Clinical Populations Research Articles

Precision Epidemiology: A Computational Analysis of the Impact of Algorithmic Prediction on the Relationship Between Population Epidemiology and Clinical Epidemiology.

Precision Medicine (PM) uses advanced Machine Learning (ML) techniques and big data to develop personalized treatments, but healthcare still relies on traditional statistical procedures not targeted on individuals. This study investigates the impact of ML on epidemiology. A quantitative analysis of the articles in PubMed for the years 2000-2019 was conducted to investigate the use of statistical methods and ML in epidemiology. Using structural topic modelling, two groups of topics were identified and analysed over time: topics closer to the clinical side of epidemiology and topics closer to the population side. The curve of the prevalence of topics associated with population epidemiology basically corresponds to the curve of the relative statistical methods, while the more dynamic curve of clinical epidemiology broadly reproduces the trend of algorithmic methods. The findings suggest that a renewed separation between clinical epidemiology and population epidemiology is emerging, with clinical epidemiology taking more advantage of recent developments in algorithmic techniques and moving closer to bioinformatics, whereas population epidemiology seems to be slower in this innovation.

Panel Estimated Glomerular Filtration Rate: Statistical Considerations for Maximizing Accuracy in Diverse Clinical Populations

Panel Estimated Glomerular Filtration Rate: Statistical Considerations for Maximizing Accuracy in Diverse Clinical Populations

Improving Access to Mental Health Care through a Stepped Care Approach: Preliminary Results from a University Students’ Sample

Introduction: Recently, university counseling services have been faced with an increasing number of students seeking psychological support. However, human resources and time constraints limit the services to respond adequately. Recently, national guidelines for Mental Health Services in Higher Education recommended the stepped care approach to increase efficiency. The present study aimed to explore the implementation of a stepped care model in a Portuguese public university, analyzing students’ sociodemographic and clinical characteristics, and presenting the flow of the stepped care approach and the students’ waiting periods in each step. Methods: An observational study was conducted in the University of Coimbra’s health services between May 2019 and June 2021. Descriptive statistics were performed to describe the sociodemographic and clinical characteristics of the sample, the flow of the stepped care approach, and students’ waiting periods. Results: We enrolled 295 students in the present study. The findings of this study revealed that over 40% had a clinical diagnosis of anxiety or depressive disorders. In terms of students’ flow within the stepped care model, 82% of students sought psychological help through self-referral. Concerning the implementation of the stepped care model, results have shown that most students wait less than a month to access each step. Discussion/Conclusions: Although preliminary, our results suggest that the stepped care model might be a useful service organization, mainly in a community in which accessibility to services and speed of response are particularly important. Most students being self-referred highlight the importance of direct contact between the university community and the health services. Additionally, anxiety and mood disorders were the most prevalent diagnoses in our sample, which also points to the relevance of a stepped care approach, since other studies have highlighted its advantages for this kind of clinical population.

Tentative Causes of Brain and Neuropsychological Alterations in Women Victims of Intimate Partner Violence.

Victims of Intimate Partner Violence Against Women (IPVAW) experience neuropsychological and cerebral changes, which have been linked to several tentative causal mechanisms, including elevated cortisol levels, psychopathological disorders, traumatic brain injury (TBI), hypoxic/ischemic brain damage, and medical conditions related to IPVAW. While these mechanisms and their effects on brain function and neuropsychological health are well-documented in other clinical populations, they manifest with unique characteristics in women affected by IPVAW. Specifically, IPVAW is chronic and repeated in nature, and mechanisms are often cumulative and may interact with other comorbid conditions. Thus, in light of existing literature on neuropsychological alterations in other populations, and recognizing the distinct features in women who experience IPVAW, we propose a new theoretical model-the Neuro-IPVAW model. This framework aims to explain the complex interplay between these mechanisms and their impact on cognitive and brain health in IPVAW victims. We anticipate that this theoretical model will be valuable for enhancing our understanding of neuropsychological and brain changes related to intimate partner violence, identifying research gaps in these mechanisms, and guiding future research directions in this area.

Optimizing wearable single-channel EEG sleep staging in a heterogeneous sleep-disordered population using transfer learning.

