For haematologists, myeloma remains one of the most challenging diseases we deal with, there is no ‘one-size-fits-all’ approach to the management of multiple myeloma, and this is especially true for relapsed or refractory disease. With the right choice of agents we can control the disease for many years , but how we sequence those agents and how we use them in combination really is something we’re still working out, and we’re often dealing with limitations from the Pharmaceutical Benefits Scheme. In this interview we talk through these challenges, to help navigate this journey in clinical practice.

Induction of labour is a daily occurrence in obstetric units around Australia, and rates of induction have been rising nationally for the past decade. The Australian Institute of Health and Welfare data shows that in 2020, 46% of first-time mums with an uncomplicated pregnancy had their labour induced. In this interview we explore new developments in the induction of labour.

Gastroenterology Miniseries (Part 3).

Multidisciplinary team meetings have proven efficacy in cancer management as well as being widely implemented in the management of chronic diseases like inflammatory bowel disease, however not all treating clinicians (particularly those in rural/regional areas, or even many of those in private practices) have access to these high quality and integrated meetings.

Given the potential for an MDT-based approach to potentially improve patient quality of care, patient satisfaction and patient outcomes, it only makes sense that such a service can be offered to the wider gastroenterology community.

In this interview we talk to Jake Begun, who along with his team at Queensland IBD have implemented the first dedicated state-wide virtual MDT in Australia.

Gastroenterology Miniseries (Part 2).

The past several years have seen an expansion in therapeutic options to care for our patients with IBD, with more agents to come in the near future.

Conventional therapies such as thiopurines, methotrexate, aminosalicylates and steroids have been supplemented by the tumour necrosis factor (TNF) inhibitors (ground-breaking when they first arrived), the anti-integrin vedolizumab, the antiIL-12/23 p40 inhibitor ustekinumab and, more recently, the JAK inhibitor tofacitinib over the past few years.

Our expectations and treatment goals have subsequently risen substantially, such that our aim for patients is to achieve sustained clinical remission, achieve endoscopic and possibly histologic and transmural healing, prevent complications and achieve as close to a normal quality of life as possible for our patients.

Despite the high prevalence of generalised anxiety disorder in Australia, identification and diagnosis is challenging as patients present with non-specific and varying symptoms. Further complicating diagnosis and treatment is the high prevalence of comorbidities, both physical and psychiatric. The complex interplay between management strategies for multiple conditions has significant impact on treatment selection. In this interview, we discuss these challenges, as well as a newly indicated treatment {agomelatine}.

SARS-CoV-2 infections continue to be a concern in Australia, and while the diagnosis and management of these infections are well understood, we less frequently hear about the diagnosis and management of secondary infections in people with COVID-19.  There are, of course, specific challenges in the diagnosis of secondary infections in COVID-19 patients. However, delayed diagnosis, has very serious consequences, given the high mortality associated with COVID-19 Associated Pulmonary Aspergillosis, or CAPA as it is now known.

Epilepsy Miniseries (Part 2):While the need to balance efficacy and safety when weighing up medication choices is well understood, the importance of tolerability can sometimes be underestimated. When it comes to anti-seizure medications, tolerability may carry more weight among people with refractory epilepsy. That’s because the impact of side effects, particularly mood, cognitive and behavioural adverse effects, on general wellbeing and quality of life can be significant. In this interview we are talking about the impact of antiseizure medication side effects on patients, and important tolerability considerations in epilepsy therapy.

Women’s Health: Talking about sexual health comes naturally to some women, but others may be hesitant to raise this topic with their doctor, even when they are going through menopause and experiencing changes to their sex life and difficulties in sexual arousal, sexual response and libido. In this interview we discuss reduced sexual desire in postmenopausal women, and the current treatment options available in Australia.

Women’s Health: Hypoactive sexual desire disorder (HSDD) is a common sexual problem in women that can negatively impact overall health and wellbeing, and is particularly prevalent in menopause. It is characterised as an absence of sexual thoughts or fantasies and/or lack of desire for sexual activity associated with personal distress and/or interpersonal difficulties, In this interview we discuss some common presentations of women with HSDD and how to diagnose and treat HSDD in different settings.

In this interview, we are speaking about epilepsy surgery and most particularly the use of Stereo-EEG in epilepsy surgery. Now epilepsy surgery is widely available for the management of adult and paediatric patients with drug-resistant seizures and is generally able to use non-invasive techniques to assess patients who are suitable candidates for surgery. Sometimes though we need more invasive techniques and I guess all the time I was in training the stereo-EEG, it was something weird that people did in France. We were familiar with seeing these remarkable x-rays with people with heads full of electrodes and wondered why they were doing it. But stereo-EEG has become immensely popular in recent times for various reasons and can be used to guide very successful surgery in patients who otherwise would not have had the opportunity to access it.