Jo Wu

Introduction:
Cardiovascular disease (CVD) remains a leading cause of death and disability both globally and in Australia [1,2]. In 2022, an estimated 1.3 million Australian adults were living with CVD [2]. Up to 57% of CVD cases and 22% of all-cause deaths are attributable to key modifiable risk factors, highlighting the substantial potential for prevention [3]. Cardiovascular rehabilitation and secondary prevention programs are highly effective strategies for reducing repeat cardiac and new stroke events, improving quality of life, and supporting long-term cardiovascular health [4–6]. The benefits of cardiovascular rehabilitation are well established and widely endorsed by national [4] and international clinical practice guidelines [5,6].

Cardiovascular rehabilitation has traditionally been delivered via structured, multidisciplinary programs that provide comprehensive risk factor management through supervised exercise training, education, psychosocial support, and by supporting adherence to evidence-based medical therapy [4,7,8]. Programs are delivered across a range of healthcare settings (public, private and community health) and through different modes, including in-person, telehealth, and digital/virtual formats. Models of care also vary and may include centre-based, home-based, hybrid and hub-and-spoke approaches [9].

Contemporary thinking frames cardiovascular rehabilitation within the broader concept of lifelong cardiovascular health, rather than as a time-limited intervention [10]. The 2026 World Heart Federation Roadmap on cardiac rehabilitation [9] defines a cardiovascular health programme as:

“...the systematic provision of ongoing care and support for individuals with, or at elevated risk of, CVD, which in combination with all aspects of evidence-based prevention and rehabilitation will lead to lifelong cardiovascular well-being. Care should be person-centred and encompass all aspects of lifestyle optimisation, clinical management of risk factors, psychosocial support, and adherence to guideline-directed medical therapy.”

This definition reinforces the central role of cardiovascular rehabilitation in supporting lifelong cardiovascular health [10].

In 2014, the Australian Cardiovascular Health and Rehabilitation Association (ACRA) published the inaugural national core components for cardiovascular rehabilitation and secondary prevention to guide practice and promote consistent, high-quality care [11]. Over the past decade, remote and hybrid models, including telehealth, virtual platforms, digital programs and wearable technologies, have gained widespread acceptance, accelerated by the COVID-19 pandemic and rapid technological advances [12].These contemporary delivery modes offer opportunities to improve equity of access, flexibility, and person-centred care, while addressing evolving workforce and health system needs [13]. Regardless of delivery format, all cardiovascular rehabilitation programs should comply with all core components and evidence-based best practices. Maintaining robust standards is essential to ensure quality, consistency, and equity of care across diverse settings.

The aim of this position statement was to update the core components of cardiovascular rehabilitation in Australia to reflect societal, technological, and health system changes since its first iteration in 2014 [11], whilst reaffirming the fundamental principles and enduring evidence base. Recognising variation in local contexts and resources, this document is not intended to be prescriptive and does not function as a clinical guideline. Rather, it informs the delivery of evidence-based, context-sensitive cardiovascular rehabilitation and defines the core components needed to promote lifelong preventative care following a cardiovascular diagnosis.

Methods:
This position statement was developed by a nationally representative, multidisciplinary writing group composed of clinician and academic ACRA members convened through an expression-of-interest call. Additional subject matter experts and two consumers were also appointed. The group reviewed the 2014 version, identified areas requiring update, and undertook an iterative process of evidence gathering and literature synthesis. Subgroups were assigned to draft specific sections based on their areas of expertise. They critically appraised the most current and highest-quality evidence, including meta-analyses, systematic reviews, randomised controlled trials, international guidelines and relevant Australian clinical guidelines or guidance documents to ensure national coherence. Although a comprehensive, systematic search was not conducted, the co-authors used a structured, consensus-driven approach to identify and assess available evidence, drawing on their disciplinary expertise to ensure that the most contemporary and methodologically robust sources informed each section. This process included cross-checking key evidence across subgroups to maintain consistency and rigour. All authors contributed to iterative revisions and resolved discrepancies through discussions. The position statement was internally peer reviewed by three independent international experts. The final manuscript was reviewed and endorsed by the 2026 ACRA Executive Management Committee.

