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Pomegranate Health is an award-winning podcast about the culture of medicine, from the Royal Australasian College of Physicians. We ask how doctors make difficult clinical and ethical decisions, how doctor-patient communication can be improved, and how healthcare delivery can be made more equitable. This is also the home of [IMJ On-Air], a podcast to accompany the RACP's Internal Medicine Journal. Interviews with authors are conducted by specialist section editors. Find out more at the websi ...
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Thrombectomy for acute ischaemic stroke has undergone great advances in the last decade, but the expertise and technology is restricted to tertiary hospitals. Outside of large metropolitan centres, thrombolytic treatment can buy a patient time, but for almost 30 years the first line agent has remained unchanged. Alteplase is an analog of the human …
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This podcast follows the case of a 48-year-old male with a 3-month history of diarrhoea and associated lymphadenopathy. A complex constellation of symptoms accompanies this presenting complaint, along with a key radiological finding that enabled the treating team to arrive at the correct diagnosis. Can you arrive at the correct diagnosis before the…
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This recording comes from the launch of the 2nd Monitoring and Evaluation Report on Hepatitis C Elimination in NSW. The work was conducted through the Kirby Institute under the guidance of infectious diseases specialist, Professor Greg Dore. As presented in this seminar, data show that the state is on track to meet the 2025 target set by NSW Health…
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Dr Karan Singh loves his job as a registrar in nuclear medicine but he thinks there isn’t enough exposure to the specialty during medical school and basic training. In this podcast we spend a day in his department at Prince of Wales Hospital Sydney and get a taste of the many different referrals that come his way; a bone scan for a young man experi…
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The LACE index is a prognostic algorithm for predicting the likelihood that a newly discharged patient will come back into hospital within 30 days because of complications. Today’s IMJ paper describes a validation of the LACE index in a regional Victorian setting. Identifying patients who are at risk could allow for better targeted care at the firs…
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This podcast follows the case of a 58 year old man who presented to the haematology department at Flinders Medical Centre with intravascular coagulation and leukocytosis. He was diagnosed with acute myeloid leukaemia and treated on standard cytarabine and daunorubicin combination therapy. Nine days after initiation, the patient developed painless d…
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The RACP Congress in May this year was opened by a fascinating lecture on mental health in the medical workforce, which has been trimmed down for audio. Professor Neil Greenberg is an occupational psychiatrist with more than 23 years in the UK Armed Forces. His extensive research within defence and health settings has informed a very pragmatic unde…
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From 2024, supervising has been recognised as a Category 2 CPD activity. This short and insightful episode focuses on recent updates to the 2024 MyCPD Framework, highlighting the recognition of supervisory activities as a critical element of Category 2 Reviewing Performance CPD. Please join Professor Martin Veysey, a renowned expert in supervision …
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This case report has been developed by Trainees, to assist their peers with preparation of long-case presentations. It is not a fully-vetted Education resource but a “passion project” from editors of the Pomegranate Health podcasts. The case is that of a 32-year-old woman presenting with constant and dull abdominal pain that had been sudden in onse…
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Australia is a big continent and sparsely populated continent. 28 percent of Australians live in areas classified regional, rural or remote and their access to health services is much more limited. It’s estimated that between 2009 and 2011 there were 19,000 excess deaths in regional and remote areas as compared to the major cities. No doubt, socioe…
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Pomegranate [Case Report] is a Q&A style podcast developed by trainees, for trainees. In our debut episode, we hear about w a who man presented to the emergency department reporting sudden onset vision loss in his right eye lasting several hours. He was 68 year old with a history of type 2 diabetes mellitus. Three differential diagnoses being consi…
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Type 1 diabetes has a very high treatment burden in terms of direct costs, inconvenience and lost productivity for patients and their carers. Further, all the glucose checking, hormone replacement and consults don’t abolish the vascular complications associated with poor glycaemic control. Only in the last few years has it been possible to pharmaco…
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Today’s guests are the hosts of This Medical Life, a wonderful podcast that delves into the archives of medical history. Dr Travis Brown describes the period after World War I when the Spanish Flu was killing tens of millions around the world. In the USA, whiskey was thought to be a powerful prophylactic but distribution was not an easy thing. Late…
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Last November an NHS Hospital Trust in Nottingham sought permission from the UK High Court to withdraw life support from a seven-month old girl called Indi Gregory. The devastated parents did not want to give up on her although they were advised there was no hope of treatment for her profound developmental disability. The family and the medical tea…
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The theory that certain fatty acids are essential to the diet and associated with reduced cardiovascular risk has been controversial since it was floated in the 1950s. In 1971 Danish researchers published the results from a cross-sectional study of Inuit people living on the west coast of Greenland. They ate a fish-based diet rich in polyunsaturate…
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Median survival for patients diagnosed with advanced cirrhosis is around 2 years and quality of life is poor. Fewer than a quarter of such patients receive referrals to palliative care and advanced care plans are also rare. Existing research from abroad suggests that hepatology staff aren’t familiar with referral criteria and assume that palliative…
