Pomegranate Health

Spirometry reference equations are central to differentiating obstructive ventilatory defects, like asthma and bronchiectasis from restrictive ventilatory defects, like sarcoidosis and idiopathic pulmonary fibrosis. Across the population, the metrics of lung function testing fall out on a bell-curve, and a person’s predicted score if health can be determined by putting their sex, age and height into a reference equation.

The shape of this bell curve does change from one population group to the next and it was classically thought that the ethnicity was an important driver in this. As such, race-specific equations were developed to provide an adjusted reference value appropriate to the individual patient. In recent years, however, it has been questioned whether ethnicity and genetics are as much a driver as are structural differences in exposure to modifiable factors. 

In a paper published in the RACP’s Internal Medicine Journal, researchers asked what effect it would have on an Australian patient cohort if diagnostic classification of chronic respiratory diseases was done using race-neutral equations of lung function instead. 

Key Reference
Implications of race-neutral equations on interpretation of lung function in Australia [Intern Med J. 2026]

Guests
Dr Daniel Tan PhD (Royal Melbourne Hospital; Monash Health; University of Melbourne)
Dr Helen Luo (Monash Health)
Professor Paul King FRACP PhD (Monash Health; Monash University)
 
Production
Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP. 

Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list.

One in twenty Australian women of reproductive age are treated with intravenous iron supplementation, almost exclusively with ferric carboxymaltose. Usually sold under the name Ferinject or also Ferricarbo and Ferivo, this formulation is well-known to reduce serum phosphate in 50 to 70% of patients taking it, recently published findings reveal that it is associated with a significant increase in fracture risk and osteomalacia.
 
Cohort studies presented in July in the journal Blood showed that the risk of bone events in the seven years after a single infusion was two to three times higher in women receiving ferric carboxymaltose, compared to those receiving ferric derisomaltose, also known as Monofer. 

The researchers followed up these observations with experiments in a mouse model of anaemia, indicating that the iron is deposited directly in developing bone. The inhibitory action on development bone-forming cells seem to occur independently of previously known signaling pathways.
 
 In this podcast we hear from lead investigator, Professor Heinz Zoller of the Medical University of Innsbruck and Christian Doppler Laboratory for Iron and Phosphate Biology. Professors Luke Grzeskowiak (Flinders University, Adelaide) and Ian Morison (University of Otago, Dunedin) also discuss the implications of these findings for prescribing, regulation and funding of iron infusions in Australia and New Zealand.

Chapters
8:58     Cohort studies showing fracture risk
24:37   Mouse models and molecular pathways
29:45   Other risks of hypophosphataemia
42:19   Prescribing landscape

Guests
Professor Heinz Zoller (Medical University of Innsbruck; Christian Doppler Laboratory for Iron and Phosphate Biology)
 Emeritus Professor Ian Morison PhD FRCPA(Haem) (Awanui labs; University of Otago, Dunedin)
Associate Professor Luke Grzeskowiak PhD FANZCAP (Flinders University; Monash University; SA Pharmacy)

Production
Production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Blacklight’ by John B. Lund and ‘Abyss’ by Luwaks. Feedback on this episode kindly provided by doctors Fionnuala Fagan, Marion Leighton, Aidan Tan, David Arroyo, Hugh Murray and Maansi Arora, as well as advisors Paul Cooper PhD and Kathryn Smith PhD. Image by Stockbyte purchased from Getty Images. 

Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list.

Key References
Ferric carboxymaltose increases fracture risk in patients and reduces bone formation in mice with iron deficiency anemia [Blood. 2026]
A bone to pick with ferric carboxymaltose [Blood. 2026]
Increasing utilisation of intravenous iron among Australian women of reproductive age, 2013-2024: an Australian population-based study [IMJ. 2026]
 

In part 1 of this series we talked about the efficiency gains from use of ambient scribes observed in some hospital settings. In this episode we discuss other opportunities that arise from granting large language models access to all the notes and test results in the patient record. 

The potential comes most clearly into perspective in regards to discharge summaries. Discharge from hospital is a notorious example of discontinuity in care, with up to half of discharged patients experiencing a related medical error over a year. This results from delays in the release of discharge letters to community practitioners, and gaps or misunderstandings in the communications contained within them. 

