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. 

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 Reference<ul><li>Samuel Thorburn, Deborah Friedman, John Burston, Paul M Kinsella, Genevieve E Martin, Deborah Williamson, Justin Jackson. <a href="https://pubmed.ncbi.nlm.nih.gov/37134258/" rel="nofollow" target="_blank">Sentinel cluster of locally acquired Japanese encephalitis in southern Australia. Internal Medicine Journal. 2023;53(5):835-840</a></li></ul><a href="https://www.racp.edu.au/fellows/resources/journals" rel="nofollow" target="_blank">Member access to Internal Medicine Journal, Journal of Paediatrics and Child Health and Occupational Medicine Journal</a>Guests Adjunct 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) Production Produced by Mic Cavazzini DPhil. Music licenced from <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> includes ‘Dusty Delta Day’ and ‘Hard Shoulder’ by Lennon Hutton. <a href="https://www.gettyimages.com.au/detail/news-photo/culex-quinquefasciatus-mosquito-on-a-human-finger-the-culex-news-photo/509399266" rel="nofollow" target="_blank">Image from Smith Collection/ Gado</a> licenced from Getty Images. Editorial feedback kindly provided by Dr Aidan Tan. <a href="https://www.racp.edu.au/pomegranate/view/imj-on-air-a-tiger-in-the-mallee-victorias-jev-cluster" rel="nofollow" target="_blank">Please visit the Pomegranate Health web page</a> for a transcript and supporting references. <a href="https://mycpdweb.racp.edu.au/User/Layout/Activity?Shortcut=JapaneseEncephalitisVirus" rel="nofollow" target="_blank">Login to MyCPD</a> to record listening and reading as a prefilled learning activity. Subscribe to <a href="https://www.racp.edu.au/podcast/subscribe" rel="nofollow" target="_blank">new episode email alerts</a> or search for ‘Pomegranate Health’ in <a href="https://podcasts.apple.com/au/podcast/pomegranate-health/id1022747864" rel="nofollow" target="_blank">Apple Podcasts</a>, <a href="https://open.spotify.com/show/66uzue0DthUrsKzGppPzen" rel="nofollow" target="_blank">Spotify</a>,<a href="https://castbox.fm/channel/3951339" rel="nofollow" target="_blank">Castbox</a>, or <a href="http://subscribeonandroid.com/www.racp.edu.au/feeds/podcasts" rel="nofollow" target="_blank">any podcasting app</a>.

[IMJ On-Air] A tiger in the mallee: Victoria’s JEV cluster

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&gt;Affiliate Associate Professor Paul Cooper PhD FAIDH CHIA AFHEA GAICD (Deakin University)&gt;Associate Professor Sandeep Reddy MBBS PhD IPFPH ECFMG CHIA FAcadTM FAIDH FCHSM SFHEA (Deakin University)&gt;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.

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 &gt;Affiliate Associate Professor Paul Cooper PhD FAIDH CHIA AFHEA GAICD (Deakin University) &gt;Associate Professor Sandeep Reddy MBBS PhD IPFPH ECFMG CHIA FAcadTM FAIDH FCHSM SFHEA (Deakin University) &gt;Professor Brent Richards MBBS FRACP JJFICM (Gold Coast Hospital and Health Service; Director, IntelliHQ)Production Produced by Mic Cavazzini DPhil. Music licenced from <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> includes ‘Thyone’ by Ben Elson, ‘Little Liberty’ by Paisley Pink. Music courtesy of <a href="https://freemusicarchive.org/" rel="nofollow" target="_blank">Free Music Archive</a> includes ‘Impulsing’ and ‘You are not alone’ by Borrtex. <a href="https://www.gettyimages.com.au/detail/photo/reflection-of-a-circuit-board-on-glasses-royalty-free-image/1208358587" rel="nofollow" target="_blank">Image by WestEnd61</a> licenced from Getty Images.Editorial feedback kindly provided by physician Rahul Barmanray and digital health academic Natasa Lazarevic. Key References <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647243/" rel="nofollow" target="_blank">A governance model for the application of AI in health care</a> [Reddy, J Am Med Inform Assoc. 2020] <a href="https://pubmed.ncbi.nlm.nih.gov/31389031/" rel="nofollow" target="_blank">Machine learning in clinical practice: prospects and pitfalls</a> [Med J Aust. 2019] <a href="https://pubmed.ncbi.nlm.nih.gov/32816901/" rel="nofollow" target="_blank">Evidence-based medicine and machine learning: a partnership with a common purpose</a> [BMJ Evid Based Med. 2021] <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706019/" rel="nofollow" target="_blank">Explainability for artificial intelligence in healthcare: a multidisciplinary perspective</a> [BMC Med Inform Decis Mak. 2020] <a href="https://www.racp.edu.au/pomegranate/view/ep97-the-governance-of-AI" rel="nofollow" target="_blank">Please visit the Pomegranate Health web page</a> for a transcript and supporting references.<a href="https://mycpdweb.racp.edu.au/User/Layout/Activity?Shortcut=Ep97ThegovernanceofAI" rel="nofollow" target="_blank">Login to MyCPD</a> to record listening and reading as a prefilled learning activity. Subscribe to <a href="https://www.racp.edu.au/podcast/subscribe" rel="nofollow" target="_blank">new episode email alerts</a> or search for ‘Pomegranate Health’ in <a href="https://podcasts.apple.com/au/podcast/pomegranate-health/id1022747864" rel="nofollow" target="_blank">Apple Podcasts</a>, <a href="https://open.spotify.com/show/66uzue0DthUrsKzGppPzen" rel="nofollow" target="_blank">Spotify</a>,<a href="https://castbox.fm/channel/3951339" rel="nofollow" target="_blank">Castbox</a>, or <a href="http://subscribeonandroid.com/www.racp.edu.au/feeds/podcasts" rel="nofollow" target="_blank">any podcasting app</a>.

Ep97: The governance of AI

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.

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. Guests Associate 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).Production Produced by Mic Cavazzini DPhil. Music licenced from <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> includes ‘Alienated’ by ELFL and ‘Little Liberty’ by Paisely Pink. <a href="https://www.gettyimages.com.au/detail/photo/medical-mri-scan-royalty-free-image/1299730658" rel="nofollow" target="_blank">Image by Da Kuk</a> 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 <a href="https://pubmed.ncbi.nlm.nih.gov/31702559/" rel="nofollow" target="_blank">The Last Mile: Where Artificial Intelligence Meets Reality</a> [Coiera, J Med Internet Res. 2019] <a href="https://www.mja.com.au/journal/2023/219/3/we-need-chat-about-artificial-intelligence" rel="nofollow" target="_blank">We need to chat about artificial intelligence</a> [Coiera, MJA. 2023] <a href="https://pubmed.ncbi.nlm.nih.gov/33853863/" rel="nofollow" target="_blank">How machine learning is embedded to support clinician decision making: an analysis of FDA-approved medical devices</a> [Coiera, BMJ Health Care Inform. 2021] <a href="https://www.racp.edu.au/pomegranate/view/ep96-the-ergonomics-of-ai" rel="nofollow" target="_blank">Please visit the Pomegranate Health web page</a> for a transcript and supporting references. <a href="https://mycpdweb.racp.edu.au/User/Layout/Activity?Shortcut=Ep96TheergonomicsofAI" rel="nofollow" target="_blank">Login to MyCPD</a> to record listening and reading as a prefilled learning activity. Subscribe to <a href="https://www.racp.edu.au/podcast/subscribe" rel="nofollow" target="_blank">new episode email alerts</a> or search for ‘Pomegranate Health’ in <a href="https://podcasts.apple.com/au/podcast/pomegranate-health/id1022747864" rel="nofollow" target="_blank">Apple Podcasts</a>, <a href="https://open.spotify.com/show/66uzue0DthUrsKzGppPzen" rel="nofollow" target="_blank">Spotify</a>, <a href="https://castbox.fm/channel/3951339" rel="nofollow" target="_blank">Castbox</a>, or <a href="http://subscribeonandroid.com/www.racp.edu.au/feeds/podcasts" rel="nofollow" target="_blank">any podcasting app</a>.

Ep96: The ergonomics of AI

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.

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. Guest Dr Ian Scott FRACP MHA MEd (Director of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital; Professor of Medicine, University of Queensland) Production Produced by Mic Cavazzini DPhil. Music licenced from <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> includes ‘Thyone’ by Ben Elson, ‘Broke No More’ by Cushy, ‘Desert Hideout’ by Christopher Moe Ditlevesen and ‘Alienated’ by ELFL. Music courtesy of <a href="https://freemusicarchive.org/" rel="nofollow" target="_blank">Free Music Archive</a> includes ‘Capgras’ by Ben Carey. <a href="https://www.gettyimages.com.au/detail/photo/artificial-intelligence-digital-concept-abstract-royalty-free-image/1366475366" rel="nofollow" target="_blank">Image by Olemedia</a> 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 <a href="https://pubmed.ncbi.nlm.nih.gov/33462882/" rel="nofollow" target="_blank">Demystifying machine learning: a primer for physicians</a> [Scott, IMJ. 2021] <a href="https://pubmed.ncbi.nlm.nih.gov/33547086/" rel="nofollow" target="_blank">Clinician checklist for assessing suitability of machine learning applications in healthcare</a> [Scott, BMJ Health Care Inform. 2021]<a href="https://www.racp.edu.au/pomegranate/view/ep95-machine-learning-101" rel="nofollow" target="_blank">Please visit the Pomegranate Health web page</a> for a transcript and supporting references. <a href="https://mycpdweb.racp.edu.au/User/Layout/Activity?Shortcut=Ep95MachineLearning101" rel="nofollow" target="_blank">Login to MyCPD</a> to record listening and reading as a prefilled learning activity. Subscribe to <a href="https://www.racp.edu.au/podcast/subscribe" rel="nofollow" target="_blank">new episode email alerts</a> or search for ‘Pomegranate Health’ in <a href="https://podcasts.apple.com/au/podcast/pomegranate-health/id1022747864" rel="nofollow" target="_blank">Apple Podcasts</a>, <a href="https://open.spotify.com/show/66uzue0DthUrsKzGppPzen" rel="nofollow" target="_blank">Spotify</a>, <a href="https://castbox.fm/channel/3951339" rel="nofollow" target="_blank">Castbox</a>, or <a href="http://subscribeonandroid.com/www.racp.edu.au/feeds/podcasts" rel="nofollow" target="_blank">any podcasting app</a>.

Ep95: Machine Learning 101

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.

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. <a href="https://pubmed.ncbi.nlm.nih.gov/36893444/" rel="nofollow" target="_blank">In research from the UK published in March</a> 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.  Guests Wendy Edmondson PhDc (Cultural Advisor, RACP) Dr Kudzai Kanhutu FRACP GAICD MPH (Dean, RACP; Deputy Chief Information Office, Royal Melbourne Hospital) Production Produced by Mic Cavazzini DPhil. Recording assistance from Jon Tjhia in Melbourne and Fiona Croall in Adelaide. Music licenced from <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> includes ‘You break down’ by Czar Donic and ‘Repurposed’ by Cody Francis. Music courtesy of <a href="https://freemusicarchive.org/" rel="nofollow" target="_blank">Free Music Archive</a> includes ‘New Times’ by 4T Thieves and ‘Chasing Shadows’ by Scott Holmes. <a href="https://www.gettyimages.com.au/detail/photo/close-up-of-a-patients-hand-in-a-hospital-bed-royalty-free-image/56959507" rel="nofollow" target="_blank">Image by rubberball</a> 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. <a href="https://www.racp.edu.au/pomegranate/view/ep94-facing-up-to-racial-bias" rel="nofollow" target="_blank">Please visit the Pomegranate Health web page</a> for a transcript and supporting references. <a href="https://mycpdweb.racp.edu.au/User/Layout/Activity?Shortcut=Ep94%3aFacinguptoracialbias" rel="nofollow" target="_blank">Login to MyCPD </a>to record listening and reading as a prefilled learning activity. Subscribe to <a href="https://www.racp.edu.au/podcast/subscribe" rel="nofollow" target="_blank">new episode email alerts</a> or search for ‘Pomegranate Health’ in <a href="https://podcasts.apple.com/au/podcast/pomegranate-health/id1022747864" rel="nofollow" target="_blank">Apple Podcasts</a>, <a href="https://open.spotify.com/show/66uzue0DthUrsKzGppPzen" rel="nofollow" target="_blank">Spotify</a>, <a href="https://castbox.fm/channel/3951339" rel="nofollow" target="_blank">Castbox</a>, or <a href="http://subscribeonandroid.com/www.racp.edu.au/feeds/podcasts" rel="nofollow" target="_blank">any podcasting app</a>.

Ep94: Facing up to racial bias

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.