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Semaglutide, branded as Ozempic or Wegovy, is an analogue of glucagon-like peptide 1 which has glucose-dependent effects on insulin secretion. In this episode we discuss how semaglutide performs as an antihyperglycaemic agent compared to previous GLP-1 analogues and the soon-to-be launched tirzepatide. This dual agonist also binds receptors to gluc…
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We’ve known for a decade that about 50 percent of doctors meet the criteria for burnout, and the figure is up to 70 percent among trainees. But organisations have been left to come up with their own solutions to this, the result being that many simply offer band aid solutions rather than systemic ones. Unforgiving work conditions pose a problem for…
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This is the final episode in a five-part series about artificial intelligence in medicine. We start by weighing up the costs and benefits of automation in a health system that’s increasingly pushed beyond capacity. One of the biggest time sinks for health practitioners is filling out and searching through medical records. Some of this could be perf…
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This is the fourth part in a series on artificial intelligence in medicine and we try and unpick the causes and consequences of adverse events resulting from this technology. Our guest David Lyell is a research fellow at the Australian Institute of Health Innovation (Macquarie University) who has published a first-of-its kind audit of adverse event…
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On the 28th of January 2022 a 75-year-old man was admitted to the regional Albury Wodonga Health Service with a high fever and Parkinsonian symptoms. The patient spent over a week in intensive care, but brain scans did not reveal an obvious aetiology and assays for a range of pathogens came up negative. When serology eventually revealed the presenc…
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This is the third part of a series on artificial intelligence in medicine. Previously we explained how to train and test machine learning models that assist in decision-making, and then how to iron out ergonomic friction points in the clinical workflow. We’ve mentioned how deep learning neural networks are more capable than classical models at deal…
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The allure of having devices and tasks assisted by artificial intelligence is that they will help overcome some of the natural limits of human cognition with regards to working memory and attention. And in helping with the mundane tasks, AI can buy clinicians back time to spend with the complex patients who really need it. But the way all this pans…
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AI-assisted healthcare is reaching maturity in many applications and could alleviate some of the capacity gap increasingly faced by health systems . Over the next three podcasts we focus on artificial intelligence tools designed to assist directly with clinical practice. Most commonly reported on are the algorithms capable of pattern recognition on…
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In today’s podcast we try and understand the impact that racial bias makes on variation in clinical care. For example, racialized patterns in the use of analgesia were brought to light over 20 years ago but are still occurring today. In research from the UK published in March it was found that women of African or South Asian extraction were signifi…
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The first time most of us heard of monkeypox was in May 2022. The smallpox-like infection appeared to spring from nowhere and make its way through Europe then the Americas, largely within the gay and bisexual community. But the first documented human case of mpox actually occurred in 1970 in Central Africa and it’s been endemic ever since. Last yea…
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Medical and administrative records are normally collected to help the management of patients or institutions, but it can be time consuming to extract metrics useful for practice improvement. The field known as Practice Analytics seeks to transform these data and provide clinicians with a bird’s eye view of their case load and performance. Practice …
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In the first year of the COVID-19 pandemic, a handful of international studies showed that there was increased risk of adverse outcomes in hospitalised patients comorbid for diabetes. Odds ratios for mortality conferred by pre-existing diabetes ranged from 1.5 to 3.6. What this relationship might be in Australia was not known until researchers in M…
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Hospitalisation rates for cirrhosis are increasing in Australia in part associated with the high prevalence of obesity and subsequent non-alcoholic fatty liver disease. More concerning still is the frequency with which discharged patients are readmitted within 30 days. One systematic review put the average readmission rate at 26%, but the studies c…
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ADAPT is a prospective cohort study that has been following up COVID-19 patients since the earliest days of the pandemic. It has allowed researchers to track the emergence of long COVID, a syndrome that includes symptoms such as ongoing breathlessness, fatigue, chest tightness and "brain fog". Over the course of the study, participants have contrib…
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Clinical complications suffered by patients during hospital stays are assumed to be preventable and to provide some metric of quality of care. To assist in their understanding and mitigation the Australian Commission on Safety and Quality in Healthcare established a national programme to track hospital-acquired complications (HACs) in a formalised …
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About two thirds of Australians use complementary and alternative medicines but only around half of these people will mention it to their doctor. Patients in palliative care settings may be more inclined than most to try therapies from outside the box. But they are also more vulnerable to side effects and interactions given that their drug metaboli…
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This is the first episode of a new format called “IMJ On-Air” inspired by the RACP’s Internal Medicine Journal. Each episode will be have as guest-host a section editor or reviewer of the IMJ interviewing authors of a recent article. Often these will be Clinical Perspectives reviews which summarise the latest in management of major medical disorder…