Inconsistent standards of clinical documentation also lead to inaccurate coding of clinical activity that fails to reflect the true complexity of care. This means that hospitals are inadequately remunerated through the activity-based funding model for Australian public health services. For private practitioners, poor documentation of clinical encounters also exposes them to risks should they ever be investigated by the Professional Services Review about their billing activity. We also question the light touch that regulators take towards ambient scribes and large language models. 

Chapters
1:20     Reliable discharge summaries
11:53   Improved clinical coding
21:55   Safety regulation
30:51   Patient satisfaction

Guests
Dr Andrew Vanlint FRACP AFRACMA (North Adelaide Local Health Network; Adelaide University; Genesis Care)
Professor Ian Scott FRACP MHA MEd (Princess Alexandra Hospital, Metro South Health; University of Queensland)
Dr Adam Brand FACEM MPH (Gold Coast University Hospital)   

Production
Production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Midnight sun serenade’ and ‘End of the Ocean’ by Tellsonic and ‘Multicolor’ by Chill Cole. Feedback on this episode kindly provided by Dr Aidan Tan, Dr Simeon Wong, Dr Joseph Lee, Assoc Prof Paul Cooper PhD and Loryn Einstein. Image by da-kuk purchased from Getty Images.

Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list.
 

The burden of clinical documentation is one of the top reasons given for job dissatisfaction in medicine. Physicians typically give up an hour of personal time per shift to complete paperwork and the frustration is experienced by patients too, who sometimes feel that their doctors are more focused on the computer. The promise of ambient AI scribes is that they could slash the time you spend hovering over the keyboard and in general practice some 40 percent of Australian GPs are using scribes already. Among private specialists, adoption been slower and use of ambient scribes in hospital has been prohibited until now. 

In this podcast we hear the outcomes of two pilot studies of ambient scribes in Queensland’s public hospital networks; the quality of scribe outputs and the errors you need to keep an eye out for. The efficiencies gains differ from the clinic, to the ward round to the ED, and not all specialty consults benefit to the same degree. And while some have raised questions about the gaps in skills that might result from this technology, todays’ guests expand on the training opportunities that it creates too. Part 2 of this series explores further benefits from giving large language models access not just to the consult, but the whole patient record. 
 

Chapters
6:58     Quality of outputs from ambient scribes
17:53   Real world time savings
21:55   Ward Rounds and the ED 

Guests
Dr Andrew Vanlint FRACP AFRACMA (North Adelaide Local Health Network; Adelaide University; Genesis Care)
 Professor Ian Scott FRACP MHA MEd (Princess Alexandra Hospital, Metro South Health; University of Queensland)
Dr Adam Brand FACEM MPH (Gold Coast University Hospital)   

Production
Production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘End of the Ocean’ by Tellsonic and ‘Multicolor’ by Chill Cole. Feedback on this episode kindly provided by Dr Aidan Tan, Dr Simeon Wong, Dr Joseph Lee, Assoc Prof Paul Cooper PhD and Loryn Einstein. Image by da-kuk purchased from Getty Images. 

Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list.
 
 

The avian flu H5N1 known as 2.3.4.4b has been tearing around the globe since 2021 causing significant mortality in sea birds and mammals. The Australian and New Zealand mainland were the last holdouts, but this virus was first detected near Esperance, WA on June 20th 2026 and then near Wellington, NZ on Jul 14th. Both cases involved a bird known as the brown skua, which travels across the Southern Ocean, and by August 24th the H5N1 had also been confirmed in fur seals in South Australia and associated with one seal death. While risk to humans from this clade is currently negligible, ID experts are concerned for the health of this domestic poultry and livestock, which have been hard hit internationally, and wild birds and marsupials which would be much harder to protect. This podcast discusses the surveillance and response from a One Health perspective. 

Guests
Michelle Wille PhD (University of Melbourne; Doherty Institute; WHO Collaborating Centre for Reference and Research on Influenza)
Associate Professor Michael Nissen MBBS FRACP FRCPA FFS (Royal Brisbane Hospital; Research Director, Prince Charles Hospital; University of Queensland.

