more broadly, as it saw the disestablishment of a dedicated Health Authority, Te Aka Whai Ora, after just twelve months of operation. 

Guests
Dr Danny de Lore FRACP (Rotorua Hospital; University of Auckland)
Dr Matthew Wheeler FRACP (Tauranga Hospital; University of Auckland)
Dr Ngaire Keenan PhD (Sydney Children’s Hospital, Westmead; University of Otago)

Production
Produced by Mic Cavazzini DPhil. Music provided courtesy of FreeMusicArchive includes ‘Periodicals’, ‘In Paler Skies’ by Blue Dot Sessions and ‘Wake Up’ by Kai Engel. Music licenced from Epidemic Sound includes ‘Subdivision of the Masses’ by Philip Weigl and ‘Abyss’ by Luwaks. Image of Dr Danny de Lore property of RACP
 
Editorial feedback kindly provided by RACP physicians Zac Fuller, Aidan Tan, Hugh Murray, Sasha Taylor, Anne-Marie Juengling and Simeon Wong. Thanks also to RACP staff Nick McCurdy and Sarah Millar. 

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

The gut microbiome is the subject of increasing research in medicine. Understanding this complex community offers potential new insight for treating a number of diseases—gastrointestinal and otherwise. But what's the evidence base?

In this episode Dr Peter De Cruz FRACP, Head of the Inflammatory Bowel Disease Service at the Austin Hospital, discusses his recent IMJ article 'Characterisation and Therapeutic Manipulation of the Gut Microbiome in Inflammatory Bowel Disease'. To provide further review, the episode also features an interview with Professor Finlay Macrae FRACP, Head of Colorectal Medicine and Genetics at the Royal Melbourne Hospital.

Included in the discussion are: the early establishment of the microbiome and its genetic and environmental influences, pharmacological and nutritional interventions targeting the gut, and some guarded recommendations about faecal microbiota transplantation.

This episode is presented in partnership with the Internal Medicine Journal, the official peer-reviewed publication of the College's Adult Medicine Division. Links to resources mentioned on the show are provided below. Dr De Cruz's full article is available via Wiley Online Library.

This episode was produced by Alastair Wilson, with editing by Anne Fredrickson. Music from Podington Bear ('Caravan'), Kevin MacLeod ('Isolated'), and Adrianna Krikl ('Every Way', 'Wednesday'); photo courtesy Pacific Northwest National Laboratory (via Flickr). 

Editorial feedback was provided by RACP Fellows Dr Christian Lueck, Dr Kathryn Patchett and Dr Bruce Foggo. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Obesity can seem like what strategists call a 'wicked problem'—a problem with so many parts that it's impossible to solve. But some things are changing. While prevalence is still high in developed countries, childhood obesity appears to be plateauing. Social movements like 'Health at Any Size' promote body positive approaches. And at Dr Nic Kormas' clinics, obese patients on average are able to lose 10% of their weight.

Dr Kormas FRACP is the senior endocrinologist behind the Metabolic Rehabilitation Programs at Concord, Camden and Campbelltown Hospitals. He's joined on the program by Dr Jacqui Curran FRACP, a paediatric endocrinologist at Princess Margaret Hospital in Perth; Boyd Swinburn FAFPHM, Professor of Population, Nutrition and Global Health at the University of Auckland; and Dr Sophie Lewis, a public health researcher at the University of Sydney. On today's episode, they talk about strategies and pathways available for addressing obesity—from the psychological to the physical.

 This episode was produced by Anne Fredrickson, with music from Chris Zabriskie ('Readers! Do You Read?' and 'The Temperature of the Air on the Bow of the Kaleetan'), David Szesztay ('Point Zero'), and Ayla Nereo ('Oh Love'); photo by Scott Loftesness (via Flickr). 

 Editorial feedback was provided by RACP Fellows Prof Chris Bullen, Prof Hugh Dickson, Dr Bruce Foggo, Dr Jacqueline Hewitt, A/Prof Matthew Links, Dr Rosalie Schultz and Dr Rima Staugas.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  t

By shaping the next generation of physicians, supervision affects the lives and health of patients. In this episode, our guests explore how the role of the supervisor has changed over time (as well as where the role ends), the skills needed for a good supervisor, and some suggestions on how to deliver constructive criticism. With combined decades of experience, they also share their thoughts on how to improve your own performance as a supervisor—and why they find it worthwhile. 

Three experienced supervisors share their views: Dr Peter Davoren FRACP, an endocrinologist and former Director of Physician Education at Gold Coast Hospital; Dr Marion Leighton FRACP, a general physician based in Wellington who supervises both for the RACP and for the MCNZ; and Dr Josh Francis FRACP, a Darwin-based paediatrician who provides remote supervision for doctors in Timor-Leste. We also spoke to Alexandra Greig (AT, Public Health) to hear the thoughts of a doctor who is currently being supervised

Links to resources mentioned on the show are provided below. View the RACP's curated collection on teaching for a larger guide to professional development tools.