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.  Guests Dr 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)Production Produced 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 <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> includes ‘Cocktail by Major Tweaks, ‘Broke No More’ by Cushy, ‘Temple of Ruhnha’ by ELFL and ‘Razzamatazz’ by Jules Gaia. Music courtesy of <a href="https://freemusicarchive.org/" rel="nofollow" target="_blank">Free Music Archive</a> includes ‘Out of the Skies, Under the Earth’ by Chris Zabriskie, <a href="https://www.gettyimages.com.au/detail/photo/group-of-people-having-fun-at-music-concert-royalty-free-image/451813203" rel="nofollow" target="_blank">Image by Flashpop</a> licenced from Getty Images. <a href="https://www.racp.edu.au/pomegranate/view/ep93-the-rise-and-fall-of-mpox" rel="nofollow" target="_blank">Please visit the Pomegranate Health web page</a> for a transcript and supporting references. <a href="https://mycpdweb.racp.edu.au/User/Layout/Activity?Shortcut=Ep93:Theriseandfallofmpox " rel="nofollow" target="_blank">Login to MyCPD to</a> record time spent listening and reading supporting materials. Subscribe to <a href="https://www.racp.edu.au/podcast/subscribe" rel="nofollow" target="_blank">new episode email alerts</a> or search for ‘Pomegranate Health’ in <a href="https://podcasts.apple.com/au/podcast/pomegranate-health/id1022747864" rel="nofollow" target="_blank">Apple Podcasts</a>, <a href="https://open.spotify.com/show/66uzue0DthUrsKzGppPzen" rel="nofollow" target="_blank">Spotify</a>, <a href="https://castbox.fm/channel/3951339" rel="nofollow" target="_blank">Castbox</a>, or <a href="http://subscribeonandroid.com/www.racp.edu.au/feeds/podcasts" rel="nofollow" target="_blank">any podcasting app</a>.

Ep93: The rise and fall of mpox

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.

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. Guests Professor Tim Shaw (University of Sydney; Research Director, Digital Health Cooperative Research Centre) Dr David Rankin (Director Clinical Governance and Informatics, Cabrini Health)Production Produced by Mic Cavazzini DPhil. Recording assistance from Jon Tjhia in Melbourne. Music courtesy of <a href="https://freemusicarchive.org/" rel="nofollow" target="_blank">FreeMusicArchive</a> includes ‘Transference’ by Ben Carey. Music licenced from <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> includes ‘Emerlyn’ by Valante. <a href="https://www.gettyimages.com.au/detail/photo/diverse-doctors-studying-results-together-in-office-royalty-free-image/1347994956" rel="nofollow" target="_blank">Image by Courtney Hale</a> licenced from Getty Images.<a href="https://www.racp.edu.au/pomegranate/view/ep92-data-driven-practice-improvement" rel="nofollow" target="_blank">Please visit the Pomegranate Health web page</a> for a transcript and supporting references. <a href="https://mycpdweb.racp.edu.au/User/Layout/Activity?Shortcut=hbmhdk" rel="nofollow" target="_blank">Login to MyCPD</a> to record prefilled learning activity. Subscribe to <a href="https://www.racp.edu.au/podcast/subscribe" rel="nofollow" target="_blank">new episode email alerts</a> or search for ‘Pomegranate Health’ in <a href="https://podcasts.apple.com/au/podcast/pomegranate-health/id1022747864" rel="nofollow" target="_blank">Apple Podcasts</a>, <a href="https://open.spotify.com/show/66uzue0DthUrsKzGppPzen" rel="nofollow" target="_blank">Spotify</a>, <a href="https://castbox.fm/channel/3951339" rel="nofollow" target="_blank">Castbox</a>, or <a href="http://subscribeonandroid.com/www.racp.edu.au/feeds/podcasts" rel="nofollow" target="_blank">any podcasting app</a>.

Ep92: Data-driven practice improvement

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.

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 <a href="https://onlinelibrary.wiley.com/doi/10.1111/imj.15937" rel="nofollow" target="_blank">until researchers in Melbourne retrospectively examined electronic medical records from the two waves of COVID-19 in that city</a>.  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. Guests Associate 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 Reference<ul><li>Rahul D Barmanray <a href="https://onlinelibrary.wiley.com/doi/10.1111/imj.15937" rel="nofollow" target="_blank">Diabetes IN hospital – Glucose and Outcomes in the COVID-19 pandemic (DINGO COVID-19): the 2020 Melbourne hospital experience prior to novel variants and vaccinations</a>Internal Medicine Journal 2021; 53(1)</li><li><a href="https://www.racp.edu.au/fellows/resources/journals" rel="nofollow" target="_blank">Access to IMJ, JPCH and OMJ for RACP members</a></li></ul><a href="https://www.racp.edu.au/podcast" rel="nofollow" target="_blank">Please visit the Pomegranate Health web page</a> for a transcript and supporting references. <a href="https://mycpdweb.racp.edu.au/User/Layout/Activity?Shortcut=lfuiej" rel="nofollow" target="_blank">Login to MyCPD</a> to record prefilled learning activity. Subscribe to <a href="https://www.racp.edu.au/podcast/subscribe" rel="nofollow" target="_blank">new episode email alerts</a> or search for ‘Pomegranate Health’ in <a href="https://podcasts.apple.com/au/podcast/pomegranate-health/id1022747864" rel="nofollow" target="_blank">Apple Podcasts</a>, <a href="https://open.spotify.com/show/66uzue0DthUrsKzGppPzen" rel="nofollow" target="_blank">Spotify</a>, <a href="https://castbox.fm/channel/3951339" rel="nofollow" target="_blank">Castbox</a>, or <a href="http://subscribeonandroid.com/www.racp.edu.au/feeds/podcasts" rel="nofollow" target="_blank">any podcasting app</a>.

[IMJ On-Air] Hyperglycaemia and COVID-19

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 &amp; 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.

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. <a href="https://pubmed.ncbi.nlm.nih.gov/36114610/" rel="nofollow" target="_blank">In the December edition of the Internal Medicine Journal</a> 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.  Guests Professor James O’Beirne FRCP FRACP (Director of Gastroenterology &amp; Hepatology, Sunshine Coast Hospital and Health Service; University of the Sunshine Coast) Dr Karl Vaz FRACP (Victorian Liver Transplant Unit, Austin Hospital) Key Reference<ul><li>Karl Vaz et al. <a href="https://pubmed.ncbi.nlm.nih.gov/36114610/" rel="nofollow" target="_blank">Rate of early hospital readmission amongst cirrhotic patients is high in Australia: experience from a single liver transplant centre</a> Internal Medicine Journl 2021; 52(12)</li><li><a href="https://www.racp.edu.au/fellows/resources/journals" rel="nofollow" target="_blank">Free access to IMJ for members of the RACP</a></li></ul><a href="https://www.racp.edu.au/podcast" rel="nofollow" target="_blank">Please visit the Pomegranate Health web page</a> for a transcript and supporting references. To claim learning credits <a href="https://mycpdweb.racp.edu.au/User/Layout/Activity?Shortcut=HighReadmissionRatesInCirrhoticPatients" rel="nofollow" target="_blank">login to MyCPD</a>. Subscribe to <a href="https://www.racp.edu.au/podcast/subscribe" rel="nofollow" target="_blank">new episode email alerts</a> or search for ‘Pomegranate Health’ in <a href="https://podcasts.apple.com/au/podcast/pomegranate-health/id1022747864" rel="nofollow" target="_blank">Apple Podcasts</a>, <a href="https://open.spotify.com/show/66uzue0DthUrsKzGppPzen" rel="nofollow" target="_blank">Spotify</a>, <a href="https://castbox.fm/channel/3951339" rel="nofollow" target="_blank">Castbox</a>, or <a href="http://subscribeonandroid.com/www.racp.edu.au/feeds/podcasts" rel="nofollow" target="_blank">any podcasting app</a>.

[IMJ On-Air] High readmission rates in cirrhotic patients

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.

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. Guests Professor 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) Production <a href="https://www.supportstvincents.com.au/" rel="nofollow" target="_blank">Recorded at St Vincent’s Hospital for the Curran Foundation</a>.  Post-production by Mic Cavazzini DPhil. Music licenced from <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> includes ‘Tree Tops’ and ‘Yellow Lead’ by Autohacker and ‘Thyone’ and ‘Orthosie’ by Ben Elson. <a href="https://www.gettyimages.com.au/detail/illustration/human-head-mri-dot-matrix-artwork-royalty-free-illustration/185759196" rel="nofollow" target="_blank">Image by PASIEKA</a> licenced from Getty Images.<a href="https://www.racp.edu.au/pomegranate/view/ep89-what-we-know-about-long-covid" rel="nofollow" target="_blank">Please visit the Pomegranate Health web page</a> for a transcript and supporting references. To claim learning credits <a href="https://mycpdweb.racp.edu.au/User/Layout/Activity?Shortcut=Ep89-WhatweknowaboutlongCOVID" rel="nofollow" target="_blank">login to MyCPD at this link</a>, review the prefilled activity details then click save. Subscribe to <a href="https://www.racp.edu.au/podcast/subscribe" rel="nofollow" target="_blank">new episode email alerts</a> or search for ‘Pomegranate Health’ in <a href="https://podcasts.apple.com/au/podcast/pomegranate-health/id1022747864" rel="nofollow" target="_blank">Apple Podcasts</a>, <a href="https://open.spotify.com/show/66uzue0DthUrsKzGppPzen" rel="nofollow" target="_blank">Spotify</a>, <a href="https://castbox.fm/channel/3951339" rel="nofollow" target="_blank">Castbox</a>, or <a href="http://subscribeonandroid.com/www.racp.edu.au/feeds/podcasts" rel="nofollow" target="_blank">any podcasting app</a>.

Ep89: What we know about long COVID

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. Find out more at the website of www.racp.edu.au/podcast. Get in touch via podcast@racp.edu.au

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. Find out more at the website of <a href="http://www.racp.edu.au/podcast" rel="nofollow" target="_blank">www.racp.edu.au/podcast</a>. Get in touch via podcast@racp.edu.au

Pomegranate Health

Everyone knows that adolescence is a turbulent time. Teens are faced not just with changes to their bodies, but to their moods and thought patterns as well. They might also be saying goodbye to familiar carers in the paediatric department, and in Episode 11 we heard how important it is to ensure a smooth transition to adult services, which tend to be more anonymous.This is especially true for young people with special needs such as diabetes, transplant management or intellectual disability, though they are the least likely to received dedicated transition support. The three speakers in this podcast explain that improving this transition process doesn't require going way above and beyond regular practice, it just needs a little more coordination. They were recorded at the 2019 RACP Congress. First, Dr Fran Mouat outlined Starship's transition program for young patients with diabetes, and some of the data showing its impact on glycaemic control after they've left paediatric care. Dr Rachael Harry leads a transition program for adolescents who'd undergone transplants early in life. With a moving case study, she described how all the medical care in the world needs to fit in with the lifestyle that every young adult aspires toFinally, Dr Colette Muir, described what this period is like for adolescents with developmental disabilities. Intellectual disability is associated with a lower quality of care throughout the lifespan, often because of “diagnostic overshadowing”—the phenomenon by which the complaints of such patients get attributed to the disability itself, rather than being investigated thoroughly in their own right. The RACP is a signatory to an international consensus statement called Equally Well, and has also published a position paper about transition of young people with chronic disability needs. Guests Dr Fran Mouat FRACP (Starship Children's Hospital, Auckland, Co-Chair of National Clinical Network for Intersex Disorders) Dr Rachael Harry FRACP (New Zealand Liver Transplant Unit, Auckland) Dr Collette Muir FRACP (Starship Children's Hospital, Auckland, New Zealand)Production Produced by Mic Cavazzini. Recording assistance in Auckland from Little Kong Productions. Music licensed from Epidemic Sound; 'Earthbound 3 by Joachim Nilsson; A Winter's Tale' by Magnus Ringblom; 'I Am Here Now' by Gunnar Johnsén. Image courtesy of Getty Images.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Everyone knows that adolescence is a turbulent time. Teens are faced not just with changes to their bodies, but to their moods and thought patterns as well. They might also be saying goodbye to familiar carers in the paediatric department, and in <a href="https://www.racp.edu.au/pomegranate/view/episode-11-adolescent-health-adds-up" rel="nofollow" target="_blank">Episode 11</a> we heard how important it is to ensure a smooth transition to adult services, which tend to be more anonymous.This is especially true for young people with special needs such as diabetes, transplant management or intellectual disability, though they are the least likely to received dedicated transition support. The three speakers in this podcast explain that improving this transition process doesn't require going way above and beyond regular practice, it just needs a little more coordination. They were recorded at the 2019 RACP Congress. First, Dr Fran Mouat outlined Starship's transition program for young patients with diabetes, and some of the data showing its impact on glycaemic control after they've left paediatric care. Dr Rachael Harry leads a transition program for adolescents who'd undergone transplants early in life. With a moving case study, she described how all the medical care in the world needs to fit in with the lifestyle that every young adult aspires toFinally, Dr Colette Muir, described what this period is like for adolescents with developmental disabilities. Intellectual disability is associated with a lower quality of care throughout the lifespan, often because of “diagnostic overshadowing”—the phenomenon by which the complaints of such patients get attributed to the disability itself, rather than being investigated thoroughly in their own right. The RACP is a signatory to an international consensus statement called <a href="https://www.equallywell.org.au/" rel="nofollow" target="_blank">Equally Well</a>, and has also published a position paper about <a href="https://www.racp.edu.au/docs/default-source/advocacy-library/transition-of-young-people-with-complex-and-chronic-disability-needs.pdf" rel="nofollow" target="_blank">transition of young people with chronic disability needs</a>. Guests Dr Fran Mouat FRACP (Starship Children's Hospital, Auckland, Co-Chair of National Clinical Network for Intersex Disorders) Dr Rachael Harry FRACP (New Zealand Liver Transplant Unit, Auckland) Dr Collette Muir FRACP (Starship Children's Hospital, Auckland, New Zealand)Production Produced by Mic Cavazzini. Recording assistance in Auckland from <a href="http://www.littlekongproductions.com/" rel="nofollow" target="_blank">Little Kong Productions</a>. Music licensed from <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a>; 'Earthbound 3 by Joachim Nilsson; A Winter's Tale' by Magnus Ringblom; 'I Am Here Now' by Gunnar Johnsén. Image courtesy of <a href="https://www.gettyimages.com.au/detail/photo/group-of-friends-running-into-the-water-royalty-free-image/480272808?adppopup=true" rel="nofollow" target="_blank">Getty Images</a>.<a href="https://www.racp.edu.au/pomegranate/view/ep47-complex-adolescent-transitions" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2047%3A%20%27Adolescent%20Transition%27" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep47: Complex Adolescent Transitions—Congress 2019

