Pomegranate Health

Despite Australia’s wealth and low population density, community transmission of the infection has been observed in remote Aboriginal territories. In May 2022, TB was detected on the country of the Pitjantjatjara Yankunytjatjara people, the first outbreak in five years. Administratively the APY lands cover 100,000 km squared in South Australia, and they are closer to Alice Springs than they are to Adelaide. 
Important prevention and elimination work is conducted by visiting staff from the South Australia Tuberculosis Service based at Royal Adelaide Hospital some 1400km away on some rugged roads. The growth of that TB cluster to 11 cases over 18 months represented locally, an incidence rate of 390 per 100,000, among the highest in the world. 
Logistical barriers to control in this remote and under resourced setting included the fact that there was just one X-ray machine available to serve the entire region and the timely transport of blood sample assays was very difficult. Just as critically, there were barriers of trust to be overcome with the Aboriginal community, reliant on the cultural acumen of health workers like registered nurse Carolyn Gill. She was one of the authors of a Lancet paper along with respiratory physician Dr Simone Barry, and they describe the experience for this episode of Contagious Conversations from the Australasian Society for Infectious Diseases.

Guests
Associate Professor Simone Barry FRACP PhD (Royal Adelaide Hospital; Director, South Australian Tuberculosis Service;  University of Adelaide).
Carolyn Gill (Royal Adelaide Hospital; South Australia Tuberculosis Service)

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, administrative 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.

Further Resources
Overcoming barriers in tuberculosis control: a case study from a remote community of South Australia [Lancet Reg Health West Pac. 2025]

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.