Host
Associate Professor Sanjaya Senanayake FRACP (Canberra Hospital; Australian National University)

Production
Production by Mic Cavazzini DPhil AND Dr Candice Holland, ASID. Thanks also to Inge Meggitt, events coordinator at ASID. Music licenced from Epidemic Sound includes ‘Exploring the Lake’ by View Points and ‘Emerlyn’ by Valante. Image copyright ASID (2026).

Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list.
 
 

Allergies to first-line antibiotics complicate care, and use of broad-spectrum alternatives is associated with prolonged hospital stays and increased rates of admissions to ICU. It also makes emergence of antimicrobial-resistant pathogens more likely. Ten to 16% of adult patients are marked in the record as being allergic to penicillins but the majority of these labels are applied inaccurately or have become outdated over time. 

While skin-prick testing is a safe and reliable way to delabel patients who can tolerate penicillin, it is resource-intensive and requires trained allergists on-site. In this podcast we describe a decision tool called PEN-FAST that helps to quickly identify patients suitable for direct oral challenge in almost any setting. Guests include two of the leading academics behind the validation and scale-up of this algorithm. 

Guests
Prof Jason Trubiano FRACP FAAAAI‍ (Austin Health, Director of Infectious Diseases; Peter Doherty Institute for Infection and Immunity)
Prof Suran Fernando FRACP FRCPA PhD OAM (recent!) (Royal North Shore Hospital; University of Sydney)
Dr Fionnuala Fagan FRACP FRCPA (Dunedin Hospital; Otago University) 

Chapters
10:42   PEN-FAST tool
22:23   Multi-site testing of PEN-FAST
28:27   Non allergist-led testing
32:42   System-wide outcomes

Production
Production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘The Bayou’ and ‘Feels like I’m going Crazy’ by Tigerblood Jewel. Feedback on this episode kindly provided by Dr Marion Leighton, Dr Robin Sia, Dr Aidan Tan, Dr Hugh Murray, Arnika Martus and Paul Cooper PhD. Image courtesy of Thirteen of Clubs at Flickr.

Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list. 

This popular episode was first published in 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.

There are diagnoses that should raise red flags for driving fitness in various specialty areas, and a clinician can be drawn into the issue by two main pathways. The more straightforward 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 is when the clinician detects a new or worsening condition in a patient who is already licenced. They are expected to warn their patients off driving and in some jurisdictions to report them to the DLA if this advice isn't being heeded.

Chapters
7:48     Legal expectations on a practitioner
17:20   Medical conditions affecting to fitness to drive
24:48   Considering age in driving performance
35:28   Approaching driving ‘retirement’
45:28   Updates to national standards

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 (University of UNSW)
Marilyn Di Stefano PhD (Victorian Department of Transport and Planning)
Serge Zandegu (Victorian Department of Transport and Planning)

Production
Written and produced by Mic Cavazzini DPhil. 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. Music licenced from Epidemic Sound includes ‘Knowledge is Power’ by Matt Large. 

Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list. 

This is the second episode of in the series, [Contagious Conversations] from the Australasian Society for Infectious Diseases. Expert guests in this series will come from right across the interface of research, clinical care and public health.

In today’s episode we look at the immense progress that has been made over three decades in the management of HIV. Once a fatal diagnosis, the disease can now be completely controlled by anti-retroviral therapy. Access to prophylactic treatment has also made a huge impact on rates of transmission in the community although barriers still remain to equitable access.

Guests
Professor Sharon Lewin OA FRACP PhD (Peter Doherty Institute for Infection and Immunity, Director; University of Melbourne; Cumming Global Centre for Pandemic Therapeutics, Director)
Professor Dato’ Dr Adeeba Kamarulzaman FRACP FASc (Monash University Malaysia, President & Pro Vice-Chancellor; Centre of Excellence for Research in AIDS).
Richard Keane (Living Positive Victoria, CEO)

Host
Associate Professor Sanjaya Senanayake FRACP (Canberra Hospital; Australian National University)

Production
Production supported by Mic Cavazzini DPhil, and the Viral Hepatitis and HIV Special Interest Group particularly Dr Emma Paige and Dr Sushena Krishnaswamy. Thanks also to Inge Meggitt, events coordinator at ASID. Music licenced from Epidemic Sound includes ‘Exploring the Lake’ by View Points and ‘Emerlyn’ by Valante. Image copyright ASID (2026).

Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list.
 

This episode is a teaser for RACP LIFT 2026, a series of in-person events to promote Learning, Innovation and Forward Thinking. Coming up on the 1st of August in Melbourne there will be a Rapid Fire Clinical Update on Respiratory medicine, infectious diseases and critical illness. And on the 20th In Brisbane another one themed around Palliative medicine and also population health. In March, the Sydney RACP offices hosed a meeting on cardiometabolic and vascular health, and the talk shared here covers everything a generalist needs to know about metabolic dysfunction-associated fatty liver disease. 

The seminar was presented by Professor Jacob George, Director of the Storr Liver Centre at the Westmead Institute for Medical Research, and author of over 1300 peer-reviewed papers. He explains why fatty liver disease is a "canary in the coal mine" for metabolic health more generally, how to diagnose using scans and bloods, and the use of the FIB-4 index. Professor George also describes how patients can be stratified and managed for risk of more complex liver disease and reviews outcomes from the latest pharmacological interventions. 
 
Guests
Professor Jacob George FRACP PhD FAASLD (The Westmead Institute for Medical Research, Centre Director; University of Sydney)

Chapters
3:09     MAFLD is a positive definition
4:29     How common are MAFLD and MASH?
5:58     How do you define metabolic health?
9:02     Mortality and cardiovascular outcomes in patients with T2D
10:07   MAFLD in primary care guideline
12:40   Current and future therapies for MAFLD / MASH
15:24   Management algorithm for MAFLD
16:50   Test your knowledge

Production
Rapid Fire Clinical Update developed by LIFT advisory group and hosted/recorded by RACP Events team and. Podcast production by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Kryptonite’ by Blue Steel and ‘Simmering Anxiety’ by Christian Andersen and ‘Little Liberty’ by Paisely Pink. 

Visit the Pomegranate Health web page for a transcript and supporting references. Add educational activity to MyCPD. Subscribe through any podcasting app or our email alerts list.
 

Adverse drug events cause 5-15% of admissions to hospital and drug-drug interactions make up about a fifth of these. Most common are pharmacodynamic situations where two drugs have a similar outcome thereby overdoing the intended outcome. Pharmacokinetic interactions are more complicated to understand as they’re more indirect. For example, while medications are cleared by oxidative metabolism in the liver and gut, there are many drugs that interfere with the function of the cytochrome enzymes responsible. This can result in clearance of the first drug at too fast or too slow a rate.

Polypharmacy has become more frequent over the decades with more than half of people over the age of 75 on five or more prescriptions. This episode examines some of the systems that have led to current rates of polypharmacy, and strategies for deprescribing safely in a given patient. We're REWINDing it nine years after it was first published to celebrate the career of Professor Ric Day who has just retired after sixty years of service at St Vincent’s Hospital, Sydney. He has been a much-appreciated clinician and prolific research academic with several hundred published papers that have been cited more than forty thousand times.

Chapters
0:50 Prevalence of drug interactions
5:52 Pharmacodynamic vs pharmacokinetic interactions
9:25 Cytochrome enzymes
17:33 ACE inhibitors and more
26:48 Strategies for deprescribing

Guests
Professor Richard Day AM MBBS, FRACP (St Vincent’s Hospital; UNSW),
Professor Sarah Hilmer AM PhD FRACP FAAHMS (Royal North Shore Hospital; Kolling Institute/ USyd).
 
Production
Produced by Mic Cavazzini DPhil. Music courtesy of FreeMusicArchive includes ‘Flying Pea’ and ‘Cherry Blossom’ by Daddy Scrabble and “Manly Nunn Steps Out” by Doctor Turtle. Music licenced from Epidemic Sound includes ‘Train Ride’ (Instrumental) by Alex Kehm and ‘Yellow Leaf’ by Autohacker. Image adapted for RACP

Add educational activity to MyCPD as educational activity or visit web page for a transcript and references.

Key References
Life-threatening drug interactions: what the physician needs to know [Internal Medicine Journal]
Polypharmacy in older people: when should you deprescribe? [Medicine Today]