Antimicrobial Stewardship

Tired of getting yellow cards from the infectious diseases team for prescribing meropenem for 3 months?

Sick of Scott appearing behind you with a cat o’ nine tails to administer the requisite antibiotic punishment?

Well this episode has it all – what is antimicrobial stewardship? why do so many people care about it? what can you do to avoid being on the pharmacy’s wanted list? Most importantly, we expertly blend in some music and cold openings for the first time. Jump in, the water is warm!

Pacemakers

2023 got you feeling out of rhythm? Finding yourself a bit behind the beat when it comes to pacemakers? Pour yourself a frosty, frothy, fibre-filled glass of your favourite plum juice and strap on your electric earmuffs. We’re going charging on an audio adventure from cathode to anode with Scott and Rahul which will help you nail pacemakers with aplomb!

Gram Negative Bacteria and Treatment

Nasty Bugs. You gotta treat ‘em! In this, truly, tremendous second antibiotic episode, Sleepy Scott, Deranged Davor, Crooked Bec (and Obama Zala) cover all the gram negative bacteria – from microbiology to antibiotics and resistance. Believe me, you’ll be tired of winning!

Depression part 2 – evaluation

This is part 2 of our series on depression. Davor and Dean chat about how to evaluate someone you think might have depression. As fascinating as part 1 was, this is much more clinically relevant. Filled with Dean’s wisdom and clinical pearls, listen on if you want to smash your psych OSCEs or perhaps even to be a better doctor.

Depression overview – definitions, epidemiology, pathophysiology

This episode is a bit of new thing we’re trying – interviews with our friends! As we’ve progressed in our careers, we’ve all started specializing and become increasingly unqualified to talk about large swathes of medicine. On the flipside, our mates have done the same thing in all manner of interesting fields, so we’ve decided to start utilizing this amazing resource.

In this episode, Davor talks to senior psychiatry registrar Dean Whitty about depression. This episode is an overview of the Black Dog – definitions, burden of disease and pathophysiology. To be completely honest, only the first 20 minutes or so are directly clinically applicable. If you decide to stay onboard for the whole journey though, you’ll get Dean’s fascinating thoughts on whether you can make epidemiological conclusions across cultures, the different models of depression and how you might be able to unify them, as well the inherent tension between the biological and psychosocial approaches. We’re planning on following this one up with episodes on evaluation and management.

Hypertension Part 2 (Drugs and their Mechanisms)

Image result for old people partying | Cool kids, Old people, University of  california irvine

Curious about what all those party drugs you’ve been taking with your grandma down at the local aged care facility are? Wondering why you always need to cough after you’ve taken your morning ramipril?

Jump on board the high pressure conga line with Rahul and Davor as we cover the ins, outs and sideways of hypertension therapy.

Radiculopathy

Episode on radiculopathy!

Davor, Bec and Scott sit down and chat about nerve roots. Well, to be honest, it’s more like Davor relentlessly interrogates Bec and Rahul about radiculopathy for an hour. Although ethically questionable, it appears to have worked because by the end they seemed to understand which nerve roots are damaged by which disc, how to differentiate between L5 and other causes of foot drop and lots of other cool stuff. Hopefully you will too!

This is also the first episode we recorded with our new equipment. We saw some of the feedback about audio issues, and we reckon things sound much, much better with our new gear. If you’ve stopped listening because you were sick of it sounding like one of us was in a different room, give this ep a whirl.

Hypertension Part 1

We’re back with a mammoth topic. Often consigned to a 1-liner in the past history – it’s time to find out just how little you know about the silent killer. Much like the mounds of hair that accumulate in your drain pipes, hypertension is known for a sudden and unexpected day-wrecking by blocking up your plumbing.

Sit back, grab the saltiest nuts you can find and prepare for part 1 of our bigger than Ben-Hur epic on the mechanisms and pathophysiology of hypertension.

