![[Case Report] 48yo with diarrhoea and lymphadenopathy](https://is3-ssl.mzstatic.com/image/thumb/Podcasts125/v4/69/a2/1e/69a21e05-65e8-5cba-d47c-eec22fa25430/mza_9229135947102686699.jpg/250x250bb.jpg)
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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 tissue plasminogen activator which activates plasmin to dissolve fibrin blood clots. For many years it was assumed that alteplase should be administered within 3 hours of symptom onset, thus it was a big deal when in 2008, research showed that that window could be safely broadened out to four and a half hours.
Todayâs guests have over the intervening years been pushing the envelope even further, in an effort to help the more than two thirds of stroke patients who present after that threshold. In this podcast, Professors Bruce Campbell and Mark Parsons discuss a trial of the relatively novel agent, tenecteplase. The publication in the New England Journal of Medicine showed that tenecteplase could improve patient outcomes even if administered up to 24 hours out from a large vessel occlusion. The researchers explain the steps that led up to their study, and the importance of perfusion imaging to identify candidates with salvageable brain tissue.
Key Reference
Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy [NEJM. 2024]
Guests
Dr Duncan Austin PhD FRACP MRCP (Cabrini Health)
Professor Bruce Campbell PhD FRACP (Cabrini Health; Royal Melbourne Hospital; University of Melbourne)
Professor Mark Parsons PhD FRACP, FAAHMS (Sydney Neurointerventional Specialists; Consulting in Neurology, Maitland).Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âThings to Sort Outâ by Walt Adams and âthe Appalachian Trailâ by Hunter Quinn. Image produced and copyrighted by RACP.Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, Courtney Dowd, Saion Chaterjee and David Arroyo.
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 âPomegranate Healthâ in Apple Podcasts, Spotify,Castbox or any podcasting app.
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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 treating team? This case was managed at the Queen Elizabeth Hospital and is presented by Dr Andrew Vanlint from the Northern Adelaide Local Health Network and University of Adelaide.
Credits
Dr Andrew Vanlint FRACP AFRACMA (Northern Adelaide Local Health Network and University of Adelaide
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes âRockinâ for Decadesâ by Blue Texas and âBrighton Breakdownâ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physician David Arroyo.Key Reference (Spoiler Alert)
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*Lessons from practice: Low attenuation lymphadenopathy on computed tomography leading to diagnosis of Whipple disease [Vanlint; Med J Aust. 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 âPomegranate Healthâ in Apple Podcasts, Spotify,Castbox or any podcasting app. -
Puuttuva jakso?
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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, and the national target for 2030, but there have been surprises along the way that have required an adaptable approach to surveillance and intervention.
This is particularly true in correctional settings which typically have high rates of hep C transmission due to the amount of injecting drug use that takes place coupled with an absence of needle exchange programs. Presenting on this theme was Colette McGrath, who is General Manager of Population and Preventative Health for Justice Health NSW. Her very pragmatic approach is informed by almost a decade of experience working with this population.
Key Reference
Hepatitis C Elimination in NSW: Monitoring and Evaluation Report, 2024 [Kirby Institute]
Video Recording from launch eventGuests
Prof Greg Dore FRACP (Kirby Institute, Viral Hepatitis Clinical Research Program Head; St Vincentâs Hospital).
Colette McGrath (Population and Preventative Health, General Manager, Justice Health NSW)
Production
Recorded by Kirby Institute staff. Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âSouthern Sunâ and âQuiet Watersâ by Walt Adams, âTrain Rideâ by Alex Kehm and âThe Appalachian Trailâ by Hunter Quinn. Image produced and copyrighted by RACP.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 âPomegranate Healthâ in Apple Podcasts, Spotify, Castbox or any podcasting app.
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Dr Karan Singh loves his job as a registrar in nuclear medicine but he thinks there isnât 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 experiencing leg spasms after recovering from a car crash; myocardial perfusion imaging for an elderly gentleman with coronary artery disease; staging for prostate and breast cancer; and radiation therapy for a toxic multinodular goiter. The âreality audioâ format gives a good sense of the daily tasks and responsibilities involved in this career pathway.