Misdiagnosis or delayed diagnosis occurs in 10-15 per cent of acute presentations, although fortunately only a tenth of these lead to serious consequences. But of concern is the fact that this figure hasn't changed in three decades, despite progress in clinical knowledge. Errors in diagnostic reasoning occur at the same rate in senior clinicians as they do in juniors, even though mistakes from poor examination or knowledge become less frequent as one gains experience. Compared to problems in maths or physics, diagnostic problems are thought of as ill-structured: because information isn't readily available, the problem can keep changing and often you're not certain you've reached a solution and are free to stop searching. Cognitive errors result from jumping to conclusions on the basis of intuition and incomplete information. There are a hundred different types of such bias. On this episode, the most common types will be discussed, as well as strategies to force a more considered process of diagnostic reasoning. In about two thirds of cases, systems problems like design and workflow contribute to diagnostic error. These will be discussed in the second episode of this series. Guests Dr Nicolas Szecket FRACP (Auckland City Hospital) Dr Arthur Nahill FRACP (Auckland City Hospital). Production Written and produced by Mic Cavazzini. Music courtesy of Mystery Mammal ('To be Decided,' 'Data'), RGIS VICTOR ('Lampagisto') and Lobo Loco ('Spook Castle'). Image courtesy of iStock. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP members Dr Paul Jauncey, Dr Alan Ngo, Dr Katrina Gibson. Dr Marion Leighton, Dr Michael Herd and Dr Joseph Lee. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Misdiagnosis or delayed diagnosis occurs in 10-15 per cent of acute presentations, although fortunately only a tenth of these lead to serious consequences. But of concern is the fact that this figure hasn't changed in three decades, despite progress in clinical knowledge. Errors in diagnostic reasoning <a href="https://www.ncbi.nlm.nih.gov/pubmed/2375637" rel="nofollow" target="_blank">occur at the same rate</a> in senior clinicians as they do in juniors, even though mistakes from poor examination or knowledge become less frequent as one gains experience. Compared to problems in maths or physics, diagnostic problems are thought of as ill-structured: because information isn't readily available, the problem can keep changing and often you're not certain you've reached a solution and are free to stop searching. Cognitive errors result from jumping to conclusions on the basis of intuition and incomplete information. There are a hundred different types of such bias. On this episode, the most common types will be discussed, as well as strategies to force a more considered process of diagnostic reasoning. In about two thirds of cases, <a href="https://www.ncbi.nlm.nih.gov/pubmed/16009864" rel="nofollow" target="_blank">systems problems like design and workflow</a> contribute to diagnostic error. These will be discussed in the second episode of this series. Guests Dr Nicolas Szecket FRACP (Auckland City Hospital) Dr Arthur Nahill FRACP (Auckland City Hospital). Production Written and produced by Mic Cavazzini. Music courtesy of <a href="http://freemusicarchive.org/music/mystery_mammal" rel="nofollow" target="_blank">Mystery Mammal</a> ('To be Decided,' 'Data'), <a href="http://freemusicarchive.org/music/rgis_victor" rel="nofollow" target="_blank">RGIS VICTOR</a> ('Lampagisto') and <a href="http://freemusicarchive.org/music/lobo_loco" rel="nofollow" target="_blank">Lobo Loco</a> ('Spook Castle'). Image courtesy of <a href="https://www.istockphoto.com/au/photo/vintage-bulbs-gm467647718-60488462" rel="nofollow" target="_blank">iStock</a>. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP members Dr Paul Jauncey, Dr Alan Ngo, Dr Katrina Gibson. Dr Marion Leighton, Dr Michael Herd and Dr Joseph Lee. <a href="https://www.racp.edu.au/pomegranate/view/ep32-diagnostic-error-1" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20%27Diagnostic%20Reasoning%201%3A%20Cognitive%20Error%27%20and%20further%20reading" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep32: Diagnostic Error Part 1—Cognitive Bias

This episode was recorded at the 2019 RACP Congress in Auckland and deals with the profound influence that the first 1000 days of life have on lifelong health, wellbeing, behaviour and socioeconomic outcomes.Professor Richie Poulton outlined the influential Dunedin Multidisciplinary Health and Development Study, which has followed over 1037 participants since 1972. All sorts of measures have been taken throughout the participants' lives, but Dr Poulton showed the incredible predictive power of one behavioural trait in particular: self-control.Paediatrician Dr Johan Morreau revealed how such associations between childhood deprivation and behavioural outcomes might be explained by developmental neuroscience. And finally, public health physician Professor Susan Morton showed some evidence from the Growing Up in New Zealand Study which reveals the importance of social factors in protecting against poor outcomes.Together, these speakers demonstrated that the consequences of childhood disadvantage are borne not just by individuals and families but by all of society. The lectures were framed by the launch of an RACP position statement on early childhood titled "The Importance of the Early Years" and another released last year on "Inequities in Child Health".Guests Professor Richie Poulton CNZM FRSNZ (Dunedin Multidisciplinary Health and Development Research Unit, Chief Science Advisor to the NZ Ministry of Social Development) Dr Johan Morreau FRACP (Lakes District DHB, Brainwave Trust) Professor Susan Morton FAFPHM (Director University of Auckland cross-faculty Centre for Longitudinal Research)Production Produced by Mic Cavazzini. Recording assistance in Auckland from Little Kong Productions. Music licensed from Epidemic Sound; 'Earthbound 3' by Joachim Nilsson; 'A Winter's Tale' by Magnus Ringblom; 'I Am Here Now' by Gunnar Johnsén. Image courtesy of Getty Images.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

This episode was recorded at the 2019 RACP Congress in Auckland and deals with the profound influence that the first 1000 days of life have on lifelong health, wellbeing, behaviour and socioeconomic outcomes. Professor Richie Poulton outlined the influential Dunedin Multidisciplinary Health and Development Study, which has followed over 1037 participants since 1972. All sorts of measures have been taken throughout the participants' lives, but Dr Poulton showed the incredible predictive power of one behavioural trait in particular: self-control. Paediatrician Dr Johan Morreau revealed how such associations between childhood deprivation and behavioural outcomes might be explained by developmental neuroscience. And finally, public health physician Professor Susan Morton showed some evidence from the <a href="http://www.growingup.co.nz/en.html" rel="nofollow" target="_blank">Growing Up in New Zealand Study</a> which reveals the importance of social factors in protecting against poor outcomes. Together, these speakers demonstrated that the consequences of childhood disadvantage are borne not just by individuals and families but by all of society. The lectures were framed by the launch of an RACP position statement on early childhood titled "<a href="https://www.racp.edu.au/docs/default-source/advocacy-library/early-childhood-importance-of-early-years-position-statement.pdf?sfvrsn=e54191a_4" rel="nofollow" target="_blank">The Importance of the Early Years</a>" and another released last year on "<a href="https://www.racp.edu.au/advocacy/policy-and-advocacy-priorities/inequities-in-child-health" rel="nofollow" target="_blank">Inequities in Child Health</a>". Guests Professor Richie Poulton CNZM FRSNZ (Dunedin Multidisciplinary Health and Development Research Unit, Chief Science Advisor to the NZ Ministry of Social Development) Dr Johan Morreau FRACP (Lakes District DHB, Brainwave Trust) Professor Susan Morton FAFPHM (Director University of Auckland cross-faculty Centre for Longitudinal Research) Production Produced by Mic Cavazzini. Recording assistance in Auckland from <a href="http://www.littlekongproductions.com/" rel="nofollow" target="_blank">Little Kong Productions</a>. Music licensed from <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a>; 'Earthbound 3' by Joachim Nilsson; 'A Winter's Tale' by Magnus Ringblom; 'I Am Here Now' by Gunnar Johnsén. Image courtesy of <a href="https://www.gettyimages.com.au/detail/photo/mother-holding-her-baby-girl-at-home-royalty-free-image/923027724?adppopup=true" rel="nofollow" target="_blank">Getty Images</a>. <a href="https://www.racp.edu.au/pomegranate/view/ep46-the-first-1000-days" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2046%3A%20%27The%20First%201000%20Days%27" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep46: The First 1000 Days—Congress 2019

Australia and NZ are made up of sprawling cities and far-flung towns, and driving is often viewed as a fundamental freedom. It can be hard for clinicians to challenge that freedom with patients who they consider unfit to drive safely. And harder still to deal with the consequences if a patient does have a crash.Clinicians are drawn into the question of driving fitness in two main ways. The more clearcut is when a patient presents with a medical assessment form. It's the Driver Licencing Authority in each state which ultimately issues the driving permits and may require the recommendation of a medical professional.The other way in which health professionals become involved is when they detect a new or worsening condition in a patient who is already licenced. Clinicians are expected to warn their patients off driving, and to potentially report them to the DLA if this advice isn't being heeded. There are diagnoses that should raise red flags for clinicians of all stripes. In this podcast we speak to a GP, a neurologist and an occupational therapist about how to discuss cessation from driving with patients, and where responsibilities lie in reporting to the Driver Licencing Authority.Guests Dr Genevieve Yates FRACGP (Principal Medical Educator RACGP, MDA National's Education Services Advisory Group, Black Dog Institute) Prof Roy Beran FRCP FAFPHM FRACP FRACGP FACLM (UNSW, Griffith University, Liverpool Hospital)  Dr Marilyn Di Stefano (Senior Policy Officer VicRoads, La Trobe University) Serge Zandegu (Manager of VicRoads Medical Review)Production Written and produced by Mic Cavazzini. Recording assistance in Melbourne from Sam Loy of Human/Ordinary. Music courtesy of Free Music Archive; 'John Stockton Slow Drag' and 'What True Self? Feels Bogus, Let's Watch Jason X' by Chris Zabriskie, 'Noir' by Daniel James Dolby, 'Hélice' by Monplaisir,. Image courtesy of iStock.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Australia and NZ are made up of sprawling cities and far-flung towns, and driving is often viewed as a fundamental freedom. It can be hard for clinicians to challenge that freedom with patients who they consider unfit to drive safely. And harder still to deal with the consequences if a patient does have a crash.Clinicians are drawn into the question of driving fitness in two main ways. The more clearcut is when a patient presents with a medical assessment form. It's the Driver Licencing Authority in each state which ultimately issues the driving permits and may require the recommendation of a medical professional.The other way in which health professionals become involved is when they detect a new or worsening condition in a patient who is already licenced. Clinicians are expected to warn their patients off driving, and to potentially report them to the DLA if this advice isn't being heeded. There are diagnoses that should raise red flags for clinicians of all stripes. In this podcast we speak to a GP, a neurologist and an occupational therapist about how to discuss cessation from driving with patients, and where responsibilities lie in reporting to the Driver Licencing Authority.Guests Dr Genevieve Yates FRACGP (Principal Medical Educator RACGP, MDA National's Education Services Advisory Group, Black Dog Institute) Prof Roy Beran FRCP FAFPHM FRACP FRACGP FACLM (UNSW, Griffith University, Liverpool Hospital)  Dr Marilyn Di Stefano (Senior Policy Officer VicRoads, La Trobe University) Serge Zandegu (Manager of VicRoads Medical Review)Production Written and produced by Mic Cavazzini. Recording assistance in Melbourne from Sam Loy of <a href="http://humanordinary.com/" rel="nofollow" target="_blank">Human/Ordinary</a>. Music courtesy of Free Music Archive; 'John Stockton Slow Drag' and 'What True Self? Feels Bogus, Let's Watch Jason X' by <a href="http://freemusicarchive.org/music/Chris_Zabriskie/" rel="nofollow" target="_blank">Chris Zabriskie</a>, 'Noir' by Daniel James Dolby, 'Hélice' by <a href="http://freemusicarchive.org/music/Monplaisir/" rel="nofollow" target="_blank">Monplaisir</a>,. Image courtesy of <a href="https://www.istockphoto.com/au/photo/car-window-smashed-close-up-gm175381217-20205058" rel="nofollow" target="_blank">iStock</a>. <a href="https://www.racp.edu.au/pomegranate/view/ep45-medical-fitness-to-drive" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2045%3A%20%27Fitness%20to%20Drive%27" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep45: Medical Fitness to Drive

