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 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)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel and ‘Thyone’ by Ben Elson. Music courtesy of Free Music Archive includes ‘Headway’ by Kai Engel, ‘Gramaphone’ by Jahzarr and ‘Numbers’ 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 ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app. 

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 hasn’t been well tested yet in the courts, though according to academic lawyer Rita Matulonyte, AI-enhanced devices don’t 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) ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel and ‘Illusory Motion’ by Gavin Luke. Music courtesy of Free Music Archive includes ‘Impulsing’ 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 ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app. 

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 presence of antibodies against Japanese encephalitis virus this became only the second ever locally-acquired case on Australia’s mainland. Even more startling was the fact that the previous one had been way back in 1998 in Cape York, far north Queensland. The Victorian patient was the first what would become an outbreak of 43 symptomatic human cases that resulted in six deaths. The JE virus would be detected in all mainland states and retrospectively linked to another fatality in March 2021 from the Tiwi islands of the Northern Territory. In this podcast we hear about the confluence of factors that brought a classically tropical disease to the southern states. The story is told from the perspective of the treating clinicians, microbiology specialist and public health physician who started putting the puzzle together from four sentinel cases. Key ReferenceSamuel Thorburn, Deborah Friedman, John Burston, Paul M Kinsella, Genevieve E Martin, Deborah Williamson, Justin Jackson. Sentinel cluster of locally acquired Japanese encephalitis in southern Australia. Internal Medicine Journal. 2023;53(5):835-840Member access to Internal Medicine Journal, Journal of Paediatrics and Child Health and Occupational Medicine JournalGuestsAdjunct Associate Professor Ian Woolley FRACP (Monash Infectious Diseases; Monash University) Dr Justin Jackson FRACP (Albury Wodonga Health)Dr Sam Thorburn (Austin Health)Dr Paul Kinsella (Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity)Associate Professor Deborah Friedman FRACP (Victorian Department of Health; Deakin University)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Dusty Delta Day’ and ‘Hard Shoulder’ by Lennon Hutton. Image from Smith Collection/ Gado licenced from Getty Images. Editorial feedback kindly provided by Dr 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. 

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 dealing with big noisy data sets, but also that the reasoning they use to solve questions asked of them might be inexplainable users.  This creates a certain unease among clinicians and regulators like Australia’s Therapeutic Goods Administration. According to some, we just need to test outcomes from use of AI-assisted decision-making with same rigor we do for pharmaceutical interventions, not all of which we fully understand. But despite updates to the SPIRIT and CONSORT for reporting of randomised controlled trials, there hasn’t yet been a lot of high quality clinical research into use of AI-based medical devices. Guests>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)>Professor Brent Richards MBBS FRACP JJFICM (Gold Coast Hospital and Health Service; Director, IntelliHQ)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Thyone’ by Ben Elson, ‘Little Liberty’ by Paisley Pink. Music courtesy of Free Music Archive includes ‘Impulsing’ and ‘You are not alone’ by Borrtex. Image by WestEnd61 licenced from Getty Images.Editorial feedback kindly provided by physician Rahul Barmanray and digital health academic Natasa Lazarevic.Key ReferencesA governance model for the application of AI in health care [Reddy, J Am Med Inform Assoc. 2020]Machine learning in clinical practice: prospects and pitfalls [Med J Aust. 2019] Evidence-based medicine and machine learning: a partnership with a common purpose [BMJ Evid Based Med. 2021] Explainability for artificial intelligence in healthcare: a multidisciplinary perspective [BMC Med Inform Decis Mak. 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.  

