.
Cardiovascular prevention guidelines are based on robust evidence, yet their implementation in primary healthcare remains inconsistent due to systemic barriers, workload pressures and insufficiently adapted tools. The 2025 European consensus emphasizes the need for multidisciplinary teamwork, digital innovation and equity-focused strategies to strengthen prevention across diverse healthcare systems. Translating these recommendations into actionable, context-specific approaches is essential to close the evidence-practice gap and improve population cardiovascular outcomes.
There has been an increase in the use of mobile X-ray imaging services (MXIS) in residential aged care facilities (RACFs). Nurses, as key healthcare professionals, play a dynamic and critical role in a resident’s health, care and well-being journey that includes imaging. This exploratory study examines RACF nurses’ experiences and perspectives on the effectiveness of MXIS, with a focus on its contribution to continuity of care and resident wellbeing. This study employed a qualitative exploratory approach. Thirteen nurses were recruited through purposive sampling technique from five RACFs and one hospital site offering MXIS. The data were collected through in-person, semi-structured interviews that were transcribed verbatim. Initial coding was conducted, followed by a thematic analysis to identify key themes and their corresponding subthemes. Three key themes were identified: (1) before medical imaging assessment, (2) at the point of medical imaging referral decisions, and (3) medical imaging and outcomes. The RACF–MXIS journey spans from the initial imaging request to post-imaging follow-up. Nurses described navigating a complex, hierarchical referral system involving medical professionals while also participating in flexible, shared decision-making with family members and residents. Although MXIS was widely praised for improving access and enhancing resident outcomes, delays were frequently reported due to limited availability of general practitioners, scope-of-practice restrictions, and resource constraints. The implementation of MXIS in RACFs is shaped by complex clinical, ethical, and systemic factors, with nurses playing a central role in coordinating resident imaging pathways. Strengthening nursing authority through targeted MXIS training, collaborative frameworks, and equity-focused competencies can enhance responsiveness and resident-centred care. Policy and practice reforms that empower nursing leadership are essential to achieving timely, compassionate, and integrated diagnostic outcomes in aged care.
BACKGROUND:Classical leptomeningeal disease (cLMD) impacts the entire craniospinal axis, but isolated parenchymal metastases sometimes display focal leptomeningeal extension (fLME) without diffuse LMD elsewhere. We assessed whether patients with fLME can be managed with stereotactic radiation (SRS/SRT) as opposed to whole brain/craniospinal radiation without excess development of marginal recurrences or subsequent cLMD. METHODS:We identified 796 patients with 2,354 newly-diagnosed brain metastases (BrM) without cLMD at diagnosis managed at a tertiary center between 2007 and 2022. Each metastasis was assessed for fLME, defined as isolated leptomeningeal extension of an intact BrM without cytologic or radiographic evidence of cLMD. Multivariable Fine and Gray's models were constructed for the primary outcomes of local recurrence and cLMD development. RESULTS:Among 796 patients, 138 (17.3%) displayed evidence of fLME, corresponding to 185 of 2,354 (7.9%) BrM. Patients with versus without fLME did not display excess local recurrences (1-year rate: 4.5% vs. 8.2%, respectively, P = .14; multivariable HR 0.56 [95% CI 0.30-1.07], P = .08), including in lesions managed with SRS/SRT (1-year rate: 4.4% vs. 4.9%, respectively; P = .63; multivariable HR 1.21 [95% CI 0.58-2.50], P = .61). The presence of fLME was not a significant predictor of subsequent cLMD (1-year rate: 5.2% vs. 5.2%, P = .99; multivariable HR 0.87 [95% CI 0.44-1.71], P = .68), including following treatment with SRS/SRT (1-year rate: 6.2% vs. 4.1%, P = .83; multivariable HR 0.92 [95% CI 0.36-2.39], P = .87). CONCLUSIONS:We describe a novel entity, fLME, which displays patterns of intracranial failure similar to parenchymal BrM. Stereotactic approaches may be viable in this population.
Abstract Rationale Ralinepag is a potent, once-daily, oral, highly selective IP receptor agonist. Ralinepag pharmacokinetics mimic parenteral prostacyclins and can provide continuous receptor engagement, with potential for sustained efficacy and improved tolerability. ADVANCE OUTCOMES (NCT03626688) was a multicenter, global, randomized, double-blind, placebo-controlled, morbidity and mortality study to evaluate the efficacy and safety of ralinepag in participants with pulmonary arterial hypertension (PAH). Methods In this event-driven study, participants with PAH were randomly assigned (1:1) to receive ralinepag or placebo, in addition to their standard of care PAH-specific background therapy. Dosing was individualized and titrated based on tolerability and clinical response. No dose ceiling was specified. The primary endpoint was time to first adjudicated clinical worsening event. Secondary assessments include changes from Baseline to Week 28 in N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walk distance (6MWD), WHO Functional Class (FC), and health-related quality of life measures. Participant safety was monitored throughout the study. At the time of submission, treatment assignments and results remain blinded. Results The study completed enrollment in June 2025 with headline efficacy results expected in the first half of 2026. The full analysis dataset totals 687 participants from 30 countries distributed across five continents (Table 1). The population was primarily white (80%) with a mean age of 52 and a median time since diagnosis of 2.3 years. Sixty-two percent were classified as idiopathic or heritable PAH, 28.2% PAH due to connective tissue disease, 4.1% congenital heart defect, 3.1% drug/toxin induced, and 2.6% due to HIV infection. At baseline, participants had been receiving background PAH treatment for a median of 1.8 years (range, 0.09 to 22.7) and 80% of participants were receiving 2 background PAH therapies. Overall, the population exhibited low risk characteristics, including a mean (SD) 6MWD of 439 (105) m, low median (IQR) NT-proBNP of 214 (85, 523) pg/mL, and 71% were classified as WHO FC II. REVEAL 2.0 risk scores correspond to these characteristics, with a median (IQR) of 5 (3, 7) and 74% being considered low risk at baseline. Conclusions The full analysis population for the ADVANCE OUTCOMES study represents an opportunity to determine the effect of once-daily ralinepag on patient function, disease progression, and survival in a largely low-risk PAH population receiving two background therapies. Sponsored by United Therapeutics This abstract is funded by: United Therapeutics
Perinatal education is delivered by maternity services to improve health literacy, health, and experience outcomes. The needs of parents when designing and implementing perinatal programs have been understudied. This study's aim was to understand the needs of expectant and new parents in relation to perinatal education and to apply these findings to guide the development and implementation of a new program. Following interviews with parents from a Queensland maternity hospital, thematic analysis revealed themes that were mapped to implementation science frameworks to inform implementation strategies. One metatheme, "navigating the journey," four primary themes, and eight subthemes were identified. This study identified factors that can be leveraged to support implementation success and highlights strategies to enhance implementation efficacy.
