Pomegranate Health

While waiting for COVID-19 vaccines to be rolled out, Australian jurisdictions adopted strong social restrictions to minimise community transmission of the virus. It’s estimated that together, these public health measures spared around 50,000 lives up to December 2022 and that vaccines saved three times as many again. While this public health response the pandemic is described as one of the most effective in the world it did cause unintended social harms and lingering resentment. Our leaders and community need some sober reflection on how to we might respond to the next such pandemic respiratory virus. Over two podcasts we look carefully at the how the cost-benefit calculation stacks up for each of the major interventions. In Part 1 we discuss the international borders closures and overcooked parochialism between state jurisdictions, and also how messaging around vaccine risks and mandates could be improved. In Part 2 we look at the controversial stay-at-home orders and interruptions to in-person schooling and even the evidence for faces-masks. Ultimately, there are some questions that can’t be answered scientifically, and it is for politicians and the public to decide what the cost of freedom and dignity against human lives left exposed. Chapters Part 2 3:38 Social restrictions 16:39 Facemasks 21:19 Missing behavioural and epidemiological data 30:35 Psychological morbidity from social restrictions 39:39 Human rights and moral preparedness Guests Professor Paul Kelly FRACP (Centenary Institute; Australia’s Chief Medical Officer during the pandemic) Professor Catherine Bennett PhD GAICD (Deakin University; lead author of the “COVID-19 Response Inquiry” ) Professor James McCaw PhD (The University of Melbourne; modeler for the Federal government’s “National Plan”) Lorraine Finlay PhD (Australian Human Rights Commissioner; lead author of the "Collateral Damage" report) Production Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Organic Textures 2’ by Johannes Bornlöf, ‘RGBA’ by Chill Cole, ‘Axon Terminal’ by Out to the World, ‘Soundbed’ by Blue Saga, and ‘Echo (Kerstin Ljungstrom Remix)’ by Bonsaye. Music courtesy of FreeMusicArchive includes ‘Namaste’ by Jason Shaw. Image by Westend61 licenced from GettyImages. Add Part 2 to MyCPD as educational activity or visit web page for a transcript and references.

While waiting for COVID-19 vaccines to be rolled out, Australian jurisdictions adopted strong social restrictions to minimise community transmission of the virus. It’s estimated that together, these public health measures spared around 50,000 lives up to December 2022 and that vaccines saved three times as many again. While this public health response the pandemic is described as one of the most effective in the world it did cause unintended social harms and lingering resentment. Our leaders and community need some sober reflection on how to we might respond to the next such pandemic respiratory virus. Over two podcasts we look carefully at the how the cost-benefit calculation stacks up for each of the major interventions. In Part 1 we discuss the international borders closures and overcooked parochialism between state jurisdictions, and also how messaging around vaccine risks and mandates could be improved. In Part 2 (to be released 6th April) we look at the controversial stay-at-home orders and interruptions to in-person schooling and even the evidence for faces-masks. Ultimately, there are some questions that can’t be answered scientifically, and it is for politicians and the public to decide what the cost of freedom and dignity against human lives left exposed. The esteemed panel of guests includes; Australia’s Chief Medical Officer at during the pandemic; one of the modelers advising the Federal government at the time; the epidemiologist in charge of the retrospective Commonwealth Government COVID-19 Response Inquiry and the Human Rights Commissioner who compiled her own report into the social legacy of our policy response. Part 1 Chapters 6:46 Border Closures 35:04 Vaccine Hesitancy Guests Professor Paul Kelly FRACP (Centenary Institute) Professor Catherine Bennett PhD GAICD (Deakin University) Professor James McCaw PhD (Melbourne School of Population and Global Health, The University of Melbourne) Lorraine Finlay PhD (Australian Human Rights Commissioner) Production Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘End of the Ocean’ and ‘Raised by Wolves' by Tellsonic, ‘RGBA’ by Chill Cole, ‘Organic Textures 1’ by Johannes Bornlöf and ‘Echo (Kerstin Ljungstrom Remix)’ by Bonsaye. Image by mrs licenced from GettyImages. Add Part 1 to MyCPD as educational activity or visit web page for a transcript and references.