In Episode 32  we discussed cognitive error in diagnostic reasoning. On this episode, we take a look at systems pressures that increase the likelihood of medical error, crystallised by the recent prosecution of NHS paediatrician Dr Hadiza Bawa-Garba. Almost half of diagnostic errors are due to a combination of systems errors and individual cognitive error. Obvious systems effects come into play in understaffed acute care units; if a clinician is forced to see too many patients without enough time to make careful examinations or reasoned decisions, errors become more likely. The stepping stones of ordering, receiving and reviewing diagnostic tests and scans also allow much opportunity for error and delay. Guests on this episode discuss mechanisms to improve efficiencyObvious systems effects come into play in understaffed acute care units. If a clinician is forced to see too many patients without enough time to make careful examinations or reasoned decisions, errors become more likely. And of course, long hours and fatigue will only reduce cognitive capacity. Hospital systems also include the stepping stones of ordering, receiving and reviewing diagnostic tests and scans. Missteps and delays in this cascade contribute to a large proportion of diagnostic errors. Guests on this episode discuss mechanisms to improve efficiency.Another important step in improving health systems is capturing and reporting error rates accurately. If clinical error is wrapped in culture of blame and punishment, it will make such disclosure more difficult. This concern has been raised in response to the recent prosecution of U.K. National Health Service (NHS) paediatrician Dr Hadiza Bawa-Garba, who had her licence to practice medicine revoked for her role in the death of a young patient. Six-year old Jack Adcock died on a chaotic day in 2011 at the Leicester Royal Infirmary that involved delays in the diagnosis and treatment of his sepsis. Today’s episode examines how widespread systems errors contributed to such mistakes.Guests Professor Jeffrey Braithwaite FAIM, FACHSM, FAHMS, FFPH-RCP, FAcSS, Hon FRACMA (Australian Institute for Health Innovation, Macquarie University) Associate Professor Ian Scott FRACP (Director, Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, University of Queensland) Associate Professor David Heslop FRACGP (University of New South WalProduction Written and produced by Mic Cavazzini. Additional audio recording from James Milson and Jennifer Leake. Music courtesy of Kai Engel ('Memories'), Jahzarr ('Become Death'), Sergey Cheremisinov ('Now You Are Here') and Loch Lomond ('Violins and Tea'). Image courtesy of Max Pixel. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Phillipa Wormald, Katrina Gibson, Rosalynn Pszczola, Andrea Knox, Philip Gaughwin, Rhiannon Mellor and Richard Doherty. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  &lt;

In Episode 32  we discussed cognitive error in diagnostic reasoning. On this episode, we take a look at systems pressures that increase the likelihood of medical error, crystallised by the recent prosecution of NHS paediatrician Dr Hadiza Bawa-Garba. Almost half of diagnostic errors are due to a combination of systems errors and individual cognitive error. Obvious systems effects come into play in understaffed acute care units; if a clinician is forced to see too many patients without enough time to make careful examinations or reasoned decisions, errors become more likely. The stepping stones of ordering, receiving and reviewing diagnostic tests and scans also allow much opportunity for error and delay. Guests on this episode discuss mechanisms to improve efficiencyObvious systems effects come into play in understaffed acute care units. If a clinician is forced to see too many patients without enough time to make careful examinations or reasoned decisions, errors become more likely. And of course, long hours and fatigue will only reduce cognitive capacity. Hospital systems also include the stepping stones of ordering, receiving and reviewing diagnostic tests and scans. Missteps and delays in this cascade <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108559?resultClick=1" rel="nofollow" target="_blank">contribute to a large proportion of diagnostic errors</a>. Guests on this episode discuss mechanisms to improve efficiency.Another important step in improving health systems is capturing and reporting error rates accurately. If clinical error is wrapped in culture of blame and punishment, it will make such disclosure more difficult. This concern has been raised in response to the recent prosecution of U.K. National Health Service (NHS) paediatrician Dr Hadiza Bawa-Garba, who had her licence to practice medicine revoked for her role in the death of a young patient. Six-year old Jack Adcock died on a chaotic day in 2011 at the Leicester Royal Infirmary that involved delays in the diagnosis and treatment of his sepsis. Today’s episode examines how widespread systems errors contributed to such mistakes.Guests Professor Jeffrey Braithwaite FAIM, FACHSM, FAHMS, FFPH-RCP, FAcSS, Hon FRACMA (Australian Institute for Health Innovation, Macquarie University) Associate Professor Ian Scott FRACP (Director, Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, University of Queensland) Associate Professor David Heslop FRACGP (University of New South WalProduction Written and produced by Mic Cavazzini. Additional audio recording from <a href="http://www.tricksy.xyz/" rel="nofollow" target="_blank">James Milson</a> and Jennifer Leake. Music courtesy of <a href="http://freemusicarchive.org/music/kai-engel" rel="nofollow" target="_blank">Kai Engel</a> ('Memories'), <a href="http://freemusicarchive.org/music/Jahzzar/" rel="nofollow" target="_blank">Jahzarr</a> ('Become Death'), <a href="http://freemusicarchive.org/music/sergey_cheremisinov" rel="nofollow" target="_blank">Sergey Cheremisinov</a> ('Now You Are Here') and <a href="http://freemusicarchive.org/music/loch_lomond" rel="nofollow" target="_blank">Loch Lomond</a> ('Violins and Tea'). Image courtesy of <a href="http://maxpixel.freegreatpicture.com/Pattern-Texture-Geometry-Design-Maths-Grid-871475" rel="nofollow" target="_blank">Max Pixel</a>. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Phillipa Wormald, Katrina Gibson, Rosalynn Pszczola, Andrea Knox, Philip Gaughwin, Rhiannon Mellor and Richard Doherty. <a href="https://www.racp.edu.au/pomegranate/view/ep34-diagnostic-error-2" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2034%20%27Diagnostic%20Reasoning%20Part%202%20%2D%20Systems%20Error%27" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.   &lt;

Ep34: Diagnostic Error Part 2—Systems

Chest pain and other symptoms suggestive of ACS make up the majority of presentations to hospital. 11 to 17 per cent of patients presenting to ED with such symptoms end up having the diagnosis confirmed. But follow-up studies of discharged patients show that up to six per cent of diagnoses are missed, and inappropriately discharged patients have a twofold higher mortality rate than those who are admitted.The 2016 guidelines of the Cardiac Society of Australia and New Zealand were developed to guide the rapid differentiation of patients presenting with suspected ACS. ACS takes in STEMI and non-STEMI heart attacks, and also unstable angina. This episode outlines the investigations used to distinguish these and other differential diagnoses associated with chest pain. First, electrocardiogram recordings are used to identify the occurrence of a myocardial infarction with ST segment elevation. If STEMI is discounted, the next most important step is to rule out other life-threatening causes of chest pain. Third in the diagnostic hierarchy is to establish whether there has been myocardial infarction without ST elevation, or unstable angina. This is where high sensitivity troponin markers become useful, and can feed into stratification protocols for assessing the risk of patients suffering future acute cardiac events.Guest Associate Professor Louise Cullen FACEM (Royal Brisbane and Women's Hospital, University of QueenslandProduction Written and produced by Mic Cavazzini. Additional audio recording from Michelle Ransom-Hughes. Music courtesy of Jason Shaw ('Minstrel, Pioneers'), Lee Rosevere ('Become Death'), Sergey Cheremisinov ('Pulsar') and Loch Lomond ('Listen, Lisbon'). Image courtesy of Science Photo Libary. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP members Paul Jauncey, Pavan Chandrala, Rebecca Grainger, Phillip Gaughwin, Rhiannon Mellor, Alan Ngo, and Mahesh Dhakal. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Chest pain and other symptoms suggestive of ACS make up the majority of presentations to hospital. <a href="https://www.mja.com.au/journal/2015/202/8/cost-and-outcomes-assessing-patients-chest-pain-australian-emergency-department" rel="nofollow" target="_blank">11</a> to <a href="http://www.nejm.org/doi/full/10.1056/NEJM200004203421603" rel="nofollow" target="_blank">17</a> per cent of patients presenting to ED with such symptoms end up having the diagnosis confirmed. But follow-up studies of discharged patients show that up to six per cent of diagnoses <a href="https://www.bmj.com/content/320/7251/1702" rel="nofollow" target="_blank">are missed</a>, and inappropriately discharged patients have a <a href="http://www.nejm.org/doi/full/10.1056/NEJM200004203421603" rel="nofollow" target="_blank">twofold higher mortality rate</a> than those who are admitted.The <a href="https://www.heartlungcirc.org/article/S1443-9506(16)31061-7/fulltext" rel="nofollow" target="_blank">2016 guidelines</a> of the Cardiac Society of Australia and New Zealand were developed to guide the rapid differentiation of patients presenting with suspected ACS. ACS takes in STEMI and non-STEMI heart attacks, and also unstable angina. This episode outlines the investigations used to distinguish these and other differential diagnoses associated with chest pain. First, electrocardiogram recordings are used to identify the occurrence of a myocardial infarction with ST segment elevation. If STEMI is discounted, the next most important step is to rule out other life-threatening causes of chest pain. Third in the diagnostic hierarchy is to establish whether there has been myocardial infarction without ST elevation, or unstable angina. This is where high sensitivity troponin markers become useful, and can feed into stratification protocols for assessing the risk of patients suffering future acute cardiac events.Guest Associate Professor Louise Cullen FACEM (Royal Brisbane and Women's Hospital, University of QueenslandProduction Written and produced by Mic Cavazzini. Additional audio recording from Michelle Ransom-Hughes. Music courtesy of <a href="http://freemusicarchive.org/music/jason-shaw" rel="nofollow" target="_blank">Jason Shaw</a> ('Minstrel, Pioneers'), <a href="http://freemusicarchive.org/music/Lee_Rosevere/" rel="nofollow" target="_blank">Lee Rosevere</a> ('Become Death'), <a href="http://freemusicarchive.org/music/sergey_cheremisinov" rel="nofollow" target="_blank">Sergey Cheremisinov</a> ('Pulsar') and <a href="http://freemusicarchive.org/music/loch_lomond" rel="nofollow" target="_blank">Loch Lomond</a> ('Listen, Lisbon'). Image courtesy of <a href="https://www.sciencephoto.com/media/304212/view" rel="nofollow" target="_blank">Science Photo Libary</a>. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP members Paul Jauncey, Pavan Chandrala, Rebecca Grainger, Phillip Gaughwin, Rhiannon Mellor, Alan Ngo, and Mahesh Dhakal. <a href="https://www.racp.edu.au/pomegranate/view/ep35-acute-coronary-syndrome-part1" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Acute%20Coronary%20Syndrome%20Part%201%20%2D%20Diagnosis" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep35: Acute Coronary Syndrome Part 1—Diagnosis

An empathic connection and good communication between physician and patient can promote better outcomes. In this episode of Pomegranate Health, U.S. physician A/Prof Danielle Ofri discusses where breakdowns in doctor-patient communication occur—often in the first 10 or 20 seconds of a consultation. Dr Ofri, author of What Patients Say, What Doctors Hear, suggests ways for physicians to listen better, to be understood and promote adherence.Some media also report a 'crisis of compassion' in healthcare. Burnout of staff is a major contributor, and palliative care physician Dr Shamsul Shah describes how to mitigate it by convening groups to reflect on the emotional challenges of the job. She recently published an evaluation of Schwartz Center Rounds® (case-based reflections) run at Auckland City Hospital in the College's Internal Medicine Journal.Guests A/Professor Danielle Ofri MD PhD (Bellevue Hospital, New York; New York University School of Medicine) Dr Shamsul Shah FRACP (Auckland City Hospital)Production Written and produced by Mic Cavazzini. Music courtesy of Blue Dot Sessions ('Periodicals'), Sergey Cheremisinov ('Old Ally', 'Tavern'), and Loch Lomond ('A String- Instrumental'). Image property of RACP. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Philip Gaughwin, Michael Herd, Andrea Knox, Paul Jauncey, Rebecca Grainger, Joseph Lee, Rachel Williams, Mahesh Dhakal, and Katrina Gibson. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

An empathic connection and good communication between physician and patient can promote better outcomes. In this episode of Pomegranate Health, U.S. physician A/Prof Danielle Ofri discusses where breakdowns in doctor-patient communication occur—often in the first <a href="http://www.stfm.org/FamilyMedicine/Vol33Issue7/Rhoades528" rel="nofollow" target="_blank">10 or 20 seconds of a consultation</a>. Dr Ofri, author of What Patients Say, What Doctors Hear, suggests ways for physicians to listen better, to be understood and promote adherence.Some media also report a 'crisis of compassion' in healthcare. Burnout of staff is a major contributor, and palliative care physician Dr Shamsul Shah describes how to mitigate it by convening groups to reflect on the emotional challenges of the job. She recently published an evaluation of Schwartz Center Rounds® (case-based reflections) run at Auckland City Hospital in the College's <a href="https://onlinelibrary.wiley.com/doi/10.1111/imj.13420" rel="nofollow" target="_blank">Internal Medicine Journal</a>.Guests A/Professor Danielle Ofri MD PhD (Bellevue Hospital, New York; New York University School of Medicine) Dr Shamsul Shah FRACP (Auckland City Hospital)Production Written and produced by Mic Cavazzini. Music courtesy of <a href="http://freemusicarchive.org/music/Blue_Dot_Sessions/" rel="nofollow" target="_blank">Blue Dot Sessions</a> ('Periodicals'), <a href="http://freemusicarchive.org/music/Sergey_Cheremisinov/" rel="nofollow" target="_blank">Sergey Cheremisinov</a> ('Old Ally', 'Tavern'), and <a href="http://freemusicarchive.org/music/Loch_Lomond" rel="nofollow" target="_blank">Loch Lomond</a> ('A String- Instrumental'). Image property of RACP. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Philip Gaughwin, Michael Herd, Andrea Knox, Paul Jauncey, Rebecca Grainger, Joseph Lee, Rachel Williams, Mahesh Dhakal, and Katrina Gibson. <a href="https://www.racp.edu.au/pomegranate/view/ep38-making-a-connection" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2038%20%27Making%20a%20Connection%27" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep38: Making a Connection

'Ngā Kaitiaki Hauora' translates as 'guardians of health'. This podcast emerged from a meeting near Auckland organised by the RACP's Māori Health Committee in November 2017. Members of various medical colleges and institutions came together to share perspectives on the delivery of health care to New Zealand's population of Māori and Pacific Islander people. This conversation comes in the context of the Wai 262 claim, which is forcing a re-examination of the Crown's obligations to the Māori population under the Waitangi Treaty of 1840.On this episode, Reverend Hirini Kaa proposes that all institutions of civil society must be committed to recognising Indigenous sovereignty not just over land, but also the natural environment, the language, and cultural practices. GP Dr Peter Jansen and oncologist Dr George Laking describe the variation in medical care that Māori and Pacific Islander patients receive on a day to day basis, and how this can emerge in part through cultural 'mismatches'. And public health physician Dr Elana Curtis describes the successes and future targets of streaming Māori and Pacific Islander students into medical school.Guests Dr Peter Jansen FNZCGP FRACMA (Ngāti Raukawa, Mauri Ora Associates, Accident Compensation Corporation) Dr George Laking FRACP (Te Whakatōhea, Auckland City Hospital) Dr Elana Curtis AFPHM (Ngāti Rongomai, Ngāti Pikiao, University of Auckland) Rev Hirini Kaa (Ngāti Porou, Ngati Kahungunu, University of Auckland) Mr Chayce Glass (Tumuaki, University of Otago). Commemoration to Matua Leo Buchanan given by Dr Tuwhakairiora Williams.Production Written and produced by Mic Cavazzini. Music courtesy of Jason Shaw ('Autumn Sunset'), Doctor Turtle ('Making a Change') and Broke For Free ('Feel Good Instrumental'). Image of the Te Whare Tapa Whā health model by Sir Mason Durie, provided courtesy of NZ Ministry of Health: Manatū Hauora. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Dr Katrina Gibson and Dr George Laking and RACP staff Ms Harriet Wild, Ms Nicola Fowler, and Dr Cristiana Palmieri.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.   