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 out will really depend on how seamlessly the machine learning devices fit in with the clinical workflow. Which aspect of clinical decision-making do they support and how are the consequences of error mitigated? Only a small fraction of research projects make it all the way to implementation, and in this podcast we discuss the ergonomic factors that need to be solved to effectively use AI in clinical decision support. GuestsAssociate Professor Clair Sullivan MBBS FRACP FACHI FAIDH CHIA (Director, Queensland Digital Health Centre; University of Queensland)Professor Enrico Coiera MBBS PhD FACMI, FACHI (Director, Centre for Health Informatics, Australian Institute of Health Innovation; Macquarie University).ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Alienated’ by ELFL and ‘Little Liberty’ by Paisely Pink. Image by Da Kuk licenced from Getty Images.Editorial feedback kindly provided by physicians; Rhiannon Mellor, David Arroyo, Aidan Tan, Joseph Lee, Rachel Murdoch, Michelle Chong, Phillipa Wormald and digital health academics; Paul Cooper and Natasa Lazarevic.Key References The Last Mile: Where Artificial Intelligence Meets Reality [Coiera, J Med Internet Res. 2019] We need to chat about artificial intelligence [Coiera, MJA. 2023]How machine learning is embedded to support clinician decision making: an analysis of FDA-approved medical devices [Coiera, BMJ Health Care Inform. 2021] 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.

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 medical images, that in some settings perform as well or better than expert diagnosticians at classifying disease. AI models have also been developed to perform regression analyses more complex than classical risk stratification aids.The standard statistical algorithms used to solve these problems struggle when many variables are introduced, in which case deep learning models that mimic brain networks are sometimes a powerful alternative. In this episode we explain how machine learning algorithms are trained on particular tasks and where there are risks of error and bias being introduced. In part 2, we identify the ergonomic issues that affect practical implementation of AI tools in the clinic and in the decision cascade. And in the final episode of the series we discuss the questions that regulators and lawyers should be asking of this new technology and what role natural language processors might have in medicine. GuestDr Ian Scott FRACP MHA MEd (Director of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital; Professor of Medicine, University of Queensland)ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Thyone’ by Ben Elson, ‘Broke No More’ by Cushy, ‘Desert Hideout’ by Christopher Moe Ditlevesen and ‘Alienated’ by ELFL. Music courtesy of Free Music Archive includes ‘Capgras’ by Ben Carey. Image by Olemedia licenced from Getty Images.Editorial feedback kindly provided by physicians; Rhiannon Mellor, David Arroyo, Aidan Tan, Joseph Lee, Rachel Murdoch, Michelle Chong, Phillipa Wormald and digital health academics; Paul Cooper and Natasa Lazarevic.Key ReferencesDemystifying machine learning: a primer for physicians [Scott, IMJ. 2021]Clinician checklist for assessing suitability of machine learning applications in healthcare [Scott, BMJ Health Care Inform. 2021]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 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 significantly less likely to receive an epidural during vaginal birth, or instrumental assistance with the delivery. The direct reasons for this variation were not revealed by the study, and could simply reflect the preferences of different cultural groups. But if that’s the case, it behoves us to address gaps in health education in a culturally sensitive way. This podcast highlights the subtle drivers of racialized disparity at different layers of service delivery. At an individual level implicit bias can affect clinical decision-making. At an institutional level there may be known resourcing issues not being addressed, like availability of translators to help diverse patients understand what they’re consenting to. And all this takes place within the context of structural racism, the inequity that was long ago baked into society’s power structures. That’s particularly true in colonised countries like ours, so we also ask what it means to “decolonise” medicine. GuestsWendy Edmondson PhDc (Cultural Advisor, RACP)Dr Kudzai Kanhutu FRACP GAICD MPH (Dean, RACP; Deputy Chief Information Office, Royal Melbourne Hospital) ProductionProduced by Mic Cavazzini DPhil. Recording assistance from Jon Tjhia in Melbourne and Fiona Croall in Adelaide. Music licenced from Epidemic Sound includes ‘You break down’ by Czar Donic and ‘Repurposed’ by Cody Francis. Music courtesy of Free Music Archive includes ‘New Times’ by 4T Thieves and ‘Chasing Shadows’ by Scott Holmes. Image by rubberball licenced from Getty Images. Editorial feedback on this episode kindly provided by physicians Sern Wei Yeoh, Aidan Tan, Rachel Murdoch, Priya Garg, Fionnuala Fagan, Phillipa Wormald, Amy Hughes and RACP staff Fiona Hilton, Rebecca Lewis, Michele Daly, Alexandra Kinsey. 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 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 year’s mpox outbreak eclipsed prior case numbers in just a few months thanks to a newly evolved strain. The count of confirmed cases totalled over 86,000 all around the world and it’s a testament to well-coordinated community health in the developed world that the outbreak was reigned in within a few months of the index case in Europe. But alongside this success story, there’s also a cautionary tale about global health strategy. Because mpox wasn't taken seriously in endemic countries, an incubator was created for this new strain to emerge. We also discuss the stigma associated with sexually transmitted infections and the pros and cons of applying this label. GuestsDr Vincent Cornelisse FRACGP FAChSHM PhD (Royal Prince Alfred Hospital, Royal North Shore Hospital, Sydney; Kirby Institute, UNSW)Dr Massimo Giola FRACP FAChSHM PhD (Te Whatu Ora, Tauranga, Rotorua)ProductionProduced by Mic Cavazzini DPhil. Recording assistance in Tauranga from Melissa Cox, Mockingbird Music Studios. Editorial feedback kindly provided by Dr Aidan Tan and Dr David Arroyo. Music licenced from Epidemic Sound includes ‘Cocktail by Major Tweaks, ‘Broke No More’ by Cushy, ‘Temple of Ruhnha’ by ELFL and ‘Razzamatazz’ by Jules Gaia. Music courtesy of Free Music Archive includes ‘Out of the Skies, Under the Earth’ by Chris Zabriskie, Image by Flashpop licenced from Getty Images. Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record time spent listening and reading supporting materials. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app. 