A 62‐year-old man is undergoing a CT‐guided core biopsy of a lung nodule when he develops an iatrogenic pneumothorax. After admission to the Royal Adelaide hospital he has ongoing dyspnoea, oxygen desaturation, and chest pain not helped by a preexisting Chronic Obstructive Pulmonary Disease. The treatment for the patient’s symptoms doesn’t immediately go to plan but his care team apply a combination of recent technologies to bring the condition under control. Pomegranate [Case Reports] have been developed to help Trainees rehearse diagnostic problem solving and case presentation. Guests Professor Arash Badiei FRACP (Royal Adelaide Hospital; Adelaide University) Hosts Associate Professor Stephen Bacchi FRACP (Northern Adelaide Local Health Network; Adelaide University) Dr Brandon Stretton (Central Adelaide Local Health Network;) Production Produced by Dr Stephen Bacchi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Desert Whispers’ by Tellsonic and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and med students Srishti Sharma, Prakriti Sharma and Cindy Shi. Key Reference (Spoiler Alert) * * * * * Persistent air leak successfully treated with endobronchial valves and digital drainage system [Altree, Respirol Case Rep. 2018] 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.

Médecins Sans Frontières has projects in more than 70 countries that might be affected by natural disasters, armed conflict or disease outbreaks. Its clinics see over two million emergency room admissions a year and another 16 million outpatient consults. Emergency Paediatrics consultant Josephine Goodyer and ID consultant Tasmin Hasan are two of more than a hundred Australians and New Zealanders who contributed to MSF’s missions last year. Between them they have covered practice settings as varied as Kiribati, South Sudan and Gaza. In this interview they describe the experience shipping out with MSF on their first assignment and then the kinds of responsibilities one is given with more experience. We’ll also hear how gaps of six months or more affect career progression and financial stability back home. Chapters 3:05 Starting out with MSF 15:04 Practicing in a conflict zone 50:53 Career impacts Guests Dr Josephine Goodyer FRACP (Canberra Hospital; Australian National University) Dr Tasnim Hasan FRACP (Western Sydney LHD; University of Sydney) Dr Aidan Tan (Sydney Children’s Hospital Network) Production Produced by Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Intimacy’ by Alex Kehm, ‘At the end of nothing’ by Silver Maple, ‘Below the Horizon’ by Dawn, Dawn, Dawn and ‘Nagba Algooah’ by Ebo Krdum. Image by Pablo Tosco ©2018 used with permission by MSF. Editorial feedback kindly provided by members of the podcast editorial group Dr Aidan Tan, Dr Stephen Bacchi, Dr Rahul Barmanray, Dr Maansi Arora and Dr Leon Li. Add educational activity to MyCPD or visit web page for a transcript and references.

