Recognizing kidney disease as a major global health issue, the International Society of Nephrology (ISN) convened a two-day international, multi-stakeholder meeting to develop a roadmap for advancing clinical research in nephrology. The meeting focused on promoting the use of patient-reported outcome measures (PROMs), moving beyond single biomarker targets, adopting innovative trial designs, and incorporating hierarchical composite endpoints. Participants included clinicians, trialists, regulators, patient partners, and industry experts invited from all ISN regions. Discussions emphasized the importance of inclusive trial design, validation of PROMs, predictive enrichment strategies, and broader trial accessibility across resource settings. Key recommendations included enhancing diversity in trial populations, avoiding overreliance on isolated biomarkers, adopting novel study designs, strengthening public-private partnerships, and validating composite endpoints. A coordinated effort was deemed essential to implement these strategies in both research and practice, ensuring sustainable progress and reducing the global burden of kidney disease.

Astrocytoma is a highly malignant tumor of the central nervous system with limited survival, despite standard multimodal therapies. While typically remains confined to the central nervous system, rare instances of extraneural and extracranial metastasis have been documented. The underlying pathophysiology remains poorly understood, with very few reported cases-particularly in tumors harboring isocitrate dehydrogenase mutations.We describe the case of a 21-year-old female New Zealander of European descent with O-methylguanine-DNA methyltransferase promoter-methylated, IDH1-R132H-mutant astrocytoma (World Health Organization 2021 central nervous system grade 4) containing a primitive neuroectodermal tumor-like component, which exhibited diffuse skeletal and leptomeningeal metastases.This case represents an unusual presentation of extraneural and extracranial metastatic spread in a young female New Zealander of European descent with an isocitrate dehydrogenase-mutant astrocytoma. Compared with recent literature, it is notable for early systemic dissemination and the coexistence of bone and leptomeningeal disease. A multidisciplinary discussion concluded that additional biopsy of metastatic sites was unwarranted owing to clear pathological correlation, clinical decline, and poor prognosis. Molecular characteristics such as cyclin-dependent kinase inhibitor 2A/2B deletion may further refine classification. A review of current literature underscores the importance of the 2021 World Health Organization classification updates and highlights potential roles for epithelial-mesenchymal transition and glymphatic dissemination in metastasis. Targeted therapies-particularly isocitrate dehydrogenase inhibitors-are under active investigation. This case reinforces the need for ongoing research into predictive biomarkers and individualized treatment strategies.

The alidating utcomes by ncluding onsumer xperience (VOICE) project is developing patient reported experience measure (PREM) tools to collect consumer feedback for Indigenous primary healthcare (IPHC) services' accreditation and quality improvement processes. This study aimed to explore the views of health service staff about: (1) optimising the feasibility of collection, analysis and interpretation of findings; and (2) resourcing requirements for implementation of the PREM.A participatory action research qualitative study design, guided by an Indigenous advisory group. Our team of Indigenous and non-Indigenous researchers conducted semistructured focus groups and individual interviews with IPHC staff. Focus groups and interviews were recorded, transcribed and thematically analysed. Multiple sense-making meetings were conducted with the Indigenous advisory group.Eight partner IPHC services across four Australian states and territories.All staff were eligible and invited to participate in the study via purposive and snowball sampling. Administrative staff (eg, receptionist, programme facilitator), clinicians/practitioners (eg, general practitioner, nurse, Aboriginal and Torres Strait Islander health workers and practitioners) and service managers (eg, CEO, practice manager) from partner health services participated.63 staff participated; 44 attended across 13 focus groups, with the remainder participating in individual interviews. The majority of participants were between 35 years and 55 years old (52%), female (66%) and working in frontline IPHC service delivery roles (56%). Equal numbers identified as Indigenous (50%) and non-Indigenous (50%). Many had worked in the Indigenous health and well-being sector for over 10 years (40%). 'Culturally safe care' and 'accountability' were identified as primary themes and key reasons for gathering consumer feedback. Subthemes identified were 'Relationships', 'trust and respect', 'communication about consumer feedback', 'timing and frequency of requesting consumer feedback', 'health service systems', 'health service and staff capacity', 'staff skills' and 'structure and administration of the PREM'. All themes and subthemes need to be considered for the successful design and implementation of PREMs in IPHC settings.Many of the issues identified are not currently considered in the process of collecting PREM data for accreditation yet, if addressed, would likely improve the quality and relevance of data collected. The findings from this study will inform the co-design and validation of Indigenous-specific PREM tools to collect consumer feedback. Critically, service and community input will ensure the PREM tools meet service needs for continuous quality improvement and accreditation and reflect the priorities and values of Indigenous peoples.

To propose the novel role of Aboriginal and/or Torres Strait Islander Allied Health Co-Worker to address an urgent unmet need in rural and remote Australia that focuses on disability, rehabilitation and preventative health needs in a unique cultural context.Allied health and therapy assistants represent a rapidly expanding workforce with considerable potential to relieve workforce shortages and address urgent and unmet healthcare needs in rural and remote Australia. However, the current recognised roles of "Allied Health Assistant" or "Therapy Assistant" are incompatible with the needs of the Aboriginal and Torres Strait Islander communities.This commentary prosecutes the case that for Aboriginal and Torres Strait Islander families and communities, the allied health assistant role should be adapted to an Aboriginal and/or Torres Strait Islander Allied Health Co-Worker (AHCW). The AHCW would provide allied health clinical care within the scope of an allied health assistant, as well as cultural brokerage and leadership to support the cultural needs of the people and communities with which the services are interacting. Recommendations are proposed for sustainable implementation of this role.It is proposed that Aboriginal and/or Torres Strait Islander Allied Health Co-Workers' roles and appropriate recognition of their cultural leadership roles be introduced and embedded in health and disability employment policies.

PS5 Standard for Pharmacy Based Immunisation Programs

Application for registering a radiation apparatus