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 Analytics can draw attention to cases that stood out from the trend, not for any regulatory purpose, but simply to help clinicians reflect and improve. This could even act a shortcut to meeting the new requirements for CPD imposed by the medical boards. GuestsProfessor Tim Shaw (University of Sydney; Research Director, Digital Health Cooperative Research Centre) Dr David Rankin (Director Clinical Governance and Informatics, Cabrini Health)ProductionProduced by Mic Cavazzini DPhil. Recording assistance from Jon Tjhia in Melbourne. Music courtesy of FreeMusicArchive includes ‘Transference’ by Ben Carey. Music licenced from Epidemic Sound includes ‘Emerlyn’ by Valante. Image by Courtney Hale licenced from Getty Images.Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record 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 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 Melbourne retrospectively examined electronic medical records from the two waves of COVID-19 in that city.  The prevalence of diabetes among Melbourne inpatients is around 35% and in 2020 over 70% of all Australia’s case load was in Victoria. This presented an opportunity to observe the relationship between the conditions with substantial statistical power. But while ICU admission and mortality were more common in those with diabetes than those without, neither diabetes nor hyperglycaemia were independently associated with in-hospital mortality. In this podcast the authors speculate as to why there was this deviation from patterns observed internationally. A possible explanation involves the receipt of dexamethasone therapy in patients with hyperglycaemia, which was found by other researchers to be preventative for COVID-19-associated mortality. GuestsAssociate Professor John Wentworth FRACP (Royal Melbourne Hospital, Walter and Eliza Hall Institute) Dr Rahul Barmanray FRACP (Royal Melbourne Hospital; the University of Melbourne)Dr Dev Kevat FRACP (Western Health; Monash University)Dr Mohammad Ashraful Islam (Goulburn Valley Health) Key ReferenceRahul D Barmanray Diabetes IN hospital – Glucose and Outcomes in the COVID-19 pandemic (DINGO COVID-19): the 2020 Melbourne hospital experience prior to novel variants and vaccinationsInternal Medicine Journal 2021; 53(1)Access to IMJ, JPCH and OMJ for RACP membersPlease visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.

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 cited varied greatly in their inclusion and exclusion criteria and not much is known from Australia and Aotearoa-New Zealand. In the December edition of the Internal Medicine Journal researchers at the Austin Hospital Liver Transplant Unit in Melbourne reported a 46% readmission rate among their patients. This was based on a retrospective audit of medical records, which also suggested that a fifth of readmissions might have been preventable. Better adherence to practice guidelines when patients are first hospitalised for cirrhosis may reduce a significant burden on patients and the healthcare system.  GuestsProfessor James O’Beirne FRCP FRACP (Director of Gastroenterology & Hepatology, Sunshine Coast Hospital and Health Service; University of the Sunshine Coast)Dr Karl Vaz FRACP (Victorian Liver Transplant Unit, Austin Hospital)Key ReferenceKarl Vaz et al. Rate of early hospital readmission amongst cirrhotic patients is high in Australia: experience from a single liver transplant centre Internal Medicine Journl 2021; 52(12)Free access to IMJ for members of the RACPPlease visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app. 