This episode was produced by Alastair Wilson, with editing by Anne Fredrickson. Music from Scott Holmes ('Oceans Apart'), Squire Tuck ('Song for the Chameleon'), Cahill Locksmith ('Diamond Variety'), and Julianna Barwick ('I Wish I Could Create'); photo by Isaac Bowen (via Flickr). 

Editorial feedback was provided by RACP Fellows Dr Libby Smales, Dr Lionel Lubitz, Dr Mandy Fletcher, Dr Rachel Wong, A/Prof Matthew Links, Dr Marie-Louise Stokes, and Dr Hamish McCay, and RACP staff member Ms Erin Murphy. 

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

'One Health' is a contemporary movement based on a long-held observation: that the health of humans, animals, and the environment are inextricably linked. In the current issue of the Internal Medicine Journal, Prof Peter Collignon FRACP has published a One Health-informed clinical perspective: Antibiotic Resistance – Are We All Doomed? But paradoxically, he says, he's optimistic about the future

On this episode, Prof Collignon is joined in a review of his article by fellow ID physician Dr David Looke FRACP. They discuss the sobering trends in global and Australasian resistance rates, mechanisms driving the spread of resistance genes, and practical steps doctors can take for better antibiotic stewardship. 

This episode is presented in partnership with the Internal Medicine Journal, the official peer-reviewed publication of the College's Adult Medicine Division. Links to resources mentioned on the show are provided below. Prof Collignon's full article is available via Wiley Online Library.

 Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Prof David Gordon and A/Prof Matthew Links.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Most preventive health messages focus on diet, exercise, and stress reduction. But are doctors taking this advice for themselves?

The Doctors' Health Advisory Service, or DHAS, was created in 1981 to offer confidential help to practitioners in both Australia and New Zealand. This episode features Dr Jill Gordon FASPsychMed, president of DHAS New South Wales; Dr Roger Sexton FRACGP, medical director of the South Australia office; and Dr Edwin Whiteside FRACP, director of the New Zealand office. They discuss why doctors may experience higher rates of depression and anxiety, and common fears around mandatory reporting. The conversation also includes Dr Kieran Le Plastrier (Western Sydney University), who is currently completing a PhD on 'the fit professional.

Dr Gordon's 'five steps to help a colleague' are:

1. Don't ignore the situation. Approach the person and the problem and ask if you can help.
2. Listen non-judgementally to what they say.
3. Give emotional support and any information you think might help.
4. Encourage them to seek professional help.
5. Encourage other forms of support.

Links to resources mentioned on the show are provided below. View the RACP's support services page for more organisations supporting doctors' health.

 This episode was produced by Alastair Wilson, with editing by Anne Fredrickson. Music from Podington Bear ('Driftwood'), Nick Jaina ('Mississippi Turn-Around'), Cory Gray ('Low Rollers'), and Doctor Turtle ('G of the Bang'); photo by University of Liverpool Medical Archive (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Hugh Aders, Dr Terence Donald, A/Prof Matthew Links, Dr Martina Moorkamp, Dr Kathryn Patchett, Prof Peter Procopis, Dr Simon Quilty, Dr Elizabeth Smales, Dr Emma-Leigh Synnott and Dr Barry Taylor.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

This month we're presenting a review of stem cell research and stem cell therapies from Professor John Rasko FRACP, head of the Department of Cell and Molecular Therapies at the Royal Prince Alfred Hospital

A self-confessed 'stem cell tragic,' Professor Rasko routinely separates the hope and hype surrounding any new medical research. In this episode, he reviews the stem cell treatments currently available in Australia and New Zealand, and a few of the many clinical trials worth watching. He also discusses why some patients engage with unproven and riskier procedures, and what advice he offers them. 

Production
This episode was produced by Anne Fredrickson, with reporting by Michael Pooley. Music from Lloyd Rogers ('Red Fish on Television'), Podington Bear ('Many Hands'), The Womb ('Amiga Power Viking Funeral'), and Cloud Mouth ('Bedtime'); photo by Eckhard Völcker (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Chris Juttner, A/Prof Matthew Links, Dr Christian Lueck, A/Prof Ruth Marshall and Dr Emma-Leigh Synnott, and A/Prof Megan Munsie (University of Melbourne).

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

In the final of our three-part series on end-of-life decision-making, we're integrating perspectives from the law.