While various wearable EEG devices have been developed, performance evaluation of the devices and their associated automated sleep stage classification models is mostly limited to healthy subjects. A major barrier for applying automated wearable EEG sleep staging in clinical populations is the need for large-scale data for model training. We therefore investigated transfer learning as strategy to overcome limited data availability and optimize automated single-channel EEG sleep staging in people with sleep disorders. We acquired 52 single-channel frontopolar headband EEG recordings from a heterogeneous sleep-disordered population with concurrent PSG. We compared three model training strategies: 'pre-training' (i.e., training on a larger dataset of 901 conventional PSGs), 'training-from-scratch' (i.e., training on wearable headband recordings), and 'fine-tuning' (i.e., training on conventional PSGs, followed by training on headband recordings). Performance was evaluated on all headband recordings using 10-fold cross-validation. Highest performance for 5-stage classification was achieved with fine-tuning (κ = .778), significantly higher than with pre-training (κ = .769) and with training-from-scratch (κ = .733). No significant differences or systematic biases were observed with clinically relevant sleep parameters derived from PSG. All sleep disorder categories showed comparable performance. This study emphasizes the importance of leveraging larger available datasets through deep transfer learning to optimize performance with limited data availability. Findings indicate strong similarity in data characteristics between conventional PSG and headband recordings. Altogether, results suggest the combination of the headband, classification model, and training methodology can be viable for sleep monitoring in the heterogeneous clinical population.

Psilocybin increases optimistic engagement over time: computational modelling of behaviour in rats.

Psilocybin has shown promise as a novel pharmacological intervention for treatment of depression, where post-acute effects of psilocybin treatment have been associated with increased positive mood and decreased pessimism. Although psilocybin is proving to be effective in clinical trials for treatment of psychiatric disorders, the information processing mechanisms affected by psilocybin are not well understood. Here, we fit active inference and reinforcement learning computational models to a novel two-armed bandit reversal learning task capable of capturing engagement behaviour in rats. The model revealed that after receiving psilocybin, rats achieve more rewards through increased task engagement, mediated by modification of forgetting rates and reduced loss aversion. These findings suggest that psilocybin may afford an optimism bias that arises through altered belief updating, with translational potential for clinical populations characterised by lack of optimism.

Validity Study of an Emotional Face-Database in Iranian Community

Objective: To investigate the accuracy of facial emotion recognition in the Iranian community, a face database validated in this community is required. To do this, we conducted a validation study on the Radboud face database. The primary objective of this study was to evaluate the accuracy of recognizing emotions through faces in an Iranian sample and then to choose the pictures with high agreement in terms of detecting emotions. Method: This is a cross sectional study recruiting a total number of 142 males and females aged between 20 and 50 years old (Mean ± SD of age 31.7 ± 7.07). The participants were instructed to detect the type of emotion of each face as well as its valence and arousal. The percentage of participants’ agreement on evaluating each picture was assessed. To evaluate the effect of different variables on participants’ accuracy, one way and repeated measure ANOVA analyses were also used. Results: Emotional faces were recognized by around 84% of the participants. The highest accuracy belongs to happy (Mean ± SD of 98 ± 6.1%) and the lowest one to neutral (75 ± 18.06%) faces. The accuracy for detecting other emotions were as follows: sad (91 ± 8.7%), surprised (87 ± 10.64%), angry (77 ± 15.6%), and fearful (76 ± 15.26%). Additionally, we found no differences between male and female participants in terms of recognizing emotions. Then we selected the pictures with high agreement (above 85 percent) in labeling emotions among the participants. Conclusion: The current study provided a valid emotional face database based on Iranian participants’ responses in terms of recognizing basic emotions. The selected pictures can be used in designing tasks to evaluate emotion recognition ability in clinical and nonclinical populations. It can also be used in designing applications to improve detecting emotion in clinical samples such as individuals with autism spectrum disorder.