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 contributed blood cells, cardiac and brain MRIs, tests of respiratory function and more. The research has uncovered molecular and functional correlates that are helping to explain long COVID. Meanwhile, clinicians at the St Vincents’ Hospital, Sydney long COVID clinic are successfully applying rehabilitation strategies drawn from the treatments of chronic pain and other functional disorders. GuestsProfessor Gail Matthews MRCP FRACP (Head of Infectious Diseases, St Vincent's Hospital, Sydney; Kirby Institute)Dr David Darley FRACP (St Vincent’s Hospital, Sydney)Professor Steven Faux FRACGP FAFRM FFPMANZCA (Director Rehabilitation and Pain Medicine, Vincent’s Hospital, Sydney)Professor Bruce Brew AM FRACP FAAN (Director of the Peter Duncan Neurosciences Research Unit, St Vincent's Hospital Sydney) ProductionRecorded at St Vincent’s Hospital for the Curran Foundation.  Post-production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Tree Tops’ and ‘Yellow Lead’ by Autohacker and ‘Thyone’ and ‘Orthosie’ by Ben Elson. Image by PASIEKA licenced from Getty Images.Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review the prefilled activity details then click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.

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 way. Comparison data can be found through the Health Roundtable reports and it’s been understood that hospitals with higher complication rates may have a have a lower standard of care. While the national HAC program has support from providers across all jurisdictions and makes good use of electronic medical records, some questions remain as to its methodology. In a retrospective audit of medical records published in the Internal Medicine Journal, Dr Graeme Duke and colleagues at Eastern Health Intensive Care Research have sought to validate the clinical significance of HACs identified within their service. Their research suggests that HACs are underreported by coding data and that they are more strongly associated with patient-related factors than with deviation from clinical best practice. Dr Duke and IMJ editor Professor Ian Scott discuss the research article and its implications for the national hospital-acquired complications programme.  GuestsDr Graeme Duke FCICM, FANZCA (Eastern Health Intensive Care Services)Prof Ian Scott FRACP (University of Queensland, Princess Alexandra Hospital)Key ReferenceGraeme J Duke et al. Clinical evaluation of the national hospital-acquired complication programme Internal Medicine Journal 2021; 52(11); 1910-1916 Access to IMJ, JPCH and OMJ for RACP membersPlease visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app. 

Pomegranate Health is seeking fresh ears on the Podcast Editorial Group.Responsibilities of group members are to> discuss new podcast topics> suggest themes to explore and people to interview> listen to audio drafts and provide feedback before publicationGroup communication is done informally by email and there's a time commitment of approximately 90 minutes per month. Please download an application form and return it before February 2023 to podcast@racp.edu.au. ******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 metabolism and clearance mechanisms are often impaired. In this podcast you’ll hear the authors of a Clinical Perspectives article titled "Complementary and alternative therapies in the palliative setting." It’s published in the in the October issue of the Internal Medicine Journal which can be accessed by all RACP members at the login page racp.edu.au/fellows/resources/journals.Professor Jennifer Martin and Joanne Patel describe how cannabinoid products, especially, have become more readily accessible to patients in recent years and often considered a panacea for many different symptoms. But given the wide variety of products each with a different concentration of active ingredients, drug effects are not always as a patient or doctor might expect. These compounds also have suppressive effects on P450 and other clearance enzymes which can alter the outcomes of other prescribed drugs.  But practitioners also need to consider their relationship with a patient when giving advice on the use of complementary medicines.     GuestsDr Jonathan Brett FRACP FAChAM (St Vincent’s Hospital, Sydney)Professor Jennifer Martin FRACP (University of Newcastle, John Hunter Hospital)Dr Joanne Patel FRACP FAChPM (University of Newcastle, John Hunter Hospital)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Crossing Borders’ by Mindserver Unlimited. Image by DrAfter123 licenced from Getty Images.Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review/amend the prefilled activity details and click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app.

