A cute rheumatic fever (ARF) and its sequelae are now rare in wealthy industrialised nations.1 Yet, ARF and rheumatic heart disease (RHD) remain important causes of mortality and chronic ill health in poor countries and minority Indigenous populations, such as Aboriginal Australians. 2,3 In the Top End of the Northern Territory, 2.7% of Aboriginal people have an episode of ARF in their lifetime, compared with 0.014% of the non-Aboriginal population. 4 Primary prophylaxis of ARF, the provision of antibiotics to treat streptococcal pharyngitis, is largely unworkable and unsustainable in high-incidence populations, especially where health services are underresourced. 5 Besides, many cases of ARF do not follow clinically identified pharyngitis. Register-based secondary prevention programs can be effective at limiting recurrent ARF and progression to RHD, 7,8 but require early and correct diagnosis of ARF/RHD, followed by long-term administration of an antibiotic (usually benzathine penicillin) on a regular basis. The establishment of a register of patients with known past ARF and/or RHD is the central requirement of a secondary prevention program.9,10 Evaluation of service delivery is regarded as an important part of program design. 11,12A register-based RHD secondary prevention program was established in the Top End of the Northern Territory (NT) in 1997.13 New and recurrent cases of ARF are notif iable in the NT. Clinicians are encouraged to inform the register of all new cases of ARF and newly diagnosed RHD, including 'probable' cases where the diagnosis has not been proven but there is a high index of suspicion. Sources of data for the register include notifications, hospital discharge records, community clinic records, echocardiogram reports and professional correspondence. The register keeps details

Background Recently, the number of prehabilitation trials has increased significantly. The identification of key research priorities is vital in guiding future research directions. Thus, the aim of this collaborative study was to define key research priorities in prehabilitation for patients undergoing cancer surgery. Methods The Delphi methodology was implemented over three rounds of surveys distributed to prehabilitation experts from across multiple specialties, tumour streams and countries via a secure online platform. In the first round, participants were asked to provide baseline demographics and to identify five top prehabilitation research priorities. In successive rounds, participants were asked to rank research priorities on a 5-point Likert scale. Consensus was considered if > 70% of participants indicated agreement on each research priority. Results A total of 165 prehabilitation experts participated, including medical doctors, physiotherapists, dieticians, nurses, and academics across four continents. The first round identified 446 research priorities, collated within 75 unique research questions. Over two successive rounds, a list of 10 research priorities reached international consensus of importance. These included the efficacy of prehabilitation on varied postoperative outcomes, benefit to specific patient groups, ideal programme composition, cost efficacy, enhancing compliance and adherence, effect during neoadjuvant therapies, and modes of delivery. Conclusions This collaborative international study identified the top 10 research priorities in prehabilitation for patients undergoing cancer surgery. The identified priorities inform research strategies, provide future directions for prehabilitation research, support resource allocation and enhance the prehabilitation evidence base in cancer patients undergoing surgery.

No abstract