Credits
Dr Karan Singh
Staff and patients at Prince of Wales Nuclear Medicine and PET DepartmentProduction
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âSalty Sailsâ and âNunaâ by Sindrandi, âBetween Four Eyesâ by Czar Donic, âOrganic Textures 2â by Johannes Bornlöf and âPunjabi Swagâ by Aks and Lakshmi. Image by JohnnyGreig licenced through Getty Images.Editorial feedback kindly provided by RACP physicians Jamie Bellinge, Joseph Lee, Sern Wei Yeoh, Zac Fuller and Stephen Bacchi.
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.
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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. Todayâs 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 first admission, reducing harm to patients and inefficient use of healthcare resources.
The researchers also tested a novel classification tool for scoring which readmissions are avoidable and which are just an unfortunate outcome of the patientâs illness. This could help more accurately track quality of care within and between healthcare service providers.Guests
Prof Christian Gericke PhD FRACP FAFPHM AFRACMA FRCP Edin FEAN FAAN (Calvary Mater, Newcastle; University of Newcastle; University of Queensland)
Dr Reinhardt Dreyer (South West Medicine ; University of Stellenbosch)
Dr James Gome FRACP (South West Medicine, Clinical Director General Medicine)
Production
Produced by Mic Cavazzini. Music licenced from Epidemic Sound includes âTreetopsâ by Autohacker and âThe Cold Shoulderâ by Kylie Dailey. Image created and copyrighted by RACP.Editorial feedback kindly provided by RACP physicians Aidan Tan, Joseph Lee, David Arroyo and Stephen Bacchi.
Key Reference
Causes for 30-day readmissions and accuracy of the LACE index in regional Victoria, Australia [IMJ. 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 âPomegranate Healthâ in Apple Podcasts, Spotify,Castbox or any podcasting app. -
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 diplopia and ptosis, and the story is picked up with a referral to the neurology department.
Guests
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
Dr James Triplett FRACP (Flinders Medical Centre, consultant neurologist)
Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes âRockinâ for Decadesâ by Blue Texas and âBrighton Breakdownâ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Brandon Stretton.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.
Key Reference and Learning Points (Spoiler Alert)
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*Painless progressive mononeuritis multiplex secondary to AML associated neuroleukemiosis [J Neuroimmunol. 2023]
(1) Chemotherapy can have neurological complications, including chemotherapy induced peripheral neuropathy (e.g., oxaliplatin).(2) A third (oculomotor) cranial nerve palsy has multiple possible causes, which can be divided into painful vs painless causes, and compressive (classically with pupillary involvement) vs non-compressive (can spare pupil, as with microvascular insult) causes.
(3) Conduction block is shown by a significant reduction in compound muscle action potential, between proximal and distal stimulation, the criteria for which varies by nerve.
(4) Ascertaining whether conduction block occurs at compressible vs non-compressible sites can be a useful distinguishing feature for the various possible causes e.g. including compression, demyelination, and ischaemia, and
(5) Mononeuritis multiplex, while classically associated with a vasculitic neuropathy, has a number of causes, including leukaemia. This is the very rare condition known as neuroleukemiosis.
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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 understanding of the impact of trauma and relationships in the workplace. Professor Greenberg overturns some entrenched beliefs we have about the presentation and management of mental illness, as does guest host Dr David Beaumont from the College Member Health and Wellbeing Committee. He reflects on the role of the Committee and how his own understanding of health has shifted in response to personal distress.
Guests
Professor Neil Greenberg FRCPsych, FHEA, MFMLM, MInstLM, MEWI, MFFLM (Kings College, London; March on Stress)
Dr David Beaumont FAFOEM (Positive Medicine, Director; RACP Member Health and Wellbeing Committee)Production
Produced by Mic Cavazzini. Music licenced from Epidemic Sound includes âBlacklightâ by John B. Lund and âLukas Got Luckyâ by Rate 44. Image by Richard Drury licenced through Getty Images.Editorial feedback kindly provided by RACP physicians David Arroyo, Stephen Bacchi, Nele Legge, Ronaldo Piovezan, Rachel Murdoch, Aidan Tan and Rachel Bowden.
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 âPomegranate Healthâ in Apple Podcasts, Spotify,Castbox or any podcasting app.
Counselling Support
College EAP
Member service provided by TELUS Health
Australia: 1300 361 008
Aotearoa-NZ: 0800 155 318 (Aotearoa New Zealand).