A 75 year-old man with severe aortic stenosis is deemed unsuitable for surgery on the basis of a porcelain aorta detected with cross-sectional imaging. The patient had, a decade earlier, been diagnosed with hypertrophic cardiomyopathy after presenting with cardiac arrhythmia. A dual chamber ICD was implanted at the time for secondary prevention and other comorbidities were managed. The patient is now being considered for staged alcohol septal ablation (for the HCM) and transcatheter aortic valve replacement (for the aortic stenosis), however, additional complications force an experimental two-in-one procedure. Guest Professor Ross Roberts-Thomson FRACP (Central Adelaide Local Health Network; University of Adelaide) Hosts Associate Professor Stephen Bacchi FRACP (Northern Adelaide Local Health Network; University of Adelaide) Dr Alistair Leslie (Central Adelaide Local Health Network;) Key Reference (Spoiler Alert) * * * * * Two-in-one: Combined transcatheter therapy for hypertrophic cardiomyopathy and aortic stenosis [IHJ Cardiovascular Case Reports (CVCR). 2020] Production Produced by Stephen Bacchi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Desert Whispers’ by Tellsonic and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPDto 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 2027, NASA’s is planning to land astronauts on the moon for the first time in 53 years with the expectation that there will be a permanent base there by the early 2030s. And the ever-humble Elon Musk reckons he’ll be sending people to Mars by then too. This has prompted a renewed interest in the prolonged effects of space travel on the human body, and a lot of fascinating research has been conducted aboard the International Space Station over the last two decades. The main objective risk to astronauts is exposure to galactic cosmic radiation. This can be reduced to some degree by shielding of space habitats, however, the impacts of microgravity are much harder to engineer away. In part 1 we’ll discuss spaceflight associated neuro-ocular syndrome and other sensorimotor impacts. In part 2 we’ll focus on the effects of microgravity on bone density and the circulatory system. We’ll also talk through the management of a cases of suspected thrombosis on the international space station from a few years ago. Medical care on orbit has many parallels with the remote medicine you’re already familiar with. Guests Professor Gordon Cable (Australian National University; Co-founder, Human Aerospace) Dr Alicia Tucker FACEM, FAWM (Royal Hobart Hospital; University of Tasmania) Dr John Cherry DPhil. FACRRM (Deputy CMO, Australian Antarctic Division) Chapters 4:55 Cosmic Radiation 18:34 Spaceflight Associated Neuro-ocular Syndrome 33:01 Occupational Hazards Production Produced by Mic Cavazzini DPhil. Recording of ‘Also Sprach Zarathustra’ by Richard Strauss, licenced under Creative Commons from the Lud and Schlatts Musical Emporium Conducted by Philip Milman. Music licenced from Epidemic Sound includes ‘Orthosie’ by Ben Elson, ‘Spring Water’ By Chill Cole and ‘Temple of Runha’ by ELFL. Music courtesy of Free Music Archive includes ‘The Undertake’ and ‘Operation A’ by Borttex. NASA audio downloaded from SPACE.com YouTube channel. Image courtesy of NASA and WikiCommons. Image of first US moonwalk by Ed White courtesy of NASA and WikiCommons. Editorial feedback kindly provided by members of the podcast editorial group Paul Cooper PhD, Dr Aidan Tan, Dr Rahul Barmanray, Dr Simeon Wong, Dr Fionnuala Fagan, Dr Maansi Arora, Dr Jia-Wen Chong, Dr Aafreen Khalid and Associate Professor Dr 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. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

The record for the longest space-flight is held by physician-cosmonaut Valeri Polyakov. Back in 1994-95, he spent 437 days on the Mir space station and grew 4 centimetres in height through elongation of his spine in micro-gravity. Polyakov had an uncomfortable ride back to Earth in the very precisely customised descent module. Microgravity also causes demineralization of weight-bearing bones that is faster than age-related decline. But the cosmonaut had worked out religiously for the entire mission and after his capsule parachuted to the ground he made a point of walking from it relatively unassisted. One of the main objectives of the marathon flight had been to prove that walking proudly onto the Martian surface after a 9-month journey might be possible, given it only has 37 percent the gravitational force that Earth does. But microgravity also results in adaptive plasticity of the vestibular and sensorimotor networks and deconditioning of the cardiovascular system. Indeed, several years ago there was a medical emergency aboard the international space station when an ultrasound investigation revealed thrombosis of the internal jugular vein in one astronaut. In this podcast we discuss how management of cases like this has many parallels with remote medicine on earth. Part 1 of this series examined the risks of cosmic radiation and spaceflight-associated neuro-ocular syndrome among other things. Guests Professor Gordon Cable (Australian National University; Co-founder, Human Aerospace) Dr Alicia Tucker FACEM, FAWM (Royal Hobart Hospital; University of Tasmania) Dr John Cherry DPhil. FACRRM (Deputy CMO, Australian Antarctic Division) Chapters 1:08 Bone mineral density 15:35 Circulation and a case study in remote medicine 35:04 Historic medevacs from space Production Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Spring Water’ By Chill Cole, ‘At the End of Nothing’ by Silver Maple and ‘Mega Woman IV’ by ELFL. Music courtesy of Free Music Archive includes ‘Snowfall’ by Kai Engel. Graphic is AI-generated and shared online with a Creative Commons licence. Editorial feedback kindly provided by members of the podcast editorial group Paul Cooper PhD, Dr Aidan Tan, Dr Rahul Barmanray, Dr Simeon Wong, Dr Fionnuala Fagan, Dr Maansi Arora, Dr Jia-Wen Chong, Dr Aafreen Khalid and Associate Professor Dr 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. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