Background
Stress adversely affects nursing students’ well-being and clinical communication. This study examined the effects of a newly developed mindfulness-based nursing education programme (MINDNUEDU) on perceived stress, resilience, and heart rate variability (HRV) among nursing students.

Methods
A quasi-experimental, two-arm pre–post design was conducted at a university in Taiwan. Seventy nursing students were allocated to either an eight-week mindfulness intervention group (n = 36) or a standard curriculum control group (n = 34) based on academic scheduling constraints. Primary outcomes were perceived stress, measured using the Perceived Stress Scale, and resilience, measured using the Connor–Davidson Resilience Scale. Secondary outcomes included HRV indices (SDNN, RMSSD, and HF power), assessed within the intervention group. Adjusted between-group differences over time were analyzed using Generalized Estimating Equations, controlling for baseline values and year of study.

Results
After adjustment for baseline differences, significant Group × Time interactions were observed for perceived stress (p = .004) and resilience (p < .001), indicating greater improvements in the intervention group compared with controls. The mean increase in resilience exceeded the minimal clinically important difference. A significant dose–response relationship was also identified, with higher attendance linearly associated with greater reductions in stress (p = .003) and greater gains in resilience (p = .004). Within the intervention group, session-level analyses demonstrated acute post-session increases in parasympathetic-related HRV indices across several weeks.

Conclusions
Participation in the MINDNUEDU programme was associated with reduced perceived stress and increased resilience among nursing students. While physiological findings reflected short-term autonomic changes during sessions rather than confirmed long-term trait adaptation, the results support the feasibility of integrating structured mindfulness training into nursing education. Randomized controlled trials with longitudinal follow-up are needed to confirm sustainability and causal effects.

Background
Cardiac rehabilitation is a structured secondary prevention program delivered in three phases that aims to improve health outcomes, quality of life, and economic benefits for people with cardiovascular disease. Despite its proven effectiveness, participation in Phase II cardiac rehabilitation remains low due to a range of individual, clinical, logistical, and health‑system barriers.
Aim
Our study aimed to identify contemporary trends and factors associated with cardiac rehabilitation referrals and assessments for patients undergoing elective percutaneous coronary intervention.
Methods
We performed a secondary analysis using extracted data for all patients who underwent elective percutaneous coronary intervention between July 2014 and December 2021 among six public hospitals in Queensland, Australia.
Results
Of 3081 patients, 1845 (59.9%) had cardiac rehabilitation referrals within 30 days of hospital discharge. Of the 1845 patients with a referral, 1022 (55.4%) underwent an initial assessment, and of those, 400 (39.1%) completed a final assessment. There was variation in the trends of referrals (declining from 69.7% to 57.1%), initial assessment (declining from 62.4% to 51.1%), and final assessment (increasing from 32.2% to 40.5%) across the study period. Those who stayed overnight were 10.2 times more likely to receive a referral than those who were discharged the same day. However, overnight stay was not a factor associated with completing the initial and final assessments.
Discussion
Cardiac rehabilitation participation showed decreasing referral and initial assessment rates, with slight improvement in final assessment completion. Although overnight stay strongly increased referral likelihood, discharge status did not influence engagement once patients entered the program.
Conclusion
Referral rates were moderate, and same-day discharge patients had lower odds of referral. More work is needed to understand barriers to referral, especially for same-day discharge patients. Also, strategies are required to promote sustained participation in cardiac rehabilitation activities.