See also the TELUS wellbeing app.Doctorâs Health Advisory Service Helpline
Aotearoa-NZ: 800 471 2654
NSW/ACT: 02 9437 6552
VIC: 03 9280 8712
TAS: 03 9280 8712
SA: 08 8366 0250
NT: 08 8366 0250
QLD: 07 3833 4352
WA: 08 9321 3098
Lifeline
Australia: 13 11 14.
Aotearoa-NZ: 0800 54 33 54 -
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 and medical education, and Associate Professor Kudzai Kanhutu, College Dean, as they delve into the practicalities and strategic benefits of integrating supervision into your CPD activities. This podcast offers guidance on planning and recording supervising activities, using MyCPD tools to streamline the process efficiently.Guests
Associate Professor Kudzai Kanhutu FRACP GAICD (College Dean; Royal Melbourne Hospital; University of Melbourne)
Professor Martin Veysey FRACP, FRCP (Gastro Healthcare; Australian National University)Production
CPD OnDemand project production by Rebecca Lewis and David Tarr. Audio editing by Mic Cavazzini. Music licenced from Epidemic Sound includes âBookiesâ by Jones Meadow and âLove Thingâ by Paisley Pink. Image created and copyrighted by RACP.
For more podcasts that you can credit to Category 1 CPD , please visit the Pomegranate Health web page. And there are many more educational videos and eLearning resources at RACP Online Learning.
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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 âpassion projectâ 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 onset. The pain is accompanied by nausea and vomiting but bowel habits were unchanged. The patient has a history of type 1 diabetes and a simultaneous pancreas-kidney transplant two years prior to the presentation. There is no history of rejection of pancreatitis and serum creatinine appears normal.
The attending nephrologist walks through the elimination of differential diagnoses typical of any patient and also of particular relevance to a transplant patient.Guests
Dr Chiang Sheng Lee FRACP (Lyell McEwin Hospital; University of Adelaide)
Dr Stephen Bacchi (Lyell McEwin Hospital)
Dr Amitjeet Singh (Lyell McEwin Hospital)Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âRockinâ for Decadesâ by Blue Texas and âBrighton Breakdownâ by BDBs. Image created and copyrighted by RACP.
Editorial feedback kindly provided by RACP physicians Aidan Tan, Brandon Stretton, David Arroyo, Keith Ooi and Fionnuala Fagan. Thanks also to Adelaide medical students Benjamin Cook, Srishti Sharma and Prakriti Sharma.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.
Key Reference (Spoiler Alert)
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Gadolinium-Induced Acute Graft Pancreatitis in a Simultaneous Pancreas-Kidney Transplant Recipient [Case Rep Nephrol. 2022] -
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. Itâs 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, socioeconomic disadvantage is factor in that mortality gap, but inequitable access to healthcare is also a major driver.
In this podcast we focus specifically on the shortage in health practitioners in the regions. Even in regional centres, the density of physicians by population count is two thirds what it is in the major cities. By the time you get to large rural towns itâs just over a third that baseline. In this podcast we discuss opportunities to lift recruitment and retention. This means improving the experience for trainees and the esteem for rural medicine in the eyes of the profession at large.
Guests
âAdjunct Professor Graeme Maguire PhD FRACP MHM MPHTM (President Adult Medicine Division, RACP and Director of Medical Education, WA Country Health Service)
Dr Sarah Straw FRACP (WACHS Kimberley Regional Physician Team; Northern Hospital, Melb; Rural, Regional and Remote Working Group, RACP)
âAssociate Professor Matthew McGrail PhD (Head Regional Training Hub Research, University of Queensland)Production
Produced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes âThe Envelopeâ, âCast in Wickerâ and âPlanting Flagsâ by Blue Dot Sessions. Music licenced from Epidemic Sound includes âThe Missionâ by J. F. Gloss. Photo by Pearshop on behalf of RACP.Editorial feedback kindly provided by RACP physicians Steve Flecknoe-Brown, Zac Fuller, Aidan Tan, Sasha Taylor, Jia Wen Chong, Joseph Lee, Fionnuala Fagan, Stephen Bacchi, Chris Leung, David Arroyo, Nele Legge, Li-Zsa Tan and Thazin Thazin.
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 âPomegranate Healthâ in Apple Podcasts, Spotify,Castbox or any podcasting app.
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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 considered were optic neuropathy, vitreoretinal disease, or corneal oedema following from potential uveitis. In this podcast consultant ophthalmologist, Dr Sumu Simon, walks through an approach to this presentation and an exploratory therapy.