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The National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders in Australia aspires to streamline referral pathways so that children can get the right help as early as possible. But despite the best intentions of many clinicians, there are drivers in the health system that make implementation difficult. There are constraints i…
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The average age at which autism spectrum disorder is diagnosed four, though signs are often present well before that. Even where families and GPs may have concerns early in a child’s development, it can take a year or more for a consult with a paediatrician to become available. There are similar waiting lists to see other allied health and sub-spec…
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In the last episode we heard some powerful examples of the challenges faced by some practitioners in medicine. Every situation has its idiosyncrasies, but most people start out with a passion for what they’re doing. In today’s podcast we hear from doctor-career coaches Ashe Coxon and Sarah Dalton who help medics solve the workplace challenges, and …
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Not a day goes by that there isn’t a headline about the overstretched health service and the struggling professionals within it. It isn’t COVID that has created this situation. The pandemic was just the straw that broke the camel’s back. At the RACP Congress in May, ENT surgeon Eric Levi explained why burnout should be considered not as a mental he…
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In episode 78 we heard from some physicians who found themselves taking up the role of advocate, not just for their own patients but for broader system change. And health policy lobbyist Patrick Tobin explained how physicians and the College as whole can best get the attention of parliamentarians. For example, the RACP’s Healthy Climate Futures cam…
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The globe has already warmed by more than one degree Celsius over pre-industrial levels and is on track to exceed two degrees by the end of the century. It doesn’t sound like a lot but this will have profound effects on human health with Australia being particularly vulnerable. Most obviously, Australia’s biggest cities will become furnaces in summ…
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Immune checkpoint inhibitors have revolutionised care for patients with advanced melanoma and other cancers. These days around half of patients with unresectable metastatic melanoma can expect to live to five years after a regime of agents such as nivolumab and pembrolizumab. That’s up to ten times the survival rate of patients a decade ago, when t…
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The core work of being a physician is demanding enough. But if you’re seeing patients come in day after day with ailments that have social determinants behind them, you may start to feel like Sisyphus; heaving that boulder up the hill only to have to start from the bottom every time it slips your grasp. Surely it would be better to change those soc…
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This episode is shared from the Essential Ethics podcast produced at the Royal Children's Hospital in Melbourne. It is presented by paediatric respiratory physician John Massie and clinical ethicist Lynn Gillam who are respectively the Clinical Lead and Academic Director of the Children's Bioethics Centre. In a series titled “Deciding with Children…
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This is the third podcast in a series about medical injury. First we talked about what victims of injury want to hear from the health system after such an event. And then we discussed the guilt and compromised professional identity that doctors might feel when they’ve been involved in a patient harm. We also heard how fear of medicolegal suits is a…
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In the last episode we talked about what patients or their families want to hear after a iatrogenic injury. Despite best practice standards for open disclosure, this occurs far less often that it should. The reluctance from health practitioners to be more transparent is in part due to a misplaced fear of exposure to liability, but perhaps the great…
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Medical injury occurs at a rate of about 12 per cent of admissions, and errors without consequence at a higher rate still. According to Australian and New Zealand guidance documents, disclosure of error “is a patient right, anchored in professional ethics, considered good clinical practice, and is part of the care continuum.” But many practitioners…
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There are many layers of public health interventions that can reduce the rate of transmission of the novel coronavirus. Social distancing, mask wearing, lockdowns and vaccines each nudge the reproduction number down. But you need all of them working together to make a significant impact, and that means you need the community on board. In this podca…
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The COVID-19 pandemic has brought to public attention, like never before, the work of public health physicians as well as epidemiologists, statisticians and computer modelers. The crisis also shown how hard it is to take decisions affecting the lives of millions when there is so little evidence to go on. Models of viral spread and interventions to …
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In 2017, Victoria was the first state in Australia to pass voluntary assisted legislation and has been followed by Western Australia, Tasmania and now South Australia. Aotearoa-New Zealand passed its End-of-life Choice Bill two years ago and that will go live in November. This podcast draws on the experience of some very committed Victorian clinici…
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Acute Kidney Injury makes a greater contribution to early mortality than acute myocardial infarction and it's been argued we should consider the concept of “kidney attack” to give it the weight that it deserves. But the presentation of kidney injury isn’t as overt or timely as a heart attack often is. While serum creatinine is a pretty good reporte…
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This is the third and final part of our series on gendered medicine. We step back and look at the way that health care and research are funded. It’s been said that the health needs of women are undervalued by our existing fee-for-service model, down to individual item numbers in the Medicare Benefits Schedule. There’s also evidence that disease pre…
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