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Pomegranate Health is a podcast about the culture of medicine. You'll hear insights from clinicians, researchers, and advocates as they tackle important questions — like how to make difficult clinical and ethical decisions without being influenced by bias, how to communicate better with patients and colleagues, and how to provide healthcare that’s both efficient and fair.
If you're a Fellow of the RACP, time spent listening can be counted toward your CPD hours. And if you're a Basic Physician Trainee, the [Case Report] series can help you prepare for your long case clinical exams.
This is also the home of [IMJ On-Air], featuring authors from the Internal Medicine Journal sharing their latest research. The [Journal Club] episodes give RACP researchers a space to talk through their work published in other academic journals. And for Basic Trainees, the [Case Report] series can help you prepare for your long case clinical exams.
Find out more at the website www.racp.edu.au/podcast and get in touch via the address podcast@racp.edu.au
135 Episodes
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Pomegranate Health has been streaming since June 2015, so we’re going to share a few more classic eps from the last ten years. First up, presenter Mic Cavazzini digs deep to find the origins of the pomegranate, featured not just on this podcast but on the crest of the RACP. The journey starts 500 years ago at an unlikely place, the marriage of Henry VIII and the first of his six wives. You’ll find much of the pageantry reproduced at the web page. We then hear from the wonderful staff at...
![[IMJ On-Air] Microbleeds and Memory](https://storage.buzzsprout.com/hgpgqxlmffqd8khw711lepfkyz04?.jpg "[IMJ On-Air] Microbleeds and Memory")
Cerebral microbleeds are a finding on MRI that are usually asymptomatic. There are two main aetiological pathways, one occurring as a result of uncontrolled hypertension and the other from the accumulation of amyloid-beta peptide. The link between cerebral amyloid angiopathy and Alzheimer’s Disease is not understood and even the impact that cerebral microbleeds more generally have on cognition. For the study discussed today, clients of an Australian memory clinic were retrospectively as...
![[Case Report] 46yo with psychosis and cold intolerance](https://storage.buzzsprout.com/2yjhs1aqc90b9g5v361922ns2tzm?.jpg "[Case Report] 46yo with psychosis and cold intolerance")
A 46-year old man is admitted to hospital following a first time presentation of psychosis that involved barricading himself inside a neighbour’s home. At admission he appears disorganised with slow movements and speech. His rambling reveals bizarre delusional beliefs of a paranoid and persecutory nature. At moments he shows aggression towards staff but when examines reports occasional dizziness and an intolerance of cold. Physical examination reveals cool peripheries, sparse axillary and pub...
Pomegranate Health marks ten years of podcasting since its launch in June 2015. This episode will be one of two samplers that dip into the back catalogue of 131 episodes to showcase some of the most compelling stories. You’ll hear how podcast themes are identified from all the domains of medicine and professionalism. And a little bit about the motivations of long-time producer and presenter, Mic Cavazzini. Pomegranate Health has several thousand listeners in over 150 countries. Three quarters...
In this podcast we discuss low-value care that has emerged from a decay in the specificity of the terms “cardiac arrest” and “cardiopulmonary resuscitation.” Patients who experience cardiac arrest in hospital are rarely more than a minute or two away from defibrillation. But the proportion of shockable rhythms in these patients is low as the heart has typically stopped after the decline of other systems. In such conditions, chest compressions are more likely to cause unnecessary trauma than i...
Despite filling more than half of places in Australian medical schools, women represent 45 per cent of all medical practitioners and just 36 per cent of specialists. Female representation dwindles further in many areas of clinical leadership, prompting what has been termed a “leaky pipeline”. It has been reported that women would progress at similar rates to men, and achieve similar remuneration, were it not for the time taken out from the profession to raise children. In this podcast we disc...
![[Case Report] 65yo with ST elevation during AF ablation procedure](https://storage.buzzsprout.com/janf3989nowkhghw5plwq92mvt5f?.jpg "[Case Report] 65yo with ST elevation during AF ablation procedure")
ST elevation is clearly a worrying finding that can herald life-threatening conditions, such as ST elevation myocardial infarction. But not all ST-elevations are created equal, and Trainees would benefit from considering a broader number of causes for this presentation. In today’s podcast the team will discuss a case of ST elevation observed in a 65-year-old female during the routine elective procedure of atrial fibrillation ablation. A range of pathophysiologies is discussed that can help li...
There is evidence that six months or more off the job leads to some loss of practical skills and knowledge and certainly, many doctors report a loss of self-confidence. People take time out from medical practice for many different reasons but career breaks to raise children are more common than ever before. Senior staff at Sydney Children’s Hospital have developed a day-long workshop to help medics brush off the cobwebs before they return to practice. It involves rehearsal of specific skills,...
![[Case Report] 74yo with dyspnoea after AF ablation](https://storage.buzzsprout.com/os4x17h65ezq3sne0vozk5ohk4rt?.jpg "[Case Report] 74yo with dyspnoea after AF ablation")
In this episode we hear about an emergency presentation to a South Australian hospital, of a 74-year-old male with shortness of breath. The curve ball is that he had undergone ablation for drug-refractory atrial fibrillation less than two weeks prior. This discussion gives an overview of developing technologies for AF treatment and developing knowledge about the possible complications. We also have some multiple choice questions to test your understanding. Guest Dr Shaun Evans, FRACP (Royal...