Guests
Dr Sumu Simon FRANZCO (Queen Elizabeth Hospital; Royal Adelaide Hospital)
Dr Brandon Stretton (Royal Adelaide Hospital)
Dr Stephen Bacchi (Lyell McEwin Hospital)
Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âRockinâ for Decadesâ by Blue Texas and âBrighton Breakdownâ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Fionnuala Fagan.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.
Learning points and Key Reference (spoiler alert)
1. This case underscores the critical nature of timely diagnosis and aggressive treatment in conditions like giant cell arteritis (GCA), where delayed treatment can lead to irreversible complications such as vision loss. Thorough history taking and clinical acumen are still key elements in establishing a diagnosis of GCA.
2. The patient's initial response and subsequent decline in vision illustrate the need for ongoing monitoring and readiness to adapt the treatment approach. It also shows the necessity of close monitoring of inflammatory markers and clinical symptoms.
3. Amaurosis fugax warrants urgent referral to an ophthalmologist.
4. High index of suspicion for GCA and prompt referral of GCA suspects will ensure best outcome for patients.
5. Progressive visual loss and elevated inflammatory markers should alert the clinician to glucocorticoid-resistant GCA.
6. The effectiveness of tocilizumab in this case highlights its role as a valuable treatment option for refractory GCA, especially when traditional therapies are not sufficiently effective. Targeted biologic agents may open up new treatment approaches in the future particularly in patients with progressive visual loss despite administration of intravenous methylprednisolone.
7. Managing complex cases like GCA often requires a collaborative approach involving rheumatologists, ophthalmologists, and other specialists to ensure comprehensive care and optimal outcomes.
8. There is often value in case reports to start the evidence cascade that is required to bring new, life altering treatments to the forefront.
The Role of Tocilizumab in Glucocorticoid Resistant Giant Cell Arteritis: A Case Series and Literature Review [J Neuroophthalmol. 2023;43(1)] -
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 donât abolish the vascular complications associated with poor glycaemic control. Only in the last few years has it been possible to pharmacologically alter the course of type 1 diabetes and other auto-immune diseases without generating intolerable side effects.
Teplizumab is an antibody to CD3 which was presented to the world in 2019 as delaying the onset of type 1 diabetes in high-risk individuals thanks to its protective effect on pancreatic ÎČ-cells. It has not yet been registered by the Therapeutic Goods Administration but another immunomodulatory drug called baricitinib has. Baricitinib is an inhibitor of Janus Kinases indicated for the for the treatment of rheumatoid arthritis, alopecia areata, atopic dermatitis and even COVID-19.
In December of last year the results of a Phase 2 trial in patients with new-onset type 1 diabetes were published in the New England Journal of Medicine. After almost a year of taking the oral therapy, patients were found to have better glycaemic control and evoked C-peptide levels than those taking placebo, indicating a preserved ability to secrete insulin. In todayâs episode, Pomegranateâs in-house endocrinologist interviews two of the study authors.
Key Reference
Baricitinib and ÎČ-Cell Function in Patients with New-Onset Type 1 Diabetes [NEJM. 2023. 7;389(23)]Guests
Prof Jenny Couper FRACP FAHMS (Women's and Children's Hospital, University of Adelaide)
Dr Michelle So FRACP (Royal Melbourne Hospital, Northern Hospital)
Guest Host
Dr Rahul Barmanray FRACP (Royal Melbourne Hospital)Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âThings to Sort outâ and âQuiet Watersâ by Walt Adams and âThe Appalachian Trailâ by Hunter Quinn. Music courtesy of FreeMusic Archive includes âI am a Man Who Will Fight For Your Honorâ by Chris Zabriskie. Image produced and copyrighted by RACP.Editorial feedback kindly provided by RACP physicians Amy Hughes, Stephen Bacchi, Fionnuala Fagan 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 âPomegranate Healthâ in Apple Podcasts, Spotify,Castbox or any podcasting app.
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Todayâs 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. Later in the episode (22min) is the equally unlikely tale of how the pomegranate made its way from ancient myth onto this podcast by way of Henry VIII and some mystical symbolism.