'Ngā Kaitiaki Hauora' translates as 'guardians of health'. This podcast emerged from a meeting near Auckland organised by the RACP's Māori Health Committee in November 2017. Members of various medical colleges and institutions came together to share perspectives on the delivery of health care to New Zealand's population of Māori and Pacific Islander people. This conversation comes in the context of the Wai 262 claim, which is forcing a re-examination of the Crown's obligations to the Māori population under the Waitangi Treaty of 1840.On this episode, Reverend Hirini Kaa proposes that all institutions of civil society must be committed to recognising Indigenous sovereignty not just over land, but also the natural environment, the language, and cultural practices. GP Dr Peter Jansen and oncologist Dr George Laking describe the variation in medical care that Māori and Pacific Islander patients receive on a day to day basis, and how this can emerge in part through cultural 'mismatches'. And public health physician Dr Elana Curtis describes the successes and future targets of streaming Māori and Pacific Islander students into medical school.Guests Dr Peter Jansen FNZCGP FRACMA (Ngāti Raukawa, <a href="http://mauriora.co.nz/" rel="nofollow" target="_blank">Mauri Ora Associates</a>, Accident Compensation Corporation) Dr George Laking FRACP (Te Whakatōhea, Auckland City Hospital) Dr Elana Curtis AFPHM (Ngāti Rongomai, Ngāti Pikiao, University of Auckland) Rev Hirini Kaa (Ngāti Porou, Ngati Kahungunu, University of Auckland) Mr Chayce Glass (Tumuaki, University of Otago). Commemoration to Matua Leo Buchanan given by Dr Tuwhakairiora Williams.Production Written and produced by Mic Cavazzini. Music courtesy of <a href="http://freemusicarchive.org/music/jason_shaw" rel="nofollow" target="_blank">Jason Shaw</a> ('Autumn Sunset'), <a href="http://freemusicarchive.org/music/Lee_Rosevere" rel="nofollow" target="_blank">Doctor Turtle</a> ('Making a Change') and <a href="http://freemusicarchive.org/music/Broke_For_Free/" rel="nofollow" target="_blank">Broke For Free</a> ('Feel Good Instrumental'). Image of the Te Whare Tapa Whā health model by Sir Mason Durie, provided courtesy of <a href="http://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-whare-tapa-wha" rel="nofollow" target="_blank">NZ Ministry of Health: Manatū Hauora</a>. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Dr Katrina Gibson and Dr George Laking and RACP staff Ms Harriet Wild, Ms Nicola Fowler, and Dr Cristiana Palmieri. <a href="https://www.racp.edu.au/pomegranate/view/ep31-nga-kaitiaki-hauora" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;t=Pomegranate%20Health%20Podcast%20%2D%20Episode%2031%3A%20Nga%20Kaitiaki%20Hauroa" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep31: Ngā Kaitiaki Hauora

The World Medical Association has just updated the Physician's Oath in the Declaration of Geneva to include the clause, 'I will attend my own health, well-being, and abilities in order to provide care of the highest standard.' This is in recognition of the often reported figures about burnout, depression and suicide in the health workforce.These rates are typically twofold higher than they are in the general population, according to studies from New Zealand, Australia and around the world. Causes often given for psychiatric distress in the medical profession are the gruelling hours, the pressure of perfection, the unforgiving culture and the stigma associated with mental health issues. This episode examines how the system might be shaped to improve physician wellbeing.If you or someone you know is struggling with mental health issues, please seek help—call Lifeline on 13 11 14. The RACP also provides a confidential, 24-hour support program for its members. Fellows can call 1300 687 327 in Australia, and 0800 666 367 in New Zealand.Guests Dr Geoff Toogood FRACP (Alfred Hospital) Dr Margaret Kay FRACGP (University of Queensland; Medical Director, Queensland Doctors' Health Program) Dr Hilton Koppe FRACGP.Production Produced by Mic Cavazzini. Recording assistance from Michelle Ransom-Hughes and Rebecca Fary. Music courtesy of Kai Engel ('Highway to the Stars'), Cory Gray ('Low Rollers'), Blue Dot Sessions ('Periodicals') and Lee Rosevere ('Here's the Thing'). Photo via iStock. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP Fellows Dr Marion Leighton, Dr Alan Ngo, Dr Michael Herd, Dr Phillipa Wormald and Dr Paul Jauncey.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.   

The World Medical Association has just updated the Physician's Oath in the Declaration of Geneva to include the clause, 'I will attend my own health, well-being, and abilities in order to provide care of the highest standard.' This is in recognition of the often reported figures about burnout, depression and suicide in the health workforce.These rates are typically twofold higher than they are in the general population, according to studies from New Zealand, Australia and around the world. Causes often given for psychiatric distress in the medical profession are the gruelling hours, the pressure of perfection, the unforgiving culture and the stigma associated with mental health issues. This episode examines how the system might be shaped to improve physician wellbeing.If you or someone you know is struggling with mental health issues, please seek help—call Lifeline on 13 11 14. The RACP also provides a confidential, 24-hour <a href="https://www.racp.edu.au/fellows/resources/support-helpline" rel="nofollow" target="_blank">support program</a> for its members. Fellows can call 1300 687 327 in Australia, and 0800 666 367 in New Zealand.Guests Dr Geoff Toogood FRACP (Alfred Hospital) Dr Margaret Kay FRACGP (University of Queensland; Medical Director, Queensland Doctors' Health Program) Dr Hilton Koppe FRACGP.Production Produced by Mic Cavazzini. Recording assistance from Michelle Ransom-Hughes and Rebecca Fary. Music courtesy of <a href="http://freemusicarchive.org/music/Kai_Engel" rel="nofollow" target="_blank">Kai Engel</a> ('Highway to the Stars'), <a href="http://freemusicarchive.org/music/Cory_Gray" rel="nofollow" target="_blank">Cory Gray</a> ('Low Rollers'), <a href="http://freemusicarchive.org/music/Blue_Dot_Sessions" rel="nofollow" target="_blank">Blue Dot Sessions</a> ('Periodicals') and <a href="http://freemusicarchive.org/music/Lee_Rosevere" rel="nofollow" target="_blank">Lee Rosevere</a> ('Here's the Thing'). Photo via <a href="http://www.istockphoto.com/au/vector/love-sickness-3d-illustration-gm622545504-109044977" rel="nofollow" target="_blank">iStock</a>. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP Fellows Dr Marion Leighton, Dr Alan Ngo, Dr Michael Herd, Dr Phillipa Wormald and Dr Paul Jauncey. <a href="https://www.racp.edu.au/pomegranate/view/episode-30-being-human" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;t=Pomegranate%20Health%20Podcast%20%2D%20%27Being%20Human%27" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep30: Being Human

Glucose-lowering medications have been the mainstay of managing type 2 diabetes for 20 years, but in April this year a polemic erupted around specific targets for blood sugar. The American College of Physicians recommended less stringent control than had been previously accepted, and invoked fierce criticism from other diabetes organisations around the world.It all comes down to the interpretation of four key trials between designed to show a link between intensive glycemic control and improvement in cardiovascular symptoms. On this episode, Dr Paul Drury and Professor Sophia Zoungas help make sense of the inconsistencies between the findings and explain how these inform individualised strategies for patients with different historiesIn recent years there have also been trials of new drug classes that don't just lower blood glucose but appear to provide cardiovascular benefits directly in sicker patients. These are the SGLT2 inhibitors and GLP-1 receptor agonists, and we'll summarise the use advised in a very recent consensus statement.Guests Professor Sophia Zoungas FRACP (Monash Health; Board Director, Diabetes Australia; Clinical Director, National Association of Diabetes Centres) Dr Paul Drury FRACP (Clinical Advisor in Diabetes, Ministry of Health)Production Written and produced by Mic Cavazzini. Recording assistance in Auckland from Alex Aylett-McMillan and in Melbourne from Rebecca Fary. Music under licence from Epidemic Sound ('Fields' and 'World Joy' by Gunnar Johnsén, 'Organic Textures' by Johannes Bornlöf). Image under licence from iStock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Michael Herd, Phillip Gaughwin, Mahesh Dhakal, Marion Leighton, Rebecca Grainger, Rhiannon Mellor, and Alan Ngo. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Glucose-lowering medications have been the mainstay of managing type 2 diabetes for 20 years, but in April this year a polemic erupted around specific targets for blood sugar. The American College of Physicians recommended less stringent control than had been previously accepted, and <a href="https://www.medscape.com/viewarticle/893421#vp_1" rel="nofollow" target="_blank">invoked fierce criticism from other diabetes organisations around the world</a>.It all comes down to the interpretation of four key trials between designed to show a link between intensive glycemic control and improvement in cardiovascular symptoms. On this episode, Dr Paul Drury and Professor Sophia Zoungas help make sense of the inconsistencies between the findings and explain how these inform individualised strategies for patients with different historiesIn recent years there have also been trials of new drug classes that don't just lower blood glucose but appear to provide cardiovascular benefits directly in sicker patients. These are the SGLT2 inhibitors and GLP-1 receptor agonists, and we'll summarise the use advised in a <a href="http://care.diabetesjournals.org/content/early/2018/09/27/dci18-0033" rel="nofollow" target="_blank">very recent consensus statement</a>.Guests Professor Sophia Zoungas FRACP (Monash Health; Board Director, Diabetes Australia; Clinical Director, National Association of Diabetes Centres) Dr Paul Drury FRACP (Clinical Advisor in Diabetes, Ministry of Health)Production Written and produced by Mic Cavazzini. Recording assistance in Auckland from Alex Aylett-McMillan and in Melbourne from Rebecca Fary. Music under licence from <a href="https://player.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> ('Fields' and 'World Joy' by Gunnar Johnsén, 'Organic Textures' by Johannes Bornlöf). Image under licence from <a href="https://www.istockphoto.com/au/photo/hematology-blood-analysis-gm667329056-123684717" rel="nofollow" target="_blank">iStock</a>. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Michael Herd, Phillip Gaughwin, Mahesh Dhakal, Marion Leighton, Rebecca Grainger, Rhiannon Mellor, and Alan Ngo. <a href="https://www.racp.edu.au/pomegranate/view/ep41-targeting-diabetes" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=Podcast&amp;h=1&amp;t=Pomegranate%20Health%20Podcast%20%2D%20Episode%2039%20%2D%20Rebooting%20CPD%20Part%201" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep41: Targeting Diabetes