Background: Older adults are at high risk of falls, and head injuries following these events can have devastating consequences. The In-Patient Post Fall Clinical Pathway is a tool utilised in many hospitals in Queensland, Australia, to guide the need for CT brain imaging post-inpatient fall. This audit aimed to assess the use of CT imaging following inpatient falls in older adults, evaluate adherence to the In-Patient Post Fall Clinical Pathway, and explore factors associated with serious head injury. Methods: A retrospective audit was conducted across two regional Queensland hospitals over 2.5 years. Falls involving patients aged over 65 years were included. Data were analysed using descriptive and bivariate statistical tests. Results: Among 874 eligible falls, the mean patient age was 80.4 years, and approximately two-thirds were male. While 90.6% of patients who had fallen met clinical pathway criteria for a CT head scan, only 50.1% of them received a scan. Serious head injuries were uncommon (2.25% of total falls), with subdural haematoma being most frequent. Only one patient underwent neurosurgical intervention. No missed serious injuries were identified. No individual characteristic was significantly associated with serious head injury, although trends were observed for unwitnessed falls, falls from bed, falls with a head strike, new symptoms four hours post-fall, and anticoagulant use. Conclusions: There is a gap between clinical pathway recommendations and imaging practices, with clinicians often relying on judgement over strict adherence to guidelines. Further research is needed to inform evidence-based and practical decision-making to balance imaging use with clinical risk.

Aim: To explore Taiwanese adolescents' experiences with asthma.

Design: Exploratory qualitative study using semi-structured face-to-face interviews, framed within Bronfenbrenner's Ecological Systems Theory.

Methods: Data were collected until saturation was reached. The interviews focused on adolescents who experienced asthma during their developmental stages. Data were managed using NVivo V12 program.

Data Sources: This study was conducted at an outpatient paediatric clinic located within a tertiary teaching hospital (anonymised for review) in Taiwan.

Results: Seventeen Taiwanese adolescents with asthma were interviewed, resulting in the emergence of eight main themes: 'asthma exacerbation and its impacts’, ‘maintaining physical comfort’, ‘increased compliance with medication or treatment regimes’, ‘peer interactions’, ‘available resources at school’, ‘uncertainty’, ‘changes in social participation to manage symptoms’, and ‘conflicts in asthma care across different generations of family caregivers’.

Conclusion: Taiwanese adolescents with asthma experience regular disruptions to their social participation and school attendance. As a result, maintaining peer relationships may be challenging.

Implications for the Profession and/or Patient Care: Understanding the experiences of adolescents with asthma provides insights in optimising asthma care at home and school settings. Our findings highlight the importance of enabling teachers to respond appropriately to the needs of adolescents with asthma. A lack of understanding among teachers can aggravate adolescents' fear of embarrassment when using an inhaler in the presence of their peers. This may lead to reduced social interactions and feelings of isolation. To create a supportive environment, it is crucial to equip teachers and peers to recognise and respond to asthma symptoms.

Impact: This study addressed the lack of understanding of the developmental needs of Taiwanese adolescents with asthma. Adolescents' home and school environments impact asthma management. Families, teachers and healthcare professionals must consider the developmental experiences of adolescents living with asthma in order to provide appropriate care.

Reporting Method: COREQ was used.

Background
Cardiovascular disease and Type 2 diabetes are two serious chronic health conditions that impact patients, families, and health services. Patients who experience both conditions can struggle to access relevant programmes to guide and educate them on successful self-management. Peer support has been proven to assist patients in managing these dual conditions, but the experience of using an online platform has not been previously explored.
Aim
To understand the experience of using a theory-based, peer-support, self-management website for people with cardiovascular and diabetes conditions in an Australian regional health service.
Design
An exploratory qualitative study was undertaken. Our study is reported according to COREQ guidelines.
Methods
Data were collected via online, semi-structured interviews approximately one week after participants were asked to engage with the website. Interviews were conducted to focus on the user experience, feasibility and usefulness of accessing the website, and how it helped support development of self-management skills. Interview data were transcribed from audio recordings into text files, thematic analysis was conducted for evolving themes.
Results
Fifteen participants agreed to be interviewed for the study. Findings revealed that participants found the website useful for providing relevant, comprehensive, and reliable online health information to help them manage their comorbidities. Participants appreciated the opportunity to share their experiences with others, and some expressed their interest in becoming peer supporters, to help others who might be trying to manage similar comorbidities.
Conclusion
Users’ experience of the peer-support, web-based programme was positive overall and supported the physical and emotional well-being of the participants, who were trying to manage two complex chronic health conditions. Considerations for further development are reported on.