Low back pain

Low back pain! Rahul and Davor discuss one of the most common presentations in medicine. What are the most common causes? What are the most serious causes? Who do you image? What on earth does Rahul mean when he says “test the anal reflex”? Listen in to find out the answers to these eternally-vexing questions and more.

Functional Neurology

See the source image

There’s been a lot of demand for off in the weeds neurology podcasts. Luckily we have our arcane neurology specialist Davor ‘The Slovenian Sledgehammer’ Pavlin-Premrl ready and waiting.

Rahul and Davor discuss cartesian dualism and hysteria, and then after about half an hour of philoso-broing we get to some stuff that might (emphasis on the might) be clinically useful

Apologies for the sound quality – we are still working out some remote-casting CoVID solutions

Obstructive Sleep Apnoea

We’re back in the COVID era all the way from dirty Melbourne to breathe around your masks and cough on your food.

Have you been fighting with your bed-partner about excessive nocturnal noise emissions? Struggling to stay alert whilst reviewing the latest hydroxychloroquine ‘Orange’ Paper from the White House?

Well we’ve got the podcast to get you inspired before you expire. Strap on your CPAP mask and get ready to fly the skies of knowledge with Bec, Scott and Rahul.

Infective Endocarditis

Drugs. Death. Hidden infections. Bad mix tapes.No, you’re not tripping out on LSD at your uncle’s mail-order bride wedding, you’re just listening to MedConversations’ latest educational podcast packed full of infective endocarditis wisdom and copyright infringing references to one of our most beloved fictional drug dabblers.

Glomerulonephritis Part 2 – Nephritic Syndromes

If you naively thought that part 2 of glomerulonephritis would never come and you could spend the rest of your summer wallowing in glorious ignorance of those confusing glomerulonephritidis then you were wrong. Here are the rest of the nephritic syndromes in all their rosé tinted beauty.

https://media.blubrry.com/medconversations/content.blubrry.com/medconversations/Glomerulonephritis_Part_2-Nephritic.mp3

Polyneuropathies

Davor’s back doing his Davor thing and sprucing neurology to the world (whether they want to hear about it or not).

So, if the holiday blues have you feeling numb to the world or passion for the new year has you unexpectedly weak at the knees then tune in because, as usual, we’ve got the balm for your blues.

Join Rahul and Davor as they lead you with a high-stepping gait through the world of peripheral neuropathies. Perhaps after this you won’t feel so lost in the nerve network…Emphasis on the perhaps.


Fluid Assessment

Has your troubled history of pot plant homicide led to legal action over your plant carer registration AND/OR  your grandmother giving up on you and gifting all her cuttings to her previously second favourite grandchild? We can’t help you with your congenitally absent green thumb AND/OR unlovable personality but this practical episode on clinical fluid assessment will keep your patients from either wilting away or drowning in bottomless bags of normal saline.  

Hypercalcaemia

Dust off your ear horn, ruffle up your ruffles and prepare your first-born son for a painful but career-favouring transition. Bec and Scott are back and hitting every high note as they croon, roar and trill their way through hypercalcaemia

Glomerulonephritis Part 1 – Nephrotic Syndromes

Get your amphora ready to catch some of the golden stuff and see if you have the blood and the protein to raise some nephrologist eyebrows. We’ve heard the requests of the people and taken on GN in an epic two-part podcast. This podcast will deal with general approach to glomerulonephritis as well as nephrotic syndromes.

On another note, despite the fact that we are known for our outstanding sound quality we are looking to improve the quality of MedConversations. This means more frequent episodes with better sound.

We’ve started a Patreon page where you can donate as little or as much as you like to help the cause. Any amount at all is super appreciated and all funds will go towards improving the podcast.

Find us on Patreon at https://patreon.com/medconversations

Epilepsy Syndromes

Think you might have what it takes to join the extraordinary league of gentle-people against epilepsy? Well you’ll need some training first. Come join Davor and Rahul for a shake-down of the epilepsy world.