Cervical cancer is the fourth most common cancer in women worldwide, but it's almost entirely preventable. Incidence in Australia and New Zealand has fallen by half since national Pap testing programs were implemented almost thirty years ago, and it now it sits between 6 and 7 cases per 100,000 women. But this rate has been at plateau for over a decade, and Pap cytology now plays second fiddle to HPV testing. In December 2017 Australia seconded the Netherlands to adopt this as the primary tool in cervical screening, and New Zealand plans to follow suit in 2021.The most noticeable shift is that the interval between screens will now be five years rather than two. And women will enter the program at age 25 instead of 18. Modeling shows that this could halve the incidence of cervical cancer further and at much lower cost than the previous program. Some, however, are concerned about the costs and risks involved in the triage pathway. This episode of Pomegranate Health will answer some questions that women and health professionals might have about the HPV-based National Cervical Screening Program.Guests Associate Professor Julia Brotherton AFPHM (VCS Foundation, University of Melbourne) Professor Ian Hammond AM FRANZCOG (Chair, Renewal of the National Cervical Screening Program Implementation Committee, University of Western Australia)Production Written and produced by Mic Cavazzini. Recording assistance in Perth from Meri Fatin and in Melbourne from Jon Tjhia of Paper Radio. Music courtesy of Free Music Archive; 'Electro Cool' by 4T Thieves, 'Fryeri,' 'Headway,' 'Brand New World' and 'Mare' by Kai Engel. Image courtesy of Wikimedia Commons. The production manager was Anne Fredrickson.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Cervical cancer is the fourth most common cancer in women worldwide, but it's almost entirely preventable. Incidence in <a href="https://www.canceraustralia.gov.au/affected-cancer/cancer-types/cervical-cancer/statistics" rel="nofollow" target="_blank">Australia</a> and <a href="https://www.womenshealthcouncil.org.nz/Womens+Health+Issues/Cervical+Screening+and+Cervical+Cancer/Cervical+Cancer+in+New+Zealand+-+May-June+2018.html" rel="nofollow" target="_blank">New Zealand</a> has fallen by half since national Pap testing programs were implemented almost thirty years ago, and it now it sits between 6 and 7 cases per 100,000 women. But <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja16.00289?sid=nlm%3Apubmed" rel="nofollow" target="_blank">this rate has been at plateau for over a decade</a>, and Pap cytology now plays second fiddle to HPV testing. In December 2017 Australia seconded the Netherlands to adopt this as the primary tool in cervical screening, and <a href="https://www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/hpv-primary-screening" rel="nofollow" target="_blank">New Zealand plans to follow suit in 2021</a>.The most noticeable shift is that the interval between screens will now be five years rather than two. And women will enter the program at age 25 instead of 18. Modeling shows that this <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185332" rel="nofollow" target="_blank">could halve the incidence of cervical cancer further</a> and <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30007-5/fulltext" rel="nofollow" target="_blank">at much lower cost than the previous program</a>. Some, however, are concerned about the costs and risks involved in the triage pathway. This episode of Pomegranate Health will answer some questions that women and health professionals might have about the HPV-based National Cervical Screening Program.Guests Associate Professor Julia Brotherton AFPHM (VCS Foundation, University of Melbourne) Professor Ian Hammond AM FRANZCOG (Chair, Renewal of the National Cervical Screening Program Implementation Committee, University of Western Australia)Production Written and produced by Mic Cavazzini. Recording assistance in Perth from Meri Fatin and in Melbourne from Jon Tjhia of <a href="http://www.paperradio.net/" rel="nofollow" target="_blank">Paper Radio</a>. Music courtesy of Free Music Archive; 'Electro Cool' by <a href="http://freemusicarchive.org/music/4T_Thieves/" rel="nofollow" target="_blank">4T Thieves</a>, 'Fryeri,' 'Headway,' 'Brand New World' and 'Mare' by <a href="http://freemusicarchive.org/music/Kai_Engel/" rel="nofollow" target="_blank">Kai Engel</a>. Image courtesy of <a href="https://en.wikipedia.org/wiki/File:Low-grade_sil_and_endocx.jpg" rel="nofollow" target="_blank">Wikimedia Commons</a>. The production manager was Anne Fredrickson. <a href="https://www.racp.edu.au/pomegranate/view/ep44-cervical-screening-less-is-more" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2044%3A%20%27Cervical%20Screening%20Renewed%27" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep44: Cervical Screening–Less Is More

Cannabis is a plant rich with potential therapeutic compounds and centuries of cultural resonance. At this moment in Australia, media accounts are full of patient stories and lab data suggesting benefit from cannabis for scores of different conditions, while politicians discuss laxer regulation of the drug and a new lucrative industrHowever, only a few of the claimed medical effects of the plant have been proven by rigorous clinical trials in people. Nabiximols is the only medicinal cannabis product currently registered in New Zealand and Australia, and it's indicated only for­­ the treatment of spasticity in patients with multiple sclerosis (MS). Systematic reviews of the research note strong evidence that cannabis can also help with the pain associated with MS, the nausea induced by chemotherapy and some cases of epilepsy. But for many other conditions like post-traumatic stress disorder, irritable bowel syndrome, immune disorders and Parkinsonism, reviewers concluded that meaningful clinical recommendations could not be made—there simply aren't enough studies of good quality. Cannabis is complex. The flower bud contains mostly cannabidiol and tetrahydrocannabinol (THC), but there are about 100 other cannabinoid compounds. On this episode, Pomegranate Health guests explain how important it is to separate the effect of these various components in a systematic way, and why well-regulated research and prescribing will be safer for patients. Guests A/Prof Peter Grimison FRACP (Chris O'Brien Lifehouse, University of Sydney) Prof Meera Agar FRACP (UTS, USNW, IMPACCT) A/Prof Carolyn Arnold FRACP (Monash University Alfred Health) Prof Samuel Berkovic AC FRACP (Epilepsy Research Centre, University of Melbourne) Prof Jennifer Martin FRACP (Australian Centre for Cannabinoid Research Excellence, University of Newcastle, John Hunter Hospital).Production Written and produced by Mic Cavazzini. Additional audio recording from James Milson. Music courtesy of Blue Dot Sessions (“Cloud Line”), 4T Thieves (“New Times”), Mystery Mammal (“Asylum”) and Jahzarr (“Please Listen Carefully”). Image courtesy of iStock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Dr Michael Herd, Dr Pavan Chandrala, Dr Marion Leighton, Dr Rosalynn Pszczola, Dr Mahesh Dhakal, Dr Rhiannon Mellor, Dr Rebecca Grainger, Dr Philip Gaughwin and Dr Paul Jauncey, as well as Louise Hardy (Manager, RACP Policy and Advocacy) and Ms Joanna Harrison (Senior Adviser, ACRE). Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Cannabis is a plant rich with potential therapeutic compounds and centuries of cultural resonance. At this moment in Australia, media accounts are full of patient stories and lab data suggesting benefit from cannabis for scores of different conditions, while politicians discuss laxer regulation of the drug and a new lucrative industrHowever, only a few of the claimed medical effects of the plant have been proven by rigorous clinical trials in people. Nabiximols is the only medicinal cannabis product currently registered in New Zealand and Australia, and it's indicated only for­­ the treatment of spasticity in patients with multiple sclerosis (MS). Systematic reviews of the research note strong evidence that cannabis can also help with the pain associated with MS, the nausea induced by chemotherapy and some cases of epilepsy. But for many other conditions like post-traumatic stress disorder, irritable bowel syndrome, immune disorders and Parkinsonism, reviewers concluded that meaningful clinical recommendations could not be made—there simply aren't enough studies of good quality. Cannabis is complex. The flower bud contains mostly cannabidiol and tetrahydrocannabinol (THC), but there are about 100 other cannabinoid compounds. On this episode, Pomegranate Health guests explain how important it is to separate the effect of these various components in a systematic way, and why well-regulated research and prescribing will be safer for patients. Guests A/Prof Peter Grimison FRACP (Chris O'Brien Lifehouse, University of Sydney) Prof Meera Agar FRACP (UTS, USNW, IMPACCT) A/Prof Carolyn Arnold FRACP (Monash University Alfred Health) Prof Samuel Berkovic AC FRACP (Epilepsy Research Centre, University of Melbourne) Prof Jennifer Martin FRACP (Australian Centre for Cannabinoid Research Excellence, University of Newcastle, John Hunter Hospital).Production Written and produced by Mic Cavazzini. Additional audio recording from <a href="http://www.tricksy.xyz/" rel="nofollow" target="_blank">James Milson</a>. Music courtesy of <a href="http://freemusicarchive.org/music/blue_dot_sessions" rel="nofollow" target="_blank">Blue Dot Sessions</a> (“Cloud Line”), <a href="http://freemusicarchive.org/music/4T_thieves" rel="nofollow" target="_blank">4T Thieves</a> (“New Times”), <a href="http://freemusicarchive.org/music/mystery_mammal" rel="nofollow" target="_blank">Mystery Mammal</a> (“Asylum”) and <a href="http://freemusicarchive.org/music/jahzarr" rel="nofollow" target="_blank">Jahzarr</a> (“Please Listen Carefully”). Image courtesy of <a href="https://www.istockphoto.com/au/photo/marijuana-seedling-macro-detail-gm629019758-111815221" rel="nofollow" target="_blank">iStock</a>. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Dr Michael Herd, Dr Pavan Chandrala, Dr Marion Leighton, Dr Rosalynn Pszczola, Dr Mahesh Dhakal, Dr Rhiannon Mellor, Dr Rebecca Grainger, Dr Philip Gaughwin and Dr Paul Jauncey, as well as Louise Hardy (Manager, RACP Policy and Advocacy) and Ms Joanna Harrison (Senior Adviser, ACRE). <a href="https://www.racp.edu.au/pomegranate/view/ep33-early-days-for-cannabis-therapy" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2033%20%2D%20Early%20Days%20for%20Cannabis%20Therapy" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep33: Early Days for Cannabis Therapy

From 2019, there will be only three categories of activities in the RACP's CPD framework, encouraging Fellows to participate in performance review and outcome measurement alongside more traditional educational activities. Performance review can include collegiate exercises like peer review of case outcomes, or surveys of patient experiences. Multi-source feedback is one sophisticated example that has been trialled by the RACP. Outcome measurement typically refers to clinical audits of case notes and there are many forms that can easily be implemented by Fellows. In this episode, two New Zealand Fellows discuss what they've learned about this 'strengthened CPD' approach since it was nationally implemented there four years ago.Guests Professor Tony Scott FRACP (Director of Cardiology, Waitemata Cardiology, Auckland) Dr Peter Roberts FRACP (CPD Director, RACP New Zealand; Wellington Hospital)Production Written and produced by Mic Cavazzini. Recording assistance in New Zealand from Charlotte Graham-McLay. Music courtesy Gunnar Johnsén at Epidemic Sound ('Task at Hand 2', 'Task at Hand 5', 'The Sky Changes 2') and Blue Dot Sessions ('Vittoro'). Image licenced iStock. The production manager was Anne Fredrickson.  Editorial feedback for this episode was provided by RACP members Phillipa Wormald, Michael Herd, Rhiannon Mellor, Joseph Lee, Rachel Williams, Phillipa Wormald, Paul Jauncey, Rebecca Grainger, Philip Gaughwin and Alan Ngo. Thanks also to RACP staff Lianne Beckett, Michael Pooley, Elyce Pyzhov, Amy Nhieu, Shona Black, Abigail Marshall, Kerri Brown, Sandra Dias and Carol Pizzuto.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

From 2019, there will be only three categories of activities in the RACP's CPD framework, encouraging Fellows to participate in performance review and outcome measurement alongside more traditional educational activities. Performance review can include collegiate exercises like peer review of case outcomes, or surveys of patient experiences. Multi-source feedback is one sophisticated example that has been trialled by the RACP. Outcome measurement typically refers to clinical audits of case notes and there are many forms that can easily be implemented by Fellows. In this episode, two New Zealand Fellows discuss what they've learned about this 'strengthened CPD' approach since it was nationally implemented there four years ago.Guests Professor Tony Scott FRACP (Director of Cardiology, Waitemata Cardiology, Auckland) Dr Peter Roberts FRACP (CPD Director, RACP New Zealand; Wellington Hospital)Production Written and produced by Mic Cavazzini. Recording assistance in New Zealand from <a href="http://charlottegrahammclay.com/" rel="nofollow" target="_blank">Charlotte Graham-McLay</a>. Music courtesy Gunnar Johnsén at <a href="https://player.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> ('Task at Hand 2', 'Task at Hand 5', 'The Sky Changes 2') and <a href="http://freemusicarchive.org/music/Blue_Dot_Sessions/" rel="nofollow" target="_blank">Blue Dot Sessions</a> ('Vittoro'). Image licenced <a href="https://www.istockphoto.com/au/photo/rating-concept-reputation-management-gm820568870-132580413" rel="nofollow" target="_blank">iStock</a>. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Phillipa Wormald, Michael Herd, Rhiannon Mellor, Joseph Lee, Rachel Williams, Phillipa Wormald, Paul Jauncey, Rebecca Grainger, Philip Gaughwin and Alan Ngo. Thanks also to RACP staff Lianne Beckett, Michael Pooley, Elyce Pyzhov, Amy Nhieu, Shona Black, Abigail Marshall, Kerri Brown, Sandra Dias and Carol Pizzuto. <a href="https://www.racp.edu.au/pomegranate/view/episode-40-rebooting-cpd-part2" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Health%20Podcast%20%2D%20Episode%2040%3A%20Rebooting%20CPD%20Part%202" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep40: Rebooting CPD Part 2—Feedback and Audit

In this episode we put continuing professional development (CPD) under the microscope, particularly the regulatory changes on the horizon. The Medical Board of Australia is emulating shifts already made by the Medical Council of New Zealand and regulators in Canada, the U.S. and the U.K. In some cases, this 'revalidation' movement has been fiercely opposed by doctors. But where did it come from, and why is CPD even necessary after you've already done 10 to 15 years of medical training.Guests Professor Richard Doherty FRACP (Dean, RACP; Monash Childrens Hospital and University)  Dr Craig Campbell, MD FRCPC (Royal College of Physicians and Surgeons of Canada; The Ottawa Hospital)Production Written and produced by Mic Cavazzini. Recording assistance in Ottawa from Pop-Up Podcasting. Music courtesy Gunnar Johnsén at Epidemic Sound ('Task at Hand 2', 'Task at Hand 5', 'The Sky Changes 2') and Blue Dot Sessions ('Vittoro'). Image courtesy Neil Turner at Flickr.The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Phillipa Wormald, Michael Herd, Rhiannon Mellor, Joseph Lee, Rachel Williams, Phillipa Wormald, Paul Jauncey, Rebecca Grainger, Philip Gaughwin and Alan Ngo. Thanks also to RACP staff Lianne Beckett, Michael Pooley, Elyce Pyzhov, Amy Nhieu, Shona Black, Abigail Marshall, Kerri Brown, Sandra Dias and Carol Pizzuti. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