Guests
Dr Travis Brown MBBS, FRCPA (ClinPath Pathology)
Steve Davis MBA FAMI CPM (Talked About Marketing)
Production
Produced by Mic Cavazzini DPhil. Music courtesy of FreeMusic Archive includes âMendo Mulcherâ by Polyrhytmiques, âBachâs March fur die Archeâ by The United States Army old Fife and Drum Corps and âNotre Dameâ by Jahzzar. Music licenced from Epidemic Sound includes âSalat Alsabahâ by Feras Charestan and âSavannah Nights 1â by Martin Gauffin. Image courtesy of Wikimedia Commons. Recording of Allegriâs Miserere from Trinity College under Creative Commons licence from archive.org.Editorial feedback kindly provided by RACP physicians Chris Leung, Aidan Tan, David Arroyo, Ronaldo Piovezan, Rahul Barmanray and Ian Woolley.
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 âPomegranate Healthâ in Apple Podcasts, Spotify,Castbox or any podcasting app.
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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 teams returned to court two more times, right up to the day that Indi was to be extubated.
Conflicts over care have always existed but their frequency has increased as medicinal advances present more options for intervention even in the sickest patients. Added to that, the online media environment allows advocacy campaigns to grow until they spill onto the streets outside hospitals and courtrooms.
This heightened tension causes moral injury both to parents and healthcare staff looking after child patients. The Medical Mediation Foundation has developed a conflict management framework to help avoid or de-escalate such disputes and keep attention focused on the best interests of the patient. In this podcast we hear from the director of the foundation, as well as three staff from the Starship Hospital, Auckland who have undertaken this training.
Guests
Sarah Barclay (Director, the Medical Mediation Foundation)
Dr Louise Webster MBChB RANZCP FRACP (Paediatric Consult Liaison Team, Starship Hospital)
Dr Fiona Miles FRACP FFICANZCA (Paediatric Intensivist, Starship Hospital)
Fiona McIver (nurse specialist, Starship Hospital)Production
Produced by Mic Cavazzini DPhil. Recording assistance in Auckland from Dinesh Kumar. Music courtesy of FreeMusic Archive includes âDecemberâ by Kai Engel. Music licenced from Epidemic Sound includes âIkigaiâ by Twelwe and âPulse Voyage by Chill Cole. Image by Photodisc licenced from Getty Images.
Editorial feedback kindly provided by RACP physicians Michael Herd, Rosalynn Pszczola, Rachel Murdoch, Sasha Taylor, Zac Fuller, Rahul Barmanray, David Arroyo, Rachel Bowden, Chris Leung, Fionnuala Fagan, Thazin Thazin 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 âPomegranate Healthâ in Apple Podcasts, Spotify,Castbox or any podcasting app.
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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 polyunsaturated fatty acids known as omega-3s, which were found in their tissues along with much lower levels of pre-ÎČ-lipoprotein and plasma-triglycerides when compared to controls.
That association between a fishy diet and lowered cardiovascular risk has been replicated in multiple population studies since then and there are several ways omega-3 fatty acids could mediate the effect. They have anti-inflammatory and antithrombotic properties, lower circulating triglyceride concentrations and keep vessels impermeable to plaque forming lipoproteins.For many years now clinical guidelines like those of the American Heart Association and the National Heart Foundation of Australia have explicitly encouraged dietary intake of omega-3s fatty acids for those at high cardiovascular risk. But such recommendations come despite considerable inconsistency in the outcomes from intervention studies on omega-3 supplementation over the past 25 years.
From several large RCTs there have been just as many negative or neutral associations as there have been positive ones. Professor Christian Hamilton-Craig has published a viewpoint review in the December edition of the Internal Medicine Journal attempting to explain these inconsistencies.
Guests
Dr Paul Bridgman MB ChB MD FRACP FCSANZ FASE (Christchurch Hospital; St George Hospital; University of Otago)
Prof Christian Hamilton-Craig MBBS PhD FRACP FCSANZ FSCCT FSCMR FACC (Director, Noosa Hearts Cardiology; Noosa Hospital; Griffith University; University of Queensland)
âDeclarations of interest: nil
Key Reference· Christian Hamilton-Craig, Karam Kostner, David Colquhoun, Stephen J Nicholls. Omega-3 fatty acids and cardiovascular prevention: is the jury still out? IMJ. 2023 Dec;53(12):2330-2335
Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âNiagaraâ by Chris Shards and âHollow Headâ by Kenzo Almond.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 âPomegranate Healthâ in Apple Podcasts, Spotify,Castbox or any podcasting app.