For dying patients, their families, and their medical staff, the majority of decisions are reached without contention. But law in this field is complex, and varies by jurisdiction. As a result, doctors may possess knowledge gaps around end-of-life care. This episode features interviews with Prof Ben White (QUT) and A/Prof Colin Gavaghan (University of Otago). Links to resources mentioned on the show and other tools for continuing professional development (CPD) are provided below. View the RACP's curated collection on end-of-life care for an expanded guide to CPD tools.

Production
This episode was produced by Anne Fredrickson, with music from Lucky Dragons ('Open Melody'), Studio Noir ('Clarine Seymour'), BOPD ('New England Is Interesting'), and Satellite Ensemble ('Agnes'); photo by Julia Manzerova (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Martina Moorkamp, Dr Christian Lueck and Dr Marie-Louise Stokes.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Treating a dying person goes beyond understanding their disease. In the second of a three-part series, we examine the importance of family and culture in end-of-life care—from the ICU to the neonatal unit.

This episode features interviews with Dr Andrew Watkins FRACP and Dr Peter Saul FCICM.

 Production
This episode was produced by Anne Fredrickson, with music from Chris Zabriskie ('I am Running with Temporary Success…'), L.J. Kruzer ('Chantiers Navals 412'), and Sounds of Taraab ('Mahaba Wa Taka Nini'); photo by Alyssa (via Flickr).

Editorial feedback was provided by RACP Fellows Dr Bindu Bali, Dr Habib Bhurawala, A/Prof Matthew Links, Dr Hamish McCay, Dr Martina Moorkamp, Dr Rohan Vora, and A/Prof Nicholas Wickham.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

For our first show we're starting at the end: end-of-life care and decision-making. It's a hard topic to discuss with patients, but it might be the most important conversation we're not having.

This episode features interviews with Dr Amanda Walker FRACP, Dr Charlie Corke FCICM, and Dr Peter Saul FCICM.

 Production
This episode was produced by Anne Fredrickson, with music from Podington Bear ('Into the Unknown,' 'Infant') and Rebecca Foon ('Hearts Mend'); photo by Amrita B (via Flickr).
Editorial feedback was provided by RACP Fellows Dr Sarah Dalton, Dr Bruce Foggo, Dr Emma-Leigh Synnott, Dr Ranjana Srivastava, Dr Stephen Streat and Dr Simon Quilty. lickr).

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

This case report comes to you from Brigham and Women’s Hospital in Boston, a huge teaching hospital that serves the Harvard Medical School. The 52-year-old female presented with clumsiness and paresthesia of the right hand that had persisted for several days. She also had a headache and three weeks prior to presentation had undergone a suboccipital craniotomy for a Chiari I malformation. To complicate things, there was a past medical history of migraines and a family history of a Factor V Leiden mutation. The identified diagnosis is one in which evidence is limited for aspects of management, and the topics of uncertainty and mentorship in medicine also arise in this discussion.

Guest
Galina Gheihman, MD D (Brigham and Women’s Hospital; Harvard Medical School)
 
Hosts
Associate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide)
Haelynn Gim (Harvard Medical School)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by Dr Sebastiaan Lambooy.

Key Reference (Spoiler Alert)

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Isolated Cortical Vein Thrombosis [Neurohospitalist. 2023]

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Professor Gary Lee established the first dedicated pleural service in the southern hemisphere in 2009, at the Sir Charles Gairdner Hospital in Perth. He says that pleural disease has finally come to be regarded as an area of subspeciality interest in its own right, not just a complication of other comorbidities. In this podcast he presents a potted history of key developments in the management of pleural effusion in particular. 

This is diagnosed in about 60,000 people every year in Australia, mainly as a result of infection or malignancy. With mentors in the UK, Professor Lee conducted some of the earliest trials on fibrinolytics and DNAses to break down purulent effusions. They also put to the test protocols for pleurodesis via talcum insufflation that date back to the 1930s. 

Professor Lee’s more recent clinical research has focused on the use of indwelling pleural catheters that a patient can use to drain pleural effusate when feeling breathless. He has also a made an important contribution to conservative management guidelines for primary spontaneous pneumothorax. This story is great example of how clinical practice emerges imperfectly from a soup of evidence, accidents, human biases and system.
 
Guest
Prof Gary Lee PhD FRACP FRCP FCCP (Pleural Service, Sir Charles Gairdner Hospital in Perth; University of Western Australia).

Co-host
Dr Marion Leighton FRACP (Wellington Hospital).

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Reconstruct’ by Amaranth Cove, ‘Nagba Algooah’ by Ebo Krdum. ‘Vittoro’ by Borrtex provided courtesy of FreeMusicArchive. Image by ilbusca licenced through Getty Images. 
 
Editorial feedback kindly provided by RACP physicians Aidan Tan, Maansi Arora, Simeon Wong, Hugh Murray and Vanessa Wong.