In this episode we put continuing professional development (CPD) under the microscope, particularly the regulatory changes on the horizon. The Medical Board of Australia is emulating shifts already made by the Medical Council of New Zealand and regulators in Canada, the U.S. and the U.K. In some cases, this 'revalidation' movement has been fiercely opposed by doctors. But where did it come from, and why is CPD even necessary after you've already done 10 to 15 years of medical training.Guests Professor Richard Doherty FRACP (Dean, RACP; Monash Childrens Hospital and University)  Dr Craig Campbell, MD FRCPC (Royal College of Physicians and Surgeons of Canada; The Ottawa Hospital)Production Written and produced by Mic Cavazzini. Recording assistance in Ottawa from <a href="https://popuppodcasting.ca/" rel="nofollow" target="_blank">Pop-Up Podcasting</a>. Music courtesy Gunnar Johnsén at <a href="https://player.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> ('Task at Hand 2', 'Task at Hand 5', 'The Sky Changes 2') and <a href="http://freemusicarchive.org/music/Blue_Dot_Sessions/" rel="nofollow" target="_blank">Blue Dot Sessions</a> ('Vittoro'). Image courtesy <a href="https://www.flickr.com/photos/neilt/2471846" rel="nofollow" target="_blank">Neil Turner at Flickr</a>.The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP members Phillipa Wormald, Michael Herd, Rhiannon Mellor, Joseph Lee, Rachel Williams, Phillipa Wormald, Paul Jauncey, Rebecca Grainger, Philip Gaughwin and Alan Ngo. Thanks also to RACP staff Lianne Beckett, Michael Pooley, Elyce Pyzhov, Amy Nhieu, Shona Black, Abigail Marshall, Kerri Brown, Sandra Dias and Carol Pizzuti. <a href="https://www.racp.edu.au/pomegranate/view/episode-39-rebooting-cpd-part1" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Health%20Podcast%20%2D%20Episode%2039%3A%20Rebooting%20CPD%20Part%201" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep39: Rebooting CPD Part 1—Origins

In this and episode 43 we revisit the theme of 'disruption' from the 2018 RACP Congress. Disruption is what happened to the taxi industry at the hands of Google Maps and Uber. Or to the music industry with the onslaught mp3 files and digital sharing platforms.Democratizing technology is changing delivery of healthcare too and now permits remote consultations, automated dispensing, or even algorithmic diagnostics. The public also has access to more information, and even today, "Dr Google" is variously described as a tool or a hindrance.More importantly, consumer expectations are different to what they were twenty years ago. As Professor Des Gorman explains, the health system is a service industry like any other, and those working within it need to have a better understanding of the people who sustain that service. New delivery models are springing up all the time which may offer efficiencies and greater satisfaction in some consumer groups.Consumer advocate, Jen Morris, tells a story from the UK, where a man was able to bypass red tape around approval of prophylactic HIV therapy simply by setting up a website. She explains how clinicians shouldn't see the internet as a threat, but as a tool for enhancing consumer engagement. And how health literacy is more about navigating systems than it is about understanding biomedical fundamentals. Guests Professor Des Gorman FAFOEM (University of Auckland; Executive Chair, Health Workforce New Zealand) Jen MorrisProductionWritten and produced by Mic Cavazzini. Recording assistance in Auckland from Richard Smith and the University of Auckland, and in Melbourne from John Tjiha of Paper Radio. Music under licence from Epidemic Sound ('Simmering Anxiety' by Christian Andersen, 'Into the Bone' and 'Frustration in Disguise' by Jimmy Wahlsteen, 'The Sky Changes 2' and 'Calculate Journey' by Gunnar Johnsén ); and Free Music Archive ('To be Decided' by Mystery Mammal, 'Highway to the Stars' by Kai Engel and 'Waiting' by David Szesztay). Image under licence from iStock. The production manager was Anne Fredrickson.  Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Michael Herd, Mahesh Dhakal, Rhiannon Mellor, Ellen Taylor, Joseph, Lee, Philip Britton, Alan Ngo, Rachel Williams, Phillipa Wormald, Rosalynn Pszczola, Richard Doherty Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

In this and <a href="https://www.racp.edu.au/pomegranate/view/ep43-whats-in-a-name" rel="nofollow" target="_blank">episode 43</a> we revisit the theme of 'disruption' from the 2018 RACP Congress. Disruption is what happened to the taxi industry at the hands of Google Maps and Uber. Or to the music industry with the onslaught mp3 files and digital sharing platforms. Democratizing technology is changing delivery of healthcare too and now permits remote consultations, automated dispensing, or even algorithmic diagnostics. The public also has access to more information, and even today, "Dr Google" is variously described as a tool or a hindrance. More importantly, consumer expectations are different to what they were twenty years ago. As Professor Des Gorman explains, the health system is a service industry like any other, and those working within it need to have a better understanding of the people who sustain that service. New delivery models are springing up all the time which may offer efficiencies and greater satisfaction in some consumer groups. Consumer advocate, Jen Morris, tells a story from the UK, where a man was able to bypass red tape around approval of prophylactic HIV therapy simply by setting up a website. She explains how clinicians shouldn't see the internet as a threat, but as a tool for enhancing consumer engagement. And how health literacy is more about navigating systems than it is about understanding biomedical fundamentals.  Guests Professor Des Gorman FAFOEM (University of Auckland; Executive Chair, Health Workforce New Zealand) Jen Morris Production Written and produced by Mic Cavazzini. Recording assistance in Auckland from Richard Smith and the University of Auckland, and in Melbourne from John Tjiha of <a href="http://www.paperradio.net/" rel="nofollow" target="_blank">Paper Radio</a>. Music under licence from <a href="https://player.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> ('Simmering Anxiety' by Christian Andersen, 'Into the Bone' and 'Frustration in Disguise' by Jimmy Wahlsteen, 'The Sky Changes 2' and 'Calculate Journey' by Gunnar Johnsén ); and Free Music Archive ('To be Decided' by <a href="http://freemusicarchive.org/music/Mystery_Mammal/" rel="nofollow" target="_blank">Mystery Mammal</a>, 'Highway to the Stars' by <a href="http://freemusicarchive.org/music/Kai_Engel/" rel="nofollow" target="_blank">Kai Engel</a> and 'Waiting' by <a href="http://freemusicarchive.org/music/David_Szesztay/" rel="nofollow" target="_blank">David Szesztay</a>). Image under licence from <a href="https://www.istockphoto.com/au/photo/dome-lamp-of-classic-black-cab-in-london-gm914144914-251616537" rel="nofollow" target="_blank">iStock</a>. The production manager was Anne Fredrickson.  Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Michael Herd, Mahesh Dhakal, Rhiannon Mellor, Ellen Taylor, Joseph, Lee, Philip Britton, Alan Ngo, Rachel Williams, Phillipa Wormald, Rosalynn Pszczola, Richard Doherty  <a href="https://www.racp.edu.au/pomegranate/view/ep42-the-value-proposition" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2042%3A%20%27Disruption%20in%20Healthcare%201%27" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep42: The Value Proposition - Disruption Part 1

This is the second of two podcasts about "disruption" in healthcare. We hear from members of the RACP Consumer Advisory Group about the way they see the power balance in health service delivery and how to increase participation.Consumer advocate Jen Morris discusses autonomy, and all the subtle aspects of informed consent. Another factor which can give the public a greater sense of agency in their care is access to health data.Consumer expectations are different to what they were twenty years ago. As Professor Des Gorman explains, the health system is a service industry like any other, and that terms like patient and consumer might be relevant to different points in person's journey through it.Guests Professor Des Gorman FAFOEM (University of Auckland; Executive Chair, Workforce New Zealand) Jen Morris RACP Consumer Advisory Group members Hamza Vayani, Debra Letica, Ezekiel RobsonProduction Written and produced by Mic Cavazzini. Recording assistance in Auckland from Richard Smith and the University of Auckland, and in Melbourne from John Tjiha of Paper Radio. Music under licence from Epidemic Sound ('Simmering Anxiety' by Christian Andersen, 'Into the Bone' and 'Frustration in Disguise' by Jimmy Wahlsteen, 'Organic Textures 2' by Johannes Bornlöf, 'The Sky Changes 2' and 'Calculate Journey' by Gunnar Johnsén ); and Free Music Archive ('To be Decided' by Mystery Mammal, 'Highway to the Stars' by Kai Engel and 'Waiting' by David Szesztay). Image under licence from iStock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Michael Herd, Mahesh Dhakal, Rhiannon Mellor, Ellen Taylor, Joseph, Lee, Philip Britton, Alan Ngo, Rachel Williams, Phillipa Wormald, Rosalynn Pszczola, Richard Doherty Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

This is <a href="https://www.racp.edu.au/pomegranate/view/ep42-the-value-proposition" rel="nofollow" target="_blank">the second of two podcasts about "disruption" in healthcare</a>. We hear from members of the RACP Consumer Advisory Group about the way they see the power balance in health service delivery and how to increase participation.Consumer advocate Jen Morris discusses autonomy, and all the subtle aspects of informed consent. Another factor which can give the public a greater sense of agency in their care is access to health data.Consumer expectations are different to what they were twenty years ago. As Professor Des Gorman explains, the health system is a service industry like any other, and that terms like patient and consumer might be relevant to different points in person's journey through it.Guests Professor Des Gorman FAFOEM (University of Auckland; Executive Chair, Workforce New Zealand) Jen Morris RACP Consumer Advisory Group members Hamza Vayani, Debra Letica, Ezekiel RobsonProduction Written and produced by Mic Cavazzini. Recording assistance in Auckland from Richard Smith and the University of Auckland, and in Melbourne from John Tjiha of <a href="http://www.paperradio.net/" rel="nofollow" target="_blank">Paper Radio</a>. Music under licence from <a href="https://player.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> ('Simmering Anxiety' by Christian Andersen, 'Into the Bone' and 'Frustration in Disguise' by Jimmy Wahlsteen, 'Organic Textures 2' by Johannes Bornlöf, 'The Sky Changes 2' and 'Calculate Journey' by Gunnar Johnsén ); and Free Music Archive ('To be Decided' by <a href="http://freemusicarchive.org/music/Mystery_Mammal/" rel="nofollow" target="_blank">Mystery Mammal</a>, 'Highway to the Stars' by <a href="http://freemusicarchive.org/music/Kai_Engel/" rel="nofollow" target="_blank">Kai Engel</a> and 'Waiting' by <a href="http://freemusicarchive.org/music/David_Szesztay/" rel="nofollow" target="_blank">David Szesztay</a>). Image under licence from <a href="https://www.istockphoto.com/au/photo/stethoscope-on-computer-keyboard-gm583853208-99933395" rel="nofollow" target="_blank">iStock</a>. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Paul Jauncey, Michael Herd, Mahesh Dhakal, Rhiannon Mellor, Ellen Taylor, Joseph, Lee, Philip Britton, Alan Ngo, Rachel Williams, Phillipa Wormald, Rosalynn Pszczola, Richard Doherty <a href="https://www.racp.edu.au/pomegranate/view/ep43-whats-in-a-name" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2043%3A%20%27Disruption%20in%20Healthcare%202%27" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep43: What’s in a Name? - Disruption Part 2

As medicine becomes more sophisticated, discussions about clinical ethics become more common. It is now possible to support life in dire clinical circumstances, but physicians are not always sure if this is the right thing to do. There are questions about quality of life and best interests of the patient, questions about cognitive competence to make such decisions for oneself or questions about equitable distribution of limited resources.This episode was recorded at the RACP Congress in May and centres around two case studies. The first describes a three-year-old boy with a severe neurodegenerative disorder whose parents are desperate to try an expensive experimental drug. The second is about a man ravaged by bowel cancer who has spent months on life-sustaining care. You'll hear a variety of physicians express their views, and members of the College Ethics Committee describe how clinical ethics services can support decision-making in such cases.Panellists Professor David Isaacs FRACP (Children's Hospital Westmead, University of Sydney) Professor Ian Kerridge FRACP (Royal North Shore Hospital, Sydney Health Ethics) Professor Paul Komesaroff FRACP (Alfred Hospital, Monash University, Centre for Ethics in Medicine and Society) Associate Professor Jill Sewell FRACP (Royal Children's Hospital Melbourne, Children's Bioethics Centre, University of Melbourne) Dr Linda Sheahan FRACP FAChPM (St George Hospital, Sydney Health Ethics) Professor Cameron Stewart (Sydney Law School, Sydney Health Ethics)Production Produced by Mic Cavazzini. Initial interview conducted by Melissah Bell. Music courtesy of Daddy Scrabble ('Tune for Elli'), Jason Shaw ('Namaste'), and Kai Engel ('Highway to the Stars'). Image via Shutterstock. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Philippa Wormald, Andrea Knox, Rebecca Grainger, Philip Gaughwin and Rhiannon Mellor.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