Associations between eating habits and mental health among adolescents in five nordic countries: a cross-sectional survey

BackgroundThe role of eating habits in adolescent mental health has become a growing area of interest for researchers and health professionals. Recent studies suggest that healthy eating habits may play a role in the development and management of mental health. However, existing literature is largely based on clinical populations, and comparisons are challenged by sociocultural differences and methodological issues. The aim of the present study was to use nationally representative data based on standardized procedures, to explore associations between adolescents eating habits and mental health, considering the importance of age, gender, socioeconomic factors, and country.MethodsThe study was based on data from Nordic adolescents (age 11, 13 and 15 years) who participated in the 2017/2018 Health Behavior in School-aged Children (HBSC) study (n = 22384). General linear modelling and multigroup regression analysis were used to examine the relationship between food habits (intake of fruit, vegetables, sweets, soft drinks), meal habits (intake of breakfast and having family meals together), and mental health (life satisfaction and subjective health complaints). The analyses were weighted and adjusted for age, gender, socio-economic status, and country.ResultsOverall, healthier eating habits were associated with better mental health. The strongest associations were found between meal habits (breakfast consumption and having family meals together) and mental health. Gender and country differences were seen, with weaker associations found among Danish boys.ConclusionEating habits should be considered when promoting mental health in the adolescent population. While gender differences and cross-country variations exist, even minor enhancements in eating behaviors could yield meaningful benefits.

Landscape of healthcare transition services in Canada: a multi-method environmental scan

BackgroundPoorly supported transitions from pediatric to adult healthcare can lead to negative health outcomes for youth and their families. To better understand the current landscape of healthcare transition care across Canada, the Canadian Health Hub in Transition (the “Transition Hub”, established in 2019) identified a need to: (1) describe programs and services supporting the transition from pediatric to adult healthcare across Canada; and (2) identify strengths, barriers, and gaps affecting the provision of transition services.MethodsOur project included two iterative steps: a national survey followed by a qualitative descriptive study. Service providers were recruited from the Transition Hub and invited to complete the survey and participate in the qualitative study. The survey was used to collect program information (e.g., setting, clinical population, program components), and semi-structured interviews were used to explore providers’ perspectives on strengths, barriers, and gaps in transition services. Qualitative data were analyzed using the Framework Method.ResultsFifty-one surveys were completed, describing 48 programs (22 pediatric, 19 bridging, and 7 adult) across 9 provinces. Almost half of the surveyed programs were in Ontario (44%) and most programs were based in hospital (65%) and outpatient settings (73%). There was wide variation in the ages served, with most programs focused on specific diagnostic groups. Qualitative findings from 23 interviews with service providers were organized into five topics: (1) measuring transition success; (2) program strengths; (3) barriers and gaps; (4) strategies for improvement; and (5) drivers for change.ConclusionsWhile national transition guidelines exist in Canada, there is wide variation in the way young people and their families are supported. A national strategy, backed by local leadership, is essential for instigating system change toward sustainable and universally accessible support for healthcare transition in Canada.

Patterns of Child and Adolescent Psychiatric Admissions Before and After the Onset of the COVID-19 Pandemic: Take Home Messages from a Clinical Population.

: This study from Istanbul aimed to compare the child and adolescent psychiatric admissions and diagnosis rates between the first 3 months of the pandemic, the previous 3 months in the same year, and the same months in the previous year. : Children and adolescents were grouped according to the admission dates. Group A, between March 11 and June 1, 2020; Group B, between January 1 and March 11, 2020; and Group C, between March 11 and June 1, 2019. Only clinical interviews and diagnoses according to Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) interview were included. : Autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD)/tic disorder, and intellectual disability (ID) diagnoses were higher in group A than in groups B and C (for ASD, 6.4%, 4.3%, and 3.6%; for OCD/tic disorder, 2.9%, 1.8%, 1.7%; for ID, 3.7%, 2.5%, and 2.1%, respectively) (P < .001). Attention-deficit hyperactivity disorder (ADHD) diagnosis was higher in group A than in only group B (59.8% and 49.7%, respectively) (P < 0.001). Depression was higher in group A than in only group C (4.1% and 2.2%, respectively) (P < .001). Conduct disorder (CD) diagnosis was lower in group A than in only group B (3.6% and 6.4%, respectively) (P < .05). : Child psychiatry diagnosis rates were found to change significantly during the initial phase of the pandemic period. Among the referrals, ASD, OCD, Tic disorder, ID, ADHD, and depression admissions were significantly higher. The rate of pediatric neurodevelopmental disorders, particularly ASD, increased during the initial phase of the COVID-19 pandemic.

Tertiary Care Center Trends in Colonic Stent Placement over the Past Decade.