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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 arenât familiar with referral criteria and assume that palliative services become involved only at the very end of life.
To try and reduce barriers to referral, clinicians at Royal Brisbane Hospital developed a model called Hepatocare. They adapted a palliative care referral algorithm to include cirrhosis specific markers and continuity of care between the teams was provided by a clinical nurse consultant. The model was piloted model in 30 consecutive patients to the liver clinic, and its impact was assessed on rate of referrals, incidence of unplanned admissions, length of patient stay and rates of polypharmacy.
Guests
Professor James OâBeirne FRCP FRACP (Sunshine Coast Hospital and Health Service; University of the Sunshine Coast)
Dr Richard Skoien MBBS FRACP (Royal Brisbane and Womenâs Hospital; University of Queensland)
Dr Alison Kearney FRACP MRCP (Royal Brisbane and Womenâs Hospital; University of Queensland)
Olivia Cullen (Royal Brisbane and Womenâs Hospital)Key Reference
Alison Kearney, Neha Tiwari, Olivia Cullen, Amy Legg, Ismail Arbi, Carol Douglas, Barbara Leggett, Mary Fenech, Joanne Mina, Paris Hoey, Richard Skoien. Improving palliative and supportive care in advanced cirrhosis: the HepatoCare model of integrated collaborative care. Intern Medicine Journal. 2023 Nov;53(11):1963-1971Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âAfter the Freak Showâ by Luella Gren and âThe Cold Shoulderâ by Kylie Dailey.Editorial feedback kindly provided by RACP physicians Aidan Tan and David Arroyo.
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 âPomegranate Healthâ in Apple Podcasts, Spotify, Castbox or any podcasting app.
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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 glucose-dependent insulinotropic polypeptide, GIP.
GLP-1 and GIP are incretin hormones, secreted after food intake and involved in regulating gastric motility and appetite. The analogue therapies have resulted in weight loss of 10 to 20 percent in trials on patients with obesity or other weight-related comorbidities. For various reasons, however, they remain unsubsidised by the Pharmaceutical Benefits Scheme. This hasnât stopped social media influencers driving up off-label demand from the wider public, creating a problem for regulators and the diabetic patients most in need.
Guests
Professor Chris Rayner MBBS PhD FRACP (Gwendolyn Michell Professor, Adelaide Medical School; Consultant Gastroenterologist, Royal Adelaide Hospital)
Professor Gary Wittert MBBch, MD, FRACP (Mortlock Professor, Adelaide Medical School; Senior Consultant Endocrinologist, Royal Adelaide Hospital)
Production
Produced by Mic Cavazzini DPhil. Music courtesy of Free Music Archive includes âMister Sâ by Tortue Super Sonic. Music licenced from Epidemic Sound includes âMulticolorâ and âFlower Fountainâ by Chill Cole, âBlacklightâ by John B Lund, and âHabitualâ by Ava Low. Image by Ketut Subiyanto courtesy of Pexels.Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, David Arroyo, Joseph Lee, Jia-Wen Chong, Li-Zsa Tan, Fionnuala Fagan, Stella Sarlos and Marion Leighton.
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 âPomegranate Healthâ in Apple Podcasts, Spotify, Castbox or any podcasting app.
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Weâve 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 both recruitment and retention of staff to the health workforce. The New Zealand Health Department, Te Whatu Ora, forecasts that within ten years supply of doctors, pharmacists and nurses will fall short of demand by 14 to 18 percent. In response they have establish they have established a national Health Charter that sets the workplace standards to keep staff safe and engaged.
Australia is one step behind, but in early September there was a leadership conference aimed at developing a similar wellbeing strategy nationally. It was envisaged that there would be Chief Wellness Officers at every major health service, reporting validated metrics about their workforce to a national taskforce. And as explained in the keynote presentation at the conference, at the organisational level there are different responses appropriate to the three main domains that influence staff wellbeing; these being personal resilience, professional culture and basic administrative efficiency. This podcast captures reflections from wellbeing champions at several different Australasian health jurisdictions.
