108 episodes

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

Pomegranate Health the Royal Australasian College of Physicians

    • Health & Fitness
    • 4.8 • 60 Ratings

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

    [Case Report] 68yo with cardiometabolic risk factors and transient monocular vision loss

    [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 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 ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ 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. 
    Key Reference and learning points (spoiler alert)
    The Role of Tocilizumab in Glucocorticoid Resistant Giant Cell Arteritis: A Case Series and Literature Review [J Neuroophthalmol. 2023;43(1)]

    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. 

    • 32 min
    [Journal Club] Baricitinib immune therapy for new onset type 1 diabetes

    [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 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 β-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 today’s episode, Pomegranate’s in-house endocrinologist interviews two of the study authors.   

    Key Reference
    Baricitinib and β-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 ‘Things to Sort out’ and ‘Quiet Waters’ by Walt Adams and ‘The Appalachian Trail’ by Hunter Quinn. Music courtesy of FreeMusic Archive includes ‘I am a Man Who Will Fight For Your Honor’ 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 ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

    • 40 min
    Ep106: The whiskey fix and the apple of Granada

    Ep106: The whiskey fix and the apple of Granada

    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 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 ‘Mendo Mulcher’ by Polyrhytmiques, ‘Bach’s March fur die Arche’ by The United States Army old Fife and Drum Corps and ‘Notre Dame’ by Jahzzar. Music licenced from Epidemic Sound includes ‘Salat Alsabah’ by Feras Charestan and ‘Savannah Nights 1’ by Martin Gauffin. Image courtesy of Wikimedia Commons. Recording of Allegri’s 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 ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

    • 30 min
    Ep105: When parents and paediatrics clash

    Ep105: When parents and paediatrics clash

    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 ‘December’ by Kai Engel. Music licenced from Epidemic Sound includes ‘Ikigai’ by Twelwe and ‘Pulse 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 ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

    • 49 min
    [IMJ On-Air] Is the jury still out on omega-3 supplementation?

    [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 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)

    ​Declarations 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 ‘Niagara’ by Chris Shards and ‘Hollow Head’ 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 ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

    • 25 min
    [IMJ On-Air] HepatoCare: a model for palliative and supportive care in advanced cirrhosis

    [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 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 O’Beirne FRCP FRACP (Sunshine Coast Hospital and Health Service; University of the Sunshine Coast)
    Dr Richard Skoien MBBS FRACP (Royal Brisbane and Women’s Hospital; University of Queensland)
    Dr Alison Kearney FRACP MRCP (Royal Brisbane and Women’s Hospital; University of Queensland)
    Olivia Cullen (Royal Brisbane and Women’s 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 ‘After the Freak Show’ by Luella Gren and ‘The Cold Shoulder’ 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 ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.

    • 39 min

Customer Reviews

4.8 out of 5
60 Ratings

60 Ratings

~andyb~ ,

Fantastic

This is an excellent podcast by the RACP on a range of interesting and relevant topics. Fantastic job getting some quality experts in to discuss their fields. Keep up the high quality 👍

Dance student ,

Informative, topical and succinct resource

Excellent for medical students, as well as practising medical professionals.

Dr Graham Davison ,

Succinct professional content

The first episode on end-of-life conversations is excellent. I entered it out of curiosity, was pulled in because of brevity (15:18), liked the the brief fluent comments and summaries -- and that the website offers an episode transcription and references. Also the professional nature of production. Well done.

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