A 72 year old female presents to an Adelaide emergency department with bilateral eye pain and redness lasting several days. She has a history of hypertension, hypercholesterolemia and age-related macular degeneration for which she has received a range of medications. Anterior uveitis is identified as the proximal cause of the ocular pain but there are many possible aetiologies that require careful consideration. Pomegranate [Case Reports] have been developed to help Trainees rehearse diagnostic problem solving and case presentation. Guests Associate Professor Jagjit Singh Gilhotra ,FRANZCO (Queen Elizabeth Hospital; University of Adelaide) Dr Yong Min (Shane) Lee FRACP (Royal Adelaide Hospital) Host Associate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide) Production Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Key Reference (Spoiler Alert) * * * * * Bilateral occlusive retinal vasculitis secondary to intravitreal faricimab injection: a case report and review of literature [Lee, Eye Vis. 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 ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Australia has just approved a second amyloid-targeting therapy for patients with incipient Alzheimer’s dementia. Lecanemab (Leqembi) now joins donanemab (Kisunla) on the Australian Registry of Therapeutic Goods but the impact of both has been modest in Phase III trials to date. After 18 months of therapy they delay progression of disease, as quantified on neurocognitive tests, by around 5 months on average. For some, the prolonged independence and dignity will justify the $60,000 to $80,000 a year price tag for the drugs. But for the Pharmaceutical Benefits Advisory Committee “the high burden of [donanemab] treatment on both patients and the health system, combined with the risks and modest clinical impact, makes the drug unsuitable for PBS subsidy”. This burden includes specialist consults, gene screening, multiple MRI and PET brain scans, and delivery of monthly or fortnightly infusions, adding up to another $20,000 in costs. Even before considering these logistical requirements, Australian memory clinics don’t have anywhere near the capacity to address the 245,000 new cases of early dementia or mild cognitive impairment every year. Advocates see these disease-modifying therapies as a turning point for dementia research and argue for further investment in the systems infrastructure needed to roll them out. Sceptics argue that the available evidence instead questions the importance of amyloidosis in the Alzheimer’s disease cascade. Guests Professor Michael Woodward AM FRACP FANZSGM FAAG FAWMA (Austin Health, Melbourne; University of Melbourne) Dr Chrysanth Pulle FRACP (Prince Charles Hospital, Brisbane) Chapters 13:16 Time Saved 16:18 Costs of treatment 26:44 IMJ paper on resourcing 39:10 Scepticism and staging Production Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘RGBA’ and ‘Pulse Voyage’ by Chill Cole, ‘A Forest Melody’ by Tellsonic, ‘Axon Terminal’ by Out to the World, ‘Organic Textures 2’ by Johannes Bornlof and ‘Fugent’ by Lupus Nocte. Image courtesy of Wikimedia Commons and University of Pittsburgh. Editorial feedback kindly provided by physicians of the podcast editorial group Ronaldo Piovezan, Aidan Tan, Hugh Murray, Joseph Lee, Rahul Barmanray, Simeon Wong and Sebastian Lambooy. Thanks also to Profs Bruce Campbell, Mike Parsons and Amy Brodtmann and registrars Jamie Bellinge and Karan Singh for additional insights into research methods. 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.