In Aotearoa-New Zealand, the proportion of doctors identifying as Māori has doubled from where it was a decade ago to over 5 percent. But there is still a long way to go before the workforce is representative of the broader population which is 17 percent Māori. The Auckland and Otago Medical Schools have in recent years turbocharged their intake of Māori and Pasifika students but these graduates don’t seem to have trickled through to the RACP in great numbers. Just 3.5 percent of general phys...
![[Case Report] 52yo with hand clumsiness after Chiari operation](https://storage.buzzsprout.com/qywqfgh9pvc293nr5bfbla96tqd6?.jpg "[Case Report] 52yo with hand clumsiness after Chiari operation")
This case report comes to you from Brigham and Women’s Hospital in Boston, a huge teaching hospital that serves the Harvard Medical School. The 52-year-old female presented with clumsiness and paresthesia of the right hand that had persisted for several days. She also had a headache and three weeks prior to presentation had undergone a suboccipital craniotomy for a Chiari I malformation. To complicate things, there was a past medical history of migraines and a family history of a Factor V Lei...
Professor Gary Lee established the first dedicated pleural service in the southern hemisphere in 2009, at the Sir Charles Gairdner Hospital in Perth. He says that pleural disease has finally come to be regarded as an area of subspeciality interest in its own right, not just a complication of other comorbidities. In this podcast he presents a potted history of key developments in the management of pleural effusion in particular. This is diagnosed in about 60,000 people every year in Aust...
![[Case Report] 42yo male with fever following liver transplant](https://storage.buzzsprout.com/44914wiixha942ewjntm12fugg4n?.jpg "[Case Report] 42yo male with fever following liver transplant")
This case report describes a 42-year-old male from Arizona with a complex course characterised by fever following an orthotopic liver transplant. A general approach to fever in the post-transplant patient is discussed, along with specific considerations regarding travel in post-transplant patients or those on immunosuppressants for other indications. A/Prof Camille Kotton and Dr Simran Gupta from the Massachusetts General Hospital and Brigham and Women’s Hospital take listeners through the ca...
In the previous episode we heard how some rationally-designed therapies work on almost any cancer with the right molecular signature. Tumour-agnostic medications could be godsend for patients with rare cancers which have classically been overlooked by drug developers, and those with advanced cancers of unknown origin. 15,000 such patients have undergone comprehensive genome profiling of their tumours through the organisation, Omico. In this podcast, Omico’s founder explains that while the maj...
The genomic understanding of cancer has transformed a tissue-based classification model that had been dominant for 150 years or more. The last three decades have seen highly targeted therapies developed at blistering pace, and unprecedented improvements in patient outcomes. To date, these advances have been focused on more common cancers. The financing model for drug development means that rare cancers get overlooked, given the small pool of potential buyers relative to the costs and ri...
![[Case Report] 35yo male with proximal weakness and skin changes](https://storage.buzzsprout.com/yupjs6n45905dkjc8n712cukkrlo?.jpg "[Case Report] 35yo male with proximal weakness and skin changes")
This case report describes a 35-year-old Caucasian male presenting with 5 weeks of progressive weakness in the proximal limbs and trunk and associated changes to the skin. The man was previously well and not taking any regular medications. There are many pathways this undifferentiated patient could go down. Consultant physician, Professor Josephine Thomas demonstrates a systematic way to work through the differential diagnoses as would be expected in a long-case presentation for basic physici...
![[Case Report] 47yo with rapidly progressive respiratory failure requiring ECMO](https://storage.buzzsprout.com/gkf6573o9ep6er5dma7wjls6bh8v?.jpg "[Case Report] 47yo with rapidly progressive respiratory failure requiring ECMO")
In 2019 a man was referred to Royal Adelaide Hospital with worsening breathlessness and a productive cough. He was a 47 year old electrician with a history of tobacco smoking who’d been well before the onset of symptoms. Over a couple of admissions the patient’s condition progressed to type 2 respiratory failure. While the ultimate explanation for this presentation was a bit of a unicorn, the dramatic escalation of examinations and interventions runs through some textbook respiratory medicine...
![[Journal Club] Thrombolysis up to 24hr after ischaemic stroke](https://storage.buzzsprout.com/t9x0yuahlzb1elfhhxes5ewxk7ma?.jpg "[Journal Club] Thrombolysis up to 24hr after ischaemic stroke")
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 a...
![[Case Report] 48yo with diarrhoea and lymphadenopathy](https://storage.buzzsprout.com/0ylo1d36r1o9vtuy45tqk4s0qyqp?.jpg "[Case Report] 48yo with diarrhoea and lymphadenopathy")
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...
![[Guest Lecture] Fighting hepatitis C in prisons and the community](https://storage.buzzsprout.com/1jamytmzsid1bzi63raxd6dbumta?.jpg "[Guest Lecture] Fighting hepatitis C in prisons and the community")
2This 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 interv...
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