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

This case report describes a 42-year-old male from Arizona with a complex course characterised by fever following an orthotopic liver transplant. A general approach to fever in the post-transplant patient is discussed, along with specific considerations regarding travel in post-transplant patients or those on immunosuppressants for other indications. A/Prof Camille Kotton and Dr Simran Gupta from the Massachusetts General Hospital and Brigham and Women’s Hospital take listeners through the case and related issues in a step-by-step manner at a level targeted for trainees and generalists.

Guest
A/Prof Camille Kotton (Massachusetts General Hospital, Harvard University)Dr Simran Gupta (Brigham and Women’s Hospital, Harvard University)

Hosts
Associate Professor Stephen Bacchi FRACP (Fulbright Fellow, Mass General Brigham; University of Adelaide)
Christina Gao (University of Adelaide)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by doctors Maansi Arora, Brandon Stretton, Matt Lim and Ben Cook.

Key Reference (Spoiler Alert)

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Coccidioidal Meningitis after Liver Transplantation in a Nonendemic Region: A Case Report [Transplantation 2006]

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

In the previous episode we heard how some rationally-designed therapies work on almost any cancer with the right molecular signature. Tumour-agnostic medications could be godsend for patients with rare cancers which have classically been overlooked by drug developers, and those with advanced cancers of unknown origin. 15,000 such patients have undergone comprehensive genome profiling of their tumours through the organisation, Omico. In this podcast, Omico’s founder explains that while the majority have received recommendations about matched therapies, clinical trials are typically the only way to enable access. Professor David Thomas discusses why Australia’s Health Technology Assessment process appears to be so conservative and how the market price of next-generation oncotherapies might be brought down by changes across the local ecosystem. 

Guest
Prof David Thomas FRACP PhD (Director, Centre for Molecular Oncology UNSW; Founder and Chief of Science, Omico)
 
Professor Thomas or Omico have received grants, consultancies or research support from Roche, Astra Zeneca, Pfizer, Eisai, Illumina, Beigene , Elevation Oncology, RedX Pharmaceuticals, SunPharma , Bayer, George Clinical, Novotech , Merck Sharpe and Dohme, Boehringer Ingelheim, Hummingbird, Microba , BioTessellate , PMV Pharma, Australian Unity and Foundation Medicine. 

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes  ‘Multicolor’ and ‘Pulse Voyage’ by Chill Cole. ‘Impulsing’, ‘the City of Hope’ ‘Over Again’, and ‘Going Undercover’ by Borrtex provided courtesy of FreeMusicArchive. Image by Guido Mieth licenced through Getty Images. 
 
Editorial feedback kindly provided by RACP physicians Simeon Wong, Stephen Bacchi. Thanks also to Kym Bramich and Arnika Martus on staff with Omico and RACP respectively.  

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

The genomic understanding of cancer has transformed a tissue-based classification model that had been dominant for 150 years or more. The last three decades have seen highly targeted therapies developed at blistering pace, and unprecedented improvements in patient outcomes. 

To date, these advances have been focused on more common cancers. The financing model for drug development means that rare cancers get overlooked, given the small pool of potential buyers relative to the costs and risks of investment. 

However, the molecular targets characterised in more common cancers are often found in cancers of a different histotype. As such, precision therapies will sometimes have tissue-agnostic efficacy and offer a lifeline for patients with neglected diseases or cancers of unknown origin. 

Professor David Thomas has founded an NGO called Omico to enable such patients to undergo profiling for hundreds of potential molecular targets. In this interview he explains the rationale for the most promising pan cancer therapies, and in the next episode we discuss changes to the regulatory and funding model required to sustain this screening program. 

Guest
Prof David Thomas FRACP PhD (Director, Centre for Molecular Oncology UNSW; Founder and Chief of Science, Omico)

Professor Thomas or Omico have received grants, consultancies or research support from Roche, Astra Zeneca, Pfizer, Eisai, Illumina, Beigene , Elevation Oncology, RedX Pharmaceuticals, SunPharma , Bayer, George Clinical, Novotech , Merck Sharpe and Dohme, Boehringer Ingelheim, Hummingbird, Microba , BioTessellate , PMV Pharma, Australian Unity and Foundation Medicine.


Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘the Orchard’ by Jakob Ahlbom; ‘Dusty Electronics’ and ‘Pulse Voyage’ by Chill Cole; ‘Tam’ by LJ Kruzer. ‘See you soon’ and ‘Going Undercover’ by Borrtex provided courtesy of FreeMusicArchive. Image by filo licenced through Getty Images.

Editorial feedback was kindly provided by RACP physicians Nichola Ball, Stephen Bacchi, Aafreen Khalid, Simeon Wong, Maansi Arora and Aidan Tan.

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.