A 27-year-old male wakes up with weakness in the left arm and leg and gets himself admitted at Royal Adelaide Hospital. Shockingly, for an otherwise well young man with no significant medical history, a right middle cerebral artery acute ischaemic stroke is identified by CT angiogram. His condition deteriorates in hospital, and a mediastinal mass is discovered on review which gives a lead as to the distal cause. This conversation describes the expedient workup and methodical consideration of some rarer causes of ischaemic stroke. Guest Dr Rudy Goh FRACP (Lyell McEwin Hospital, University of Adelaide) Host Associate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide) Production Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Key Reference (Spoiler Alert) * * * * * Disseminated Aspergillosis with Mediastinal Invasion Causing Fatal Stroke in an Immunocompetent Young Man [Case Rep Neurol. 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 ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Diabetic ketoacidosis can be life-threatening but there’s some variability in the way it’s managed between health settings. Intervention involves intravenous insulin administration, hydration, electrolyte replacement and treatment of the underlying precipitant. In a survey of practitioners from 31 different hospitals in Australia there was an even split between those organisations which followed a fixed rate insulin infusion protocol, usually based on bodyweight, or a variable rate infusion protocol, titrated against blood glucose concentration. Three quarters of survey respondents had worked at another hospital that had different DKA management protocols raising concerns about the cognitive load on junior health staff moving between institutions. In Europe there has been some normalisation towards fixed rate protocols, despite there being no good quality evidence for superiority. In this podcast we hear some theories from two of the authors of the study published recently in the Internal Medicine Journal. 12:40 SGLT2 inhbitor-associated ketoacidosis 17:26 The cognitive burden of variation across settings 25:11 the challenges of researching this questions Guests Dr Lisa Raven FRACP PhD (St Vincent's Hospital, Sydney) Dr Mahesh Umapathysivam FRACP DPhil (Southern Adelaide Diabetes and Endocrine Service; Royal Adelaide Hospital) Guest Host Dr Mervyn Kyi FRACP PhD (Royal Melbourne Hospital; Northern Hospital) Production Produced by Dr Mervyn Kyi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan, Hugh Murray, Stephen Bacchi and Aafreen Khalid. Key Reference “Heterogeneity in the management of diabetic ketoacidosis in Australia: a national survey” [IMJ. 2025] 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.

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. We then hear from the wonderful staff at Marrabinya, a support service in western NSW that helps connect Aboriginal patients to specialist consultations. As heard in episode 53, and a handful of others, Healthy equity for First Nations people is a value embedded in the mission of the RACP. At Pomegranate Health we also try to support physician wellbeing and career development. One podcast towards that end was Episode 55: Starting out in Private Practice. We hear a pep talk from veteran rheumatologist Louis McGuigan about when and how to back yourself in such a business venture. Another episode with a practical theme was number 56 titled “Billing in Byzantium” where we heard how it is that few billion dollars at least are inappropriately billed to Medicare every year. Finally, in a sample from Episode 69 we hear about some of the structural bias in the health system that results gendered outcomes for conditions like heart disease and a gendered understanding of drugs effects. All of these episodes and more, are now available on YouTube, as well as all the usual podcast browsing apps. Sampled in this retrospective episode: Desley Mason, Possum Swinton and Kym Lees from Ep53: Marrabinya Dr Louis McGuigan from Ep55: Starting out in private practice Margaret Faux PhD from Ep56: Billing in Byzantium Professor Zoe Wainer from Ep69: Gendered Medicine 2- Funding and Research Production Credits Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Fair Game’ by Mizlo, ‘Salat Alsabah’ by Feras Charestan, ‘Your Wave’ by Cospe, ‘Dusty Delta Day’ by Lennon Hutton, ‘Corn Candy’ by Guustavv and ‘After the Freak Show’ by Luella Gren. Music courtesy of FreeMusicArchive includes JS Bach's ‘March Fur Die Arche’ performed by The United States Army Old Guard Fife and Drum Corps and ‘Notre Dame’ by Jahzarr. Allegri’s ‘Miserere’ performed by Trinity College under Creative Commons licence from archive.org. Editorial feedback kindly provided by RACP staff Kathryn Smith, Arnika Martus and Ruby Nelson. 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

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 assessed for prevalence of cerebral microbleeds and how this correlates to performance on cognitive tests and formal diagnosis categories. Prevalence of multiple cerebral microbleeds was associated with poorer cognitive performance and more severe diagnoses. And there are suggestions of a shared instigator between Alzheimer’s Disease cerebral amyloid angiopathy. But novel anti-amyloid therapies can also cause increased bleeding risk, meaning that multiple microbleeds are a contraindication for these drugs. We hear how clinicians in the memory clinic balance therapeutic outcomes and potential risks. Guest Associate Professor Paul Yates FRACP PhD (Austin Health; University of Melbourne) Co-Host Dr Duncan Austin FRACP PhD (Alfred Health; Cabrini Health) Production Produced by Dr Duncan Austin and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Joseph Lee and Aidan Tan. Key Reference Prevalence and Associations of Cerebral Microbleeds in an Australian Memory Clinic Cohort [IMJ. 2025] 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.