As medicine becomes more sophisticated, discussions about clinical ethics become more common. It is now possible to support life in dire clinical circumstances, but physicians are not always sure if this is the right thing to do. There are questions about quality of life and best interests of the patient, questions about cognitive competence to make such decisions for oneself or questions about equitable distribution of limited resources.This episode was recorded at the RACP Congress in May and centres around two case studies. The first describes a three-year-old boy with a severe neurodegenerative disorder whose parents are desperate to try an expensive experimental drug. The second is about a man ravaged by bowel cancer who has spent months on life-sustaining care. You'll hear a variety of physicians express their views, and members of the College Ethics Committee describe how clinical ethics services can support decision-making in such cases.Panellists Professor David Isaacs FRACP (Children's Hospital Westmead, University of Sydney) Professor Ian Kerridge FRACP (Royal North Shore Hospital, Sydney Health Ethics) Professor Paul Komesaroff FRACP (Alfred Hospital, Monash University, Centre for Ethics in Medicine and Society) Associate Professor Jill Sewell FRACP (Royal Children's Hospital Melbourne, Children's Bioethics Centre, University of Melbourne) Dr Linda Sheahan FRACP FAChPM (St George Hospital, Sydney Health Ethics) Professor Cameron Stewart (Sydney Law School, Sydney Health Ethics)Production Produced by Mic Cavazzini. Initial interview conducted by Melissah Bell. Music courtesy of <a href="http://freemusicarchive.org/music/Daddy_Scrabble/" rel="nofollow" target="_blank">Daddy Scrabble</a> ('Tune for Elli'), <a href="http://freemusicarchive.org/music/jason_shaw/" rel="nofollow" target="_blank">Jason Shaw</a> ('Namaste'), and <a href="http://freemusicarchive.org/music/Kai_Engel" rel="nofollow" target="_blank">Kai Engel</a> ('Highway to the Stars'). Image via <a href="https://www.shutterstock.com/image-photo/female-nurse-replacing-solution-bags-drip-789986776?src=09tRP1Nrq2N-lOT2H3gueA-1-26" rel="nofollow" target="_blank">Shutterstock</a>. The production manager was Anne Fredrickson. Editorial feedback for this episode was provided by RACP Fellows Philippa Wormald, Andrea Knox, Rebecca Grainger, Philip Gaughwin and Rhiannon Mellor.<a href="https://www.racp.edu.au/pomegranate/view/ep37-ethical-dilemmas" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2037%20%27Ethical%20Dilemmas%27" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep37: Ethical Dilemmas—Congress 2018

Medical practice is dynamic, and continually changes with evidence and experience. But costly or prolonged treatment doesn 't always translate into better outcomes for patients. In response, the College has launched EVOLVE—a partnership with specialty societies to identify and reduce low-value care.EVOLVE is part of a growing international movement to examine clinical and consumer decision-making about overused, inappropriate, or potentially harmful medical treatments. As a founding partner of Choosing Wisely Australia, EVOLVE represents the College 's major contribution to the campaign: helping Fellows develop and promote lists of low-value care items for their specialty. On this episode Prof Rachelle Buchbinder FRACP, A/Prof Warrick Inder FRACP, and A/Prof Ian Scott FRACP discuss why they support the campaign, the process of developing low-value lists, and how they work with patients when the best course of action is…to wait. This episode was produced by Anne Fredrickson, with music from Jahzzar ( 'Montmartre '), The OO-Ray ( 'Silhouettes '), Deerhunter ( 'Cryptograms ') and Delicate Steve ( 'Butterfly '); image courtesy EVOLVE.  Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Catherine Hill, A/Prof Ruth Marshall and Dr Catherine Yelland, and RACP staff members Mr Jason Soon and Ms Siobhan Marren. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Medical practice is dynamic, and continually changes with evidence and experience. But costly or prolonged treatment doesn 't always translate into better outcomes for patients. In response, the College has launched <a href="http://www.evolve.edu.au" rel="nofollow" target="_blank">EVOLVE</a>—a partnership with specialty societies to identify and reduce low-value care.EVOLVE is part of a growing international movement to examine clinical and consumer decision-making about overused, inappropriate, or potentially harmful medical treatments. As a founding partner of Choosing Wisely Australia, EVOLVE represents the College 's major contribution to the campaign: helping Fellows develop and promote lists of low-value care items for their specialty. On this episode Prof Rachelle Buchbinder FRACP, A/Prof Warrick Inder FRACP, and A/Prof Ian Scott FRACP discuss why they support the campaign, the process of developing low-value lists, and how they work with patients when the best course of action is…to wait.  This episode was produced by Anne Fredrickson, with music from <a href="http://freemusicarchive.org/music/Jahzzar/" rel="nofollow" target="_blank">Jahzzar</a> ( 'Montmartre '), <a href="http://freemusicarchive.org/music/The_OO-Ray/" rel="nofollow" target="_blank">The OO-Ray</a> ( 'Silhouettes '), <a href="http://freemusicarchive.org/music/Deerhunter/" rel="nofollow" target="_blank">Deerhunter</a> ( 'Cryptograms ') and <a href="http://freemusicarchive.org/music/Delicate_Steve/" rel="nofollow" target="_blank">Delicate Steve</a> ( 'Butterfly '); image courtesy EVOLVE.  Editorial feedback was provided by RACP Fellows Dr Bruce Foggo, Dr Catherine Hill, A/Prof Ruth Marshall and Dr Catherine Yelland, and RACP staff members Mr Jason Soon and Ms Siobhan Marren. <a href="https://www.racp.edu.au/pomegranate/view/episode-10-evolving-your-practice" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20%27Evolving%20Your%20Practice%27%20and%20further%20reading" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep10: Evolving Your Practice

This is the second of two episodes about acute coronary syndrome (ACS). In part one, the discussion focused on diagnostic workup of acute coronary events. This episode deals with secondary prevention and adherence to therapy. One-fifth of people discharged with a diagnosis of ACS have another ischaemic event within six months, and the risk of dying increases the second time round.There is an established strategy for secondary prevention of ACS that includes pharmacotherapy, cardiac rehabilitation and lifestyle management. However, 75 per cent of patients are discharged from hospital without one or more of these tools. A recently published study in the Internal Medicine Journal suggests this sets a trend for care going forward. As Professor David Brieger explains, follow-up visits to the GP are unlikely to ensure best-practice pharmacotherapy if this was not prescribed in hospital.Cardiac rehabilitation may also not be as effective as it could be in reducing the risk of further ischaemic events. On this episode, Associate Professor Julie Redfern argues that the group exercise model is outdated, and a more personalised approach is needed to keep patients engaged.Guests Professor David Brieger FRACP (Concord Repatriation General Hospital, University of Sydney) Associate Professor Julie Redfern PhD(George Institute for Global Health, University of Sydney).Production Written and produced by Mic Cavazzini. Music courtesy of Jason Shaw ('Minstrel'), Lee Rosevere ('Become Death'), Sergey Cheremisinov ('Pulsar') and Loch Lomond ('Listen, Lisbon'). Image courtesy of iStock. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP Fellows Joseph Lee, Michael Herd, Marion Leighton, Rachel Williams, and Mahesh Dhakal. Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

This is the second of two episodes about acute coronary syndrome (ACS). In <a href="https://www.racp.edu.au/pomegranate/View/ep35-acute-coronary-syndrome-part1" rel="nofollow" target="_blank">part one</a>, the discussion focused on diagnostic workup of acute coronary events. This episode deals with secondary prevention and adherence to therapy. One-fifth of people discharged with a diagnosis of ACS have <a href="https://www.mja.com.au/journal/2011/195/3/management-and-outcomes-patients-acute-coronary-syndromes-australia-and-new#CBBIBFCC" rel="nofollow" target="_blank">another ischaemic event</a> within six months, and <a href="https://www2.deloitte.com/au/en/pages/economics/articles/acs-perspective-importance-secondary-prevention.html" rel="nofollow" target="_blank">the risk of dying increases</a> the second time round.There is an established strategy for secondary prevention of ACS that includes pharmacotherapy, cardiac rehabilitation and lifestyle management. However, 75 per cent of patients are discharged from hospital without one or more of these tools. A <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.13736" rel="nofollow" target="_blank">recently published study in the Internal Medicine Journal</a> suggests this sets a trend for care going forward. As Professor David Brieger explains, follow-up visits to the GP are unlikely to ensure best-practice pharmacotherapy if this was not prescribed in hospital.Cardiac rehabilitation may also not be as effective as it could be in reducing the risk of further ischaemic events. On this episode, Associate Professor Julie Redfern argues that the group exercise model is outdated, and a more personalised approach is needed to keep patients engaged. Guests Professor David Brieger FRACP (Concord Repatriation General Hospital, University of Sydney) Associate Professor Julie Redfern PhD(George Institute for Global Health, University of Sydney).Production Written and produced by Mic Cavazzini. Music courtesy of <a href="http://freemusicarchive.org/music/jason-shaw" rel="nofollow" target="_blank">Jason Shaw</a> ('Minstrel'), <a href="http://freemusicarchive.org/music/Lee_Rosevere/" rel="nofollow" target="_blank">Lee Rosevere</a> ('Become Death'), <a href="http://freemusicarchive.org/music/sergey_cheremisinov" rel="nofollow" target="_blank">Sergey Cheremisinov</a> ('Pulsar') and <a href="http://freemusicarchive.org/music/loch_lomond" rel="nofollow" target="_blank">Loch Lomond</a> ('Listen, Lisbon'). Image courtesy of <a href="https://www.istockphoto.com/au/photo/male-swimmer-swimming-laps-in-a-pool-gm613554758-105930563" rel="nofollow" target="_blank">iStock</a>. The production manager was Anne Fredrickson.Editorial feedback for this episode was provided by RACP Fellows Joseph Lee, Michael Herd, Marion Leighton, Rachel Williams, and Mahesh Dhakal. <a href="https://www.racp.edu.au/pomegranate/view/ep36-acute-coronary-syndrome-part2" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="http://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Acute%20Coronary%20Syndrome%20Part%202%20%2D%20Secondary%20Prevention" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep36: Acute Coronary Syndrome Part 2—Secondary Prevention

Australia has one of the best value health systems in the world, but also some of the most Byzantine health regulation. Between the federal Medicare scheme, the state hospitals, the private health insurers and the patient, it’s not always clear how a provider should invoice their services.To explain some of the fundamentals our guest is former nurse and lawyer, Margaret Faux of Synapse Global Medical Administration. She also describes areas of ambiguity in the legislation and the Medicare Benefits Schedule which creates confusion as to when and where certain services can be billed, or which items should not be claimed together. While there are many traps for well-intentioned providers and loopholes for the less well-intentioned, there are some simple solutions that would make medical billing much more streamlined.GuestsMargaret Faux (CEO, Synapse Global Medical Administration)Production Written and produced by Mic Cavazzini. Tracks licenced from Epidemic Sound include ‘Organic Textures 2 – Johannes Bornlöf, ‘Temple of Runha’ – ELFL. Tracks licenced from Free Music Archive include ‘Here’s the Thing’ – Lee Rosevere, 'Secret Place' -Alex Fitch, ‘Electro Cool’—4T Thieves, ‘Please Listen Carefully’- Jahzarr. Image licenced from Getty Images. Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Jenae Valk, Seema Radhakrishnan, Phillipa Wormald, Seema Radhakrishnan, Lisa Mounsey, Alan Ngo, Oliver Dillon, Rhiannon Mellor, Alexis Frydenberg, Duncan Austin, Keith Ooi, Sern Wei Yeoh.Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.  

Australia has one of the best value health systems in the world, but also some of the most Byzantine health regulation. Between the federal Medicare scheme, the state hospitals, the private health insurers and the patient, it’s not always clear how a provider should invoice their services.To explain some of the fundamentals our guest is former nurse and lawyer, Margaret Faux of Synapse Global Medical Administration. She also describes areas of ambiguity in the legislation and the Medicare Benefits Schedule which creates confusion as to when and where certain services can be billed, or which items should not be claimed together. While there are many traps for well-intentioned providers and loopholes for the less well-intentioned, there are some simple solutions that would make medical billing much more streamlined. Guests Margaret Faux (CEO, Synapse Global Medical Administration)Production  Written and produced by <a href="http://humanordinary.com/" rel="nofollow" target="_blank">Mic Cavazzini</a>. Tracks licenced from <a href="https://www.epidemicsound.com/" rel="nofollow" target="_blank">Epidemic Sound</a> include ‘Organic Textures 2 – Johannes Bornlöf, ‘Temple of Runha’ – ELFL. Tracks licenced from <a href="https://freemusicarchive.org/" rel="nofollow" target="_blank">Free Music Archive</a> include ‘Here’s the Thing’ – Lee Rosevere, 'Secret Place' -Alex Fitch, ‘Electro Cool’—4T Thieves, ‘Please Listen Carefully’- Jahzarr. Image licenced from <a href="https://www.gettyimages.com.au/detail/photo/close-up-of-antique-cash-register-machine-royalty-free-image/658145387" rel="nofollow" target="_blank">Getty Images</a>. Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Jenae Valk, Seema Radhakrishnan, Phillipa Wormald, Seema Radhakrishnan, Lisa Mounsey, Alan Ngo, Oliver Dillon, Rhiannon Mellor, Alexis Frydenberg, Duncan Austin, Keith Ooi, Sern Wei Yeoh.<a href="https://www.racp.edu.au/pomegranate/view/ep56-billing-in-byzantium" rel="nofollow" target="_blank">Please visit the RACP website</a> for a transcript embedded with citations. Fellows of the College can <a href="https://members.racp.edu.au/mycpd/mycpd_ne/add.cfm?rId=OnlineLearningAudioVideo&amp;h=1&amp;t=Pomegranate%20Podcast%20%2D%20Episode%2056%3A%20Medical%20Billing%20Part%201" rel="nofollow" target="_blank">claim CPD credits</a> for listening and additional reading.

Ep56: Billing in Byzantium

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