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Pomegranate Health is an award-winning podcast about the culture of medicine, from the Royal Australasian College of Physicians. We ask how doctors make difficult clinical and ethical decisions, how doctor-patient communication can be improved, and how healthcare delivery can be made more equitable.
This is also the home of [IMJ On-Air], a podcast to accompany the RACP's Internal Medicine Journal. Interviews with authors are conducted by specialist section editors. Find out more at the website www.racp.edu.au/podcast and get in touch via the address podcast@racp.edu.au
108 Episodes
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![[Case Report] 68yo with cardiometabolic risk factors and transient monocular vision loss](https://storage.buzzsprout.com/zkm18o0ejo096t8a88mkkzffihoh?.jpg "[Case Report] 68yo with cardiometabolic risk factors and transient monocular vision loss")
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 ophthalmolog...
![[Journal Club] Baricitinib immune therapy for new onset type 1 diabetes](https://storage.buzzsprout.com/izj6y9ptaiqopzc8cwz6cjsbcwcz?.jpg "[Journal Club] Baricitinib immune therapy for new onset type 1 diabetes")
Type 1 diabetes has a very high treatment burden in terms of direct costs, inconvenience and lost productivity for patients and their carers. Further, all the glucose checking, hormone replacement and consults don’t abolish the vascular complications associated with poor glycaemic control. Only in the last few years has it been possible to pharmacologically alter the course of type 1 diabetes and other auto-immune diseases without generating intolerable side effects.Teplizumab is an antibody ...
Today’s guests are the hosts of This Medical Life, a wonderful podcast that delves into the archives of medical history. Dr Travis Brown describes the period after World War I when the Spanish Flu was killing tens of millions around the world. In the USA, whiskey was thought to be a powerful prophylactic but distribution was not an easy thing. 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 ...
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 freq...
![[IMJ On-Air] Is the jury still out on omega-3 supplementation?](https://storage.buzzsprout.com/eoj5cufwfyygs2zitdwtdxpo7u27?.jpg "[IMJ On-Air] Is the jury still out on omega-3 supplementation?")
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-β-lipoprotein and plasma-triglycerides...
![[IMJ On-Air] HepatoCare: a model for palliative and supportive care in advanced cirrhosis](https://storage.buzzsprout.com/jvtobpu92c72kkvwmjec9kiiqbgs?.jpg "[IMJ On-Air] HepatoCare: a model for palliative and supportive care in advanced cirrhosis")
Median survival for patients diagnosed with advanced cirrhosis is around 2 years and quality of life is poor. Fewer than a quarter of such patients receive referrals to palliative care and advanced care plans are also rare. Existing research from abroad suggests that hepatology staff aren’t familiar with referral criteria and assume that palliative services become involved only at the very end of life. To try and reduce barriers to referral, clinicians at Royal Brisbane Hospital de...
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 mo...
We’ve known for a decade that about 50 percent of doctors meet the criteria for burnout, and the figure is up to 70 percent among trainees. But organisations have been left to come up with their own solutions to this, the result being that many simply offer band aid solutions rather than systemic ones. Unforgiving work conditions pose a problem for both recruitment and retention of staff to the health workforce. The New Zealand Health Department, Te Whatu Ora, forecasts that within ten years ...
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 ...
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...
![[IMJ On-Air] A tiger in the mallee: Victoria’s JEV cluster](https://storage.buzzsprout.com/exv3pi4etmga3a58nghc9gzo2ww7?.jpg "[IMJ On-Air] A tiger in the mallee: Victoria’s JEV cluster")
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 startl...
1This 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 c...
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 ...
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 d...
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...
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 ove...
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 impr...
![[IMJ On-Air] Hyperglycaemia and COVID-19](https://storage.buzzsprout.com/u4mo5f5c6apyn1jq76pulq8obzoc?.jpg "[IMJ On-Air] Hyperglycaemia and COVID-19")
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 Me...
![[IMJ On-Air] High readmission rates in cirrhotic patients](https://storage.buzzsprout.com/gcblyryo7iygi89ndqh1wvutv1qp?.jpg "[IMJ On-Air] High readmission rates in cirrhotic patients")
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 editio...
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 correlat...
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