Guests
Dr George Eskander MB DCH DRANZCOG FRACGP (Executive Area Director Clinical Services; North Metropolitan Health Service & Sir Charles Gairdner Osborne Park Hospital Care Group)
Dr Bethan Richards MB FRACP MMed MSportsMed (Head of Rheumatology, Chief Medical Wellness Officer, Royal Prince Alfred Hospital; Senior Clinical Lecturer, The University of Sydney)
Dr Joanna Sinclair MB FANZCA (Senior Medical Officer Wellbeing Lead, Counties Manukau Health) Victoria Hirst (Chief of Knowledge Networks, General Manager of Health Roundtable, Beamtree)
Associate Professor Anne Powell BPharm, MBBS, FRACP (Program Director of Physician Education, Alfred Health in Melbourne; Monash University)
Professor Jennifer Martin MBChB MA FRACP PhD GAICD (Chair of Clinical Pharmacology, University of Newcastle; John Hunter Hospital)
Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âKryptoniteâ by Blue Steel and âThyoneâ by Ben Elson. Music courtesy of Free Music Archive includes âA Path Unwindingâ and âThe Zepplinâ by Blue Dot Sessions and âSummer Daysâ by Kai Engel. Image by sturti licenced from Getty Images.Editorial feedback kindly provided by physicians Aidan Tan and David Arroyo. Thanks also to Sarah Dalton and Fiona Fitzgerald for their coordination support.
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 âPomegranate Healthâ in -
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 thatâs 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 performed by natural language processors which are becoming more accurate thanks to deep learning.
The power of large language models has been demonstrated by the meteoritic uptake of ChatGPT and doctors are among those who have used it to summarise literature or draft letters. But professional organisations have raised concerns around the accuracy and privacy of the model and there have also been spooky demonstrations of its capacity for common sense and theory of mind.
Guests
>Professor Brent Richards MBBS FRACP JJFICM (Gold Coast Hospital and Health Service; Director, IntelliHQ)
>Affiliate Associate Professor Paul Cooper PhD FAIDH CHIA AFHEA GAICD (Deakin University)
>Associate Professor Sandeep Reddy MBBS PhD IPFPH ECFMG CHIA FAcadTM FAIDH FCHSM SFHEA (Deakin University; Founder, MedAI)
Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âKryptoniteâ by Blue Steel and âThyoneâ by Ben Elson. Music courtesy of Free Music Archive includes âHeadwayâ by Kai Engel, âGramaphoneâ by Jahzarr and âNumbersâ by Krowne. Image by VM licenced from Getty Images. Computerised voice from Online Tone GeneratorEditorial feedback kindly provided by physicians David Arroyo, Stephen Bacchi, Aidan Tan, Ronaldo Piovezan and Rahul Barmanray and RACP staff Natasa Lazarevic PhD.
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 âPomegranate Healthâ in Apple Podcasts, Spotify, Castbox or any podcasting app.
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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 events reported to the US regulator, the Federal Drugs Administration. He breaks down those that were caused by errors in the machine learning algorithm, other aspects of a device or even user error.
We also discuss where these all fit in to the four stages of human information processing, and whether this can inform determinations about liability. Uncertainty around the medicolegal aspects of AI-assisted care is of the main reasons that practitioners report discomfort about the use of this technology. It's a question that hasnât been well tested yet in the courts, though according to academic lawyer Rita Matulonyte, AI-enhanced devices donât change the scope of care that has been expected of practitioners in the past.Guests
>Rita Matuolynte PhD (Macquarie Law School, Macquarie University; ARC Centre of Excellence for Automated Decision Making and Society; MQ Research Centre for Agency, Values and Ethics)
>David Lyell PhD (Australian Institute of Health Innovation, Macquarie University; owner Future Echoes Business Solutions)
Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes âKryptoniteâ by Blue Steel and âIllusory Motionâ by Gavin Luke. Music courtesy of Free Music Archive includes âImpulsingâ by Borrtex. Image by EMS-Forster-Productions licenced from Getty Images.Editorial feedback kindly provided by physicians David Arroyo, Stephen Bacchi, Aidan Tan, Ronaldo Piovezan and Rahul Barmanray and RACP staff Natasa Lazarevic PhD.
Key References
More than algorithms: an analysis of safety events involving ML-enabled medical devices reported to the FDA [Lyell, J Am Med Inform Assoc. 2023]
How machine learning is embedded to support clinician decision making: an analysis of FDA-approved medical devices [Lyell, BMJ Health Care Inform. 2021]
Should AI-enabled medical devices be explainable? [Matulonyte, Int J Law Inform Tech. 2022]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 âPomegranate Healthâ in Apple Podcasts, Spotify, Castbox or any podcasting app.
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