Background
Critical reflection empowers nursing students understanding as they become caring health professionals. Clinical nursing staff must have cultural sensitivity and empathy to provide culturally relevant care that meets the needs of patients from diverse cultures and ethnicities. Currently, the nursing profession is facing a shortage of nurses, which challenges the quality of care in Taiwan and the global community. An important mission of education is to cultivate nursing students with the professional competence to provide appropriate care to patients and families. This study explored nursing students’ reflections on the meaning of caring in professional nursing.

Method
Data were collected from the written reflections of 32 who completed their basic professional nursing courses at a Taiwanese university. A reflective thematic analysis guided by Ray’s theory of Transcultural Caring Dynamics in Nursing and Health Care, highlighting the dimensions of caring, transcultural ethics, transcultural context, and universal sources (spirituality), was used to provide an understanding of how students viewed integrative patient-centred caring, and how they gained self-awareness and insights into their family relationships.

Findings
Four themes were derived from students’ reflective documents. The identified themes included building a caring experience to meet individuals’ physical and psychological needs; learning caring ethics by respecting individual’s integrity and rights; family, school peers, and communities affecting the caring experience, and exploring teaching and learning approaches to enhance the caring experience.

Conclusions
Findings from students’ reflections indicate that individual patient needs should be considered when providing appropriate nursing care. Additionally, multiple teaching–learning strategies demonstrated their effectiveness in enabling nursing students to develop self-awareness in seeking an understanding of culturally appropriate care decisions.

The COVID-19 pandemic had immediate impact on nursing students enrolled in postgraduate and post-registration nursing courses. Some students were required to undertake additional clinical hours and place their studies on hold, while others had clinical experiences and face-to-face classes suspended, with online learning modes quickly mobilized. While there have been many reports on the impact and experience of these changes on undergraduate students, limited reports have focused on challenges for nursing students who were registered for practice following completion of their undergraduate studies, and were enrolled in higher degree, postgraduate education programs. A scoping review was conducted to examine the literature reporting on education changes and challenges that occurred during the COVID-19 pandemic, with specific focus on the postgraduate student learning experience. The review followed reporting guidance by PRISMA-ScR and was underpinned by JBI methods. Seven databases were searched for relevant citations, published in any language, between 2019 and 2022. A protocol was registered on Open Science Framework. From 4207 citations retrieved, 14 studies were included focusing specifically on postgraduate student experiences and/or impact following curriculum changes from the pandemic. These studies included 2476 graduate students across various courses. Findings included mixed responses to e-learning and changes in clinical environments, and with additional concerns such as financial stress, mental health needs and basic food needs reported. Inequity in resources and training was also highlighted. The few studies found to focus specifically on this cohort is a notable finding and highlights a need for further research specific to postgraduate nursing students' educational needs.

Aims
To identify the prevalence, trends, and outcomes of same-day discharge following elective percutaneous coronary intervention among six public hospitals in one Australian State.

Methods and results
A retrospective observational research design was used. A total of 4387 cases were obtained from the State Cardiac Outcomes Registry and National Hospital Cost Data Collection. The two datasets were linked using identifiable data items. Patients were those who had elective percutaneous coronary intervention between December 2012 and December 2019 either discharged the same day of the procedure or the next day. Data were analysed using descriptive and inferential statistics. The overall same-day discharge prevalence was 6.5%, with a trend increasing from 0.2% in 2013 to 9.0% in 2019. The prevalence varied at the individual hospital level. Two hospitals did not perform same-day discharge during the study period. The remaining hospitals demonstrated variability in same-day discharge prevalence, with the highest from one hospital being 28.2% in 2019. Almost all same-day discharge patients experienced no complications during or following percutaneous coronary intervention within 24 hours. Compared to next-day discharge, same-day discharge reduced the length of stay by 18 hours and conferred an average of $3695 cost-savings per patient.

Conclusions
There was limited implementation of same-day discharge in the six public hospitals contributing data to this study. Improvement in the same-day discharge rate could result in better hospital resource utilisation and reduce low-value care. Hence, strategies to implement and promote same-day discharge are warranted.