Pomegranate Health is seeking fresh ears on the Podcast Editorial Group.Responsibilities of group members are to> discuss new podcast topics> suggest themes to explore and people to interview> listen to audio drafts and provide feedback before publicationGroup communication is done informally by email and there's a time commitment of approximately 90 minutes per month. Please download an application form and return it before February 2023 to podcast@racp.edu.au. ******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 disorders. In this episode we have leading respiratory physicians from the Royal Melbourne Hospital presenting current best practice in the diagnosis and treatment of severe asthma. They explain why inhaled corticosteroids have become so ubiquitous and also the remarkable impact that monoclonal antibodies have made to the field. They also discuss the lifestyle factors that can be modified to improve outcomes, and why so many people with severe asthma go undiagnosed. Finally, they reflect on the lessons learned from the 2016 “asthma storm” that send 3000 people to emergency rooms in over a single evening.  GuestsAssociate Professor Daniel Steinfort FRACP (Royal Melbourne Hospital; Principal Research Fellow, University of Melbourne)Dr Ashleigh Witt (Royal Melbourne Hospital)Associate Professor Nur-Shirin Harun FRACP (Royal Melbourne Hospital; Peter MacCallum Cancer Centre)Professor Jo Douglass FRACP FThorSoc (Director of Research, Royal Melbourne Hospital; University of Melbourne) ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Tree Tops’ by Autohacker, ‘Crossing Borders’ by Mindserver Unlimited. Image by Karl Tapales licenced from Getty Images.Please visit the Pomegranate Health web page for a transcript and supporting references. To claim learning credits login to MyCPD at this link, review/amend the prefilled activity details and click save. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app. ReferencesOverview of recent advances in asthma management [Witt 2022, IMJ]Access to IMJ, JPCH and OMJ for RACP membersAsthma action plan templates [Asthma Australia]Global Initiative for Asthma [GINA]Overview of recent advances in asthma management [

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 in the way specialists can be reimbursed for time spent managing a case through the diagnostic process. And the extent of developmental disorders in the community may not be reflected in the depth of training in this area. We also hear about some breaking research into a highly accurate diagnostic screening tool that could reveal just how prevalent ASD is in the community.GuestsDr Paul Hotton FRACP (Staff Specialist in Community Child Health and Child Protection, Sydney Children's Hospital Network; Chair of CCCH at RACP)with input from Associate Professor Josephine Barbaro (Olga Tennison Autism Research Centre, La Trobe University) ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Falling from the Clouds’ by Sven Lindvall, ‘Lantern Room (Instrumental)’ by Torii Wolf and ‘Not Blue’ by Kylie Dailey. Image by Elva Etienne licenced from Getty Images.Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD. References> Australian National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders> Implementing the National Guideline online explainer 

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-specialists who may contribute opinions to a diagnosis. And there is some inconsistency as to what kind of supporting documentation is required to access support services at different layers if government. The Autism Cooperative Research Centre published a national guideline with 70 recommendations to streamline this process and improve equity for families from different backgrounds and living in different parts of the country. In this podcast we hear from a GP and a paediatrician working in regional practice about how this can help their patients receive early intervention in the critical developmental years. In Part 2 we get a response from the RACP’s Chair of Child and Community Health about underlying structural challenges including the paediatric training curriculum and the NDIS. GuestsDr Jo McCubbin FRACP (Fitzpatrick House, Sale, VIC)Dr James Best FRAGCP (Junction Street Medical Centre, Nowra NSW)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Sleeping Starchild’ by Daniel Fridell, ‘Falling from the Clouds’ by Sven Lindvall, ‘Lantern Room (Instrumental)’ by Torii Wolf and ‘Not Blue’ by Kylie Dailey. Image by Elva Etienne licenced from Getty Images. References> Australian National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders> Implementing the National Guideline online  explainerPlease visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD.  