P.S. I tried my best to stop Davor from inflicting another neurology episode on us all, but the man is just so damn charismatic.

Diffuse Parenchymal Lung Disease (Interstitial Lung Disease)

Free your mind from the tyranny of the Lamestream media and discover the TRUTH about diffuse parenchymal lung disease (ILD) with your snowflake bustin’ hosts Rahul and Scott!

Its a long one, so buckle down with your extra doomsday preppin’ supplies.

Inflammatory Bowel Disease – Xmas Edition!

Merry Christmas from Medconversations with our long awaited ep on inflammatory bowel disease. Fake a smile and pretend its just the gift you wanted as Scott and Rahul explore the length of the disease from the mouth to the azathioprine. Get into the consumerist holiday spirit and share/comment this status for a chance to win an authentic Santa toilet seat cover to keep your own cheeks rosy this Christmas!

Hepatitis C

Call up your injection crew and gather around the gramophone, it’s time for Scott and Rahul to bring you the good news about Hepatitis C – there’s a cure and we’ve distilled it here ready for an acoustic injection. Keep the naloxone on standby, we’ll be your spiritual guides as we go deep!

Answer – HIV PEP Post 16/5/18

Which exposure would NOT be an indication for Post Exposure Prophylaxis (PEP) in an Australian (low HIV prevalence) context?

  1. A man presents after sharing needles with another man who he believes may be HIV positive.
  2. A woman presents following receptive anal intercourse with a HIV + source known to be well controlled on antiretroviral therapy
  3. A lady presents after unprotected vaginal intercourse with a man from a high HIV prevalence country
  4. A healthcare worker presents following a needlestick injury in a patient with poorly controlled HIV’

 

Answer B

New evidence from the partner study suggests that the chance of HIV transmission from a viral load suppressed source is negligible. This groundbreaking study of 1166 serodiscordant partners in whom the HIV+ partner had viral suppression reported 0 cases of HIV transmission between the partners, despite 22,000 condomless sex acts among MSM and 36000 among heterosexual partners. The study was powered to give a 95% upper confidence of 0.3/100 couple years of condomless sex, suggesting that the risk is lower than it was previously thought to be a few years ago.

Add in the the weight of new evidence about the morbidity benefits of ART in the SMART and TEMPRANO trials has led to recent changes in WHO and Australian ASHM, which now recommend starting antiretroviral therapy in almost all HIV patients.

A, C, and D would all be indications for PEP by Australian guidelines. B would not be a indication, nor would even unprotected receptive anal sex with a source with unknown HIV status from the standard Australian low prevalence community – although it could be considered if the source was from a higher prevalence group – eg a country with higher prevalence or a subgroup like IVDU. Remember, this more conservative administration of PEP reflects both new evidence and low Australian prevalence, and many countries might have higher prevalence or not have updated older more conservative guidelines yet.

 

For tons of extra information including probabilities of  transmission risks by different exposures and current indications for PEP check out ASHMs great guidelines here.

http://www.ashm.org.au/products/product/978-1-920773-47-2

And the 2016 WHO guidelines here

http://www.who.int/hiv/pub/arv/arv-2016/en/

THe PARTNER study is here

https://jamanetwork.com/journals/jama/fullarticle/2533066

Research – The How and Why

Ever pondered whether you might suit the professorial lifestyle? This episode, featuring special guests Dr. Adam Brown and Dr. Nitesh Nerlekar, will run through what the appeals of including research in your career are and some basics on how to get started. Drs. Brown and Nitesh are academic cardiologists from Monash Health in Melbourne and have mentored many medical students, junior doctors and PhD candidates in their nascent careers. So sit back, grab a Pina Colada and get caught in the research rain. 

Nitesh, Adam and Rahul (alongside a few other academic doctors) are running a research skills course in Melbourne at the Alfred Hospital over the weekend of May 19-20. This course will provide a more in-depth guide on the skills needed get some publications to your name and avoid some of the traps that many young doctors fall into. You can sign up at www.medcube.com.au