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 pubic hair, and soft adult-sized testicles. The investigating team suspect hypothyroidism and a complex series of investigations and therapies follows. Guests Dr Peak Man Mah FRACP (Lyell McEwin Hospital, University of Adelaide) Dr Malcolm Borg (Royal Adelaide Hospital) Hosts Associate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide) Mic Cavazzini DPhil Production Produced by Stephen Bacchi and Mic Cavazzini. 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 physician Simeon Wong and medical student Cindy Shi. Key Reference (Spoiler Alert) * * * * * Panhypopituitarism and psychosis in a male patient [Aust N Z J Psychiatry. 2010] 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.

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 of listeners are, predictably, in Australia and Aotearoa-New Zealand, but a full 14 per cent are located outside the traditional anglosphere. RACP is proud to provide this platform to showcase the great work and dedication of its members. It’s also a place where physicians can learn from the other professionals and patient advocates that make up the health system. Please visit the Pomegranate Health web page for a list of thankyous over the ten years. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app. Credits Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Le Hustle’ by Polyrhythmics, ‘Your Wave’ by Cospe, ‘Soul Single Serenade’ by Dusty Decks, ‘Hollow Head’ by Kenzo Almond and ‘Illusory Motion’ by Gavin Luke. Music courtesy of FreeMusicArchive includes ‘I got 99 broadswords but this one isn't one’ and ‘Friends’ by Komiku and ‘Cree’ by Satellite Ensemble. Thumbnail image is the copyright of RACP. Editorial feedback kindly provided by RACP physicians Zac Fuller and Simeon Wong. Thanks also to RACP staff Kathryn Smith, Michael Davidson and Anne Fredrickson.

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 improve survival outcomes. As retired UK palliative care physician Kathryn Mannix explains, “cardiac arrest” was originally reserved for unexpected events in relatively healthy individuals in the community. She says we need to separate this from the more progressive phenomenon that is better described as “natural dying”. There is also a semantic breakdown in the understanding of what “cardiopulmonary resuscitation” entails. Surveys of Australasian medical practitioners show that the majority consider CPR to include defibrillation and drugs not just chest compressions and ventilation. As a result, Do Not Attempt CPR orders get perceived as being “a stop sign” to other treatments that may be beneficial. We hear from the NZ-based authors of that research, cardiologist Dr Tammy Pegg, intensivist Dr Alex Psirides and palliative care physician Dr Kate Grundy. Chapters 4:00 CPR for out-of-hospital cardiac arrest 8:43 Overuse of CPR in hospitalised patients 20:08 Crude algorithms and failed conversations 40:17 Semantic confusion around what CPR entails 48:13 The midwifing of natural dying Guests Dr Kathryn Mannix (www.kathrynmannix.com) Dr Tammy Pegg MRCP FRACP FC CANZ DPhil (Nelson Marlborough Hospital cardiology department) Dr Alex Psirides FCICM (Wellington Regional Hospital intensive care unit) Dr Kate Grundy FAChPM FRACP (Christchurch Hospital palliative care service; University of Otago) Production Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Awash’ by Gavin Luke, ‘Fields 3’ by Gunnar Johnsén, ‘RGBA’ by Chill Cole and ‘Til All that’s Left is Ash’ by Ludlow. Music courtesy of FreeMusicArchive includes ‘New Times’ by 4T Thieves and ‘Secret Place’ by Alex Fitch. Image by Yuichiro Chino licenced through Getty Images. Football commentary courtesy of UEFA Euro 2021. Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Fionnuala Fagan, Simeon Wong, Hugh Murray and Aidan Tan. Thanks also to RACP staff Arnika Martus and Kathryn Smith. 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