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 remember what drew them to the profession. Associate Professor Peter Connaughton describes burnout as an occupational health issue, that needs to be solved organisationally. Those presentations were recorded at Congress 2021, but we also get a call from a listener wanting to share a simple gesture that can make a world of difference between colleagues stretched thin at a busy hospital. GuestsDr Stephen Philpot FCICM (Alfred Health, Cabrini Hospital)Dr Ash Coxon FRACGP (Townsville Hospital; Medical Career Planning)Dr Sarah Dalton FRACP (Westmead Children’s Hospital; Associate Professor Peter Connaughton FAFOEM (Curtin University; University of Notre Dame) ProductionWritten and produced by Mic Cavazzini DPhil. Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes and ‘Exploring the Lake’ by View Points and ‘Into the Bone’ by Taylor Crane. Photo image licenced through Getty Images. Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Vicka Poudyal, Michael Herd, Rhiannon Mellor, Nele Legge and Amy Hughes.Please visit the RACP website for a transcript and supporting references. RACP members can claim CPD credits for listening via MyCPD. 

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 health condition but as an occupational disorder. And apart from the stressors of the job itself and the work relationships, the medical profession has a way of consuming one’s personal life. Associate Professor Michelle Telfer talked about being hounded for two years by the conservative press over her work with young people struggling with their gender identity. And pain specialist Olivia Ong described how she’d been driven by an unhealthy professional identity until a traumatic spinal injury forced her to reconsider the meaning of self-care. Both physicians found the courage to take control of the situation and define their roles on their own terms.GuestsEric Levi FRACS (Royal Children's Hospital; St Vincent's Hospital; Ear, Nose and Throat Victoria)Associate Professor Michelle Telfer FRACP (Director Adolescent Medicine, Director Gender Service at Royal Children's Hospital Melbourne; Murdoch Children’s Research Institute)Dr Olivia Ong FAFRM FFPMANZCA (Monash Health, Advance Healthcare)ProductionWritten and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Into the Bone’ by Taylor Crane, ‘Below the Horizon’ and ‘Haunted Heart’ by Dawn Dawn Dawn and ‘Exploring the Lake’ by View Points. Photo image by Paul R. Giunta licenced through Getty Images. WellbeingDoctor’s Health Advisory Service Helpline Aotearoa-NZ:  800 471 2654NSW/ACT: 02 9437 6552VIC:      03 9280 8712TAS:     03 9280 8712SA:       08 8366 0250NT:       08 8366 0250QLD:    07 3833 4352WA:     08 9321 3098LifelineAustralia: 13 11 14.Aotearoa-NZ: 0800 54 33 54 Converge International  Aotearoa-NZ: 0800 666 367 Australia : 1300 687 327Subscribe to email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox, or any podcasting app. Fellows of the RACP can claim CPD credits for listening via MyCPD. For a transcript and further references please visit our website. 

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 campaign calls on Government to make the healthcare system more resilient against the shocks of climate heating and extreme weather events.To complete this series, this episode focuses on what happens to advocacy issues after they land on an MP’s desk, and how they get churned through the Canberra machine to eventually become policy. We hear the perspectives of two physicians turned politicians in interviews that first appeared as part of an RACP documentary called The Advocate’s Journey. Dr Mike Freelander practiced for 37 years as a paediatrician in Sydney’s southwest before being  elected to the federal Division of Macarthur in 2016. for the Labor party. Dr Katie Allen was elected in 2019 as the Liberal Member for Higgins after practicing at the Royal Children’s Hospital and directing the Australian Centre of Food and Allergy Research.While the federal election in May 2022 rearranged some of the chairs at the table, the RACP is proud of all its members who have taken the brave steps of entering the political fray. The represent all colours of the political spectrum and we are grateful to have such influential champions for health policy.Guests Dr Rob Lethbridge FRACP (Perth Children’s Hospital) Dr Mike Freelander MP FRACP Dr Katie Allen MP (at time of interview)ProductionWritten by RACP Professional Practice team. Music licenced from Epidemic Sound includes ‘Ikigai’ by Twelwe and ‘No Show (Instrumental Version)’ by Penny Lane. Photo courtesy of Michael@UnsplashPlease visit the RACP website for a transcript. RACP members can claim CPD credits for listening via MyCPD.