Despite filling more than half of places in Australian med schools, women represent 45 percent of all medical practitioners and just 36 percent 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 discuss what it would take to mitigate this so-called “motherhood penalty” through policy, workplace culture and better distribution of labour in the home. This discussion is important because it relates not just to the wellbeing and rights of individual medics, but also to the depth and diversity of the workforce.acity struggles to keep up with demand. Chapters 1:38 Better support of returning mothers in return to work 9:09 How leave and part-time work affects the medical workforce and the benefits of flexibility 19:56 The “motherhood penalty” on career progression of women to senior positions 33:52 Broader biases in society not just around gender roles but a health work-life balance Credits Guests Associate Professor Kara Allen FANZCA (Royal Melbourne Hospital; University of Melbourne) Dr Jenny Proimos FRACP (Royal Children's Hospital Melbourne; Monash Centre for Health Research and Innovation; Production Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Melting Places’ by Andres Cantú, ‘Not Blue’ by Kylie Dailey. Music courtesy of Free Music Archive includes ‘Good Days’ by Cody Francis, ‘Planting Flags’ by Blue Dot Sessions, ‘Helice’ by Monplaisir, ‘Feeling Minnesota by Gavin Luke, and ‘Maybe This Time’ by Major Tweaks. Image by George Peters licenced through Getty Images. Editorial feedback kindly provided by RACP physicians Zac Fuller, Aidan Tan, Joseph Lee, David Skalicky, and Stella Sarlos. Thanks also to RACP staff Arnika Martus and Kathryn Smith. 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.

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 listeners work though the differentials in a systematic way. Guests Assoc Prof Pramesh Kovoor FRACP FACC PhD (Westmead Hospital; the University of Sydney) Dr Neil Warwick FANZCA (Westmead Hospital) Hosts Associate Professor Stephen Bacchi FRACP (University of Adelaide) Dr Joshua Kovoor (Ballarat Base Hospital) Production Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Game show music courtesy of Waderman. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan, Aafreen Khalid, Hugh Murray and medical student Nivida Dixit. Key Reference (Spoiler Alert) * * * * * Metaraminol-induced coronary vasospasm masquerading as ST-elevation myocardial infarction during general anaesthesia [Br J Anaesth. 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 ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

There is evidence that six months or more off the job leads to some loss of practical skills and knowledge and certainly, many doctors 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. Paediatrics is one specialty where female representation exceeds 70 percent and it is also becoming more common for new fathers to take leave as primary carers. 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, refreshers on calculation and interpretation tasks and a high-fidelity critical care simulation. Just as importantly, there is open discussion and mentorship to support the transition back to work. The program is called Paediatric Returnees after Maternity or Extended Leave (PRAM) this podcast was recorded during a live workshop at the Kids Simulation Centre, Randwick. Guests Workshop participants: Elodie, Eliza, Emma, April, Stephanie, Lucy and Paula. PRAM creators: Dr Josephine Goodyer FRACP (Sydney Children’s Hospital, Randwick) Dr Sasha Symonds FRACP FACEM (Sydney Children’s Hospital, Randwick) Renee Byrne (Sydney Children’s Hospital, Randwick) Production Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Elm Lake’ by Elm Lake, ‘Quiet Waters’ by Walt Adams, ‘Illuminations 4’ by Johannes Bornlöf, ‘Feeling Minnesota by Gavin Luke, and ‘Maybe This Time’ by Major Tweaks. Image by Maskot licenced through Getty Images. Editorial feedback kindly provided by RACP physicians Sasha Taylor, Stephen Bacchi,Simeon Wong, Zac Fuller, Hugh Murray, Aidan Tan, Sern Wei Yeoh, Sasha Taylor and Stella Sarlos. Thanks also to RACP staff Arnika Martus and Kathryn Smith. 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.

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 Adelaide Hospital; University of Adelaide) Hosts Associate Professor Stephen Bacchi (Massachusetts General Hospital; University of Adelaide) Jasmine Le (University of Adelaide) Production Produced by Stephen Bacchi and Mic Cavazzini. 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 Hugh Murray, Aidan Tan, Aafreen Khalid, Sebastiaan Lambooy, Amy Hughes and Lauren Gomes. Key Reference (Spoiler Alert) * * * * * Delayed cardiac tamponade from pericarditis following pulmonary vein cryo-balloon ablation [IMJ. 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.