Colonic endoluminal stent placement is a commonly utilized and effective endoscopic approach for the management of malignant large bowel obstruction and is an emerging approach for the management of some benign etiologies of large bowel obstruction. However, recent studies evaluating the evolution of clinical scenarios and patient populations for which stenting is performed in real-world practice are lacking. We assessed colonic stent utilization patterns in a tertiary care academic medical center over the past 10 years. We analyzed the demographics and patient and procedure characteristics of the initial (first half of study period) and latter (second half of the study period) procedures to assess trends over time using standard descriptive statistics. Our analysis was notable due to its provision of some novel insights. The frequency of colonic stent placement procedures increased significantly over time by comparison of the procedure volume for the initial 5-year interval (22 colonic stent procedures) relative to the latter 5-year interval (49 colonic stent procedures) (p = 0.03). The median age of patients who underwent colonic stent placement was significantly lower in the latter 5 years, compared with the initial 5 years of the study period (mean of 81.41 vs. 58.73 years, respectively, p < 0.001). The increased diversity of indications for colonic stent placement was also noted over time. Our data highlight the evolution of colonic stent placement in tertiary care practice over time and are notable for some interesting trends, including the increased utilization of colonic stent placement over time, the broadening of indications for colonic stent placement to include benign indications, and lower patient age at the time of colonic stent placement over time. These findings will help inform the clinical practice of colonic stent placement and provide a foundation to guide future research on the topic.

Psychiatric disorder and life-event in self harm: A cross-sectional study among clinical population in Bangladesh

BackgroundMental illness is an important risk factor for self-harm behavior. However, the association between self-harm behavior and psychiatric disorders has been poorly studied in Bangladesh. AimsTo determine the prevalence of psychiatric disorders and life-events among patients with a self harm behavior. MethodsThis cross-sectional study was conducted between March 2022 and November 2023. We collected data from 100 patients with self harms from two tertiary care hospital of Dhaka by semi-structured interviews. ResultsOf the 100 cases, 72 were females, 63 % came from semi-urban background. Hanging was the commonest method (31 %) followed cutting and piercing instrument (22 %), and ingestion of Benzodiazepines (20 %). Among the cases, 71 % had at least one psychiatric disorder (Axis I 49 % and Axis II 35 %). In case of life events, 52 % had life-events within immediate 48 h, 15 % in the last one month and 17 % in the last year. Family conflict (30 %) was the commonest risk factor and increased argument with resident family members (38 %) was the commonest life event. ConclusionsThis study revealed a similar proportion of psychiatric disorders revealed in previous studies among suicide attempts. It also unveiled life events in suicide attempts indicating a potential role of life events in suicide attempts in Bangladesh. However, a prudential interpretation is warranted while considering the study results as it was conducted among clinical samples.

The severity of gambling in clinical samples of gamblers: profiles and prediction of the impulsivity and emotions.

Impulsivity and emotion impairments have been noted in individuals with gambling disorder (GD). However, little research has investigated the influence of impulsivity and emotions on the severity of gambling in clinical populations. This study aimed to examine: (i) differences in emotions and impulsivity traits according to the severity of gambling in individuals with GD, (ii) the mediating effects of emotion in the relationship between impulsivity traits and gambling severity, and (iii) the predictive effects of emotion and impulsivity traits on GD severity. The study included 214 participants seeking treatment for GD who completed assessments for emotions (Patient Health Questionnaire-9 [PHQ-9], 7-item Generalized Anxiety [GAD-7]), impulsivity traits (Barratt Impulsiveness Scale [BIS], Self-control Scale [SCS]), and GD severity (DSM-5). Participants were categorized into mild (n = 78), moderate (n = 63), and severe (n = 73) gambling severity groups. Significant differences in emotions and impulsivity traits were observed across these groups. The severe GD group exhibited higher levels of depression, anxiety, and impulsivity traits, along with lower self-control, compared to the moderate and mild groups. Mediation analyses demonstrated that negative emotions mediated the association between impulsivity traits and the severity of gambling. More specifically, the indirect effects of impulsivity traits through PHQ-9 and GAD-7 were found to be significant, indicating a mediating role of emotions. Moreover, a predictive model incorporating emotion and impulsivity traits showed moderate accuracy in predicting the severity of gambling, with an area under the receiver operating characteristic curve of 0.714. This study highlights the distinct pathways through which impulsivity traits operate and emphasizes the need for prevention and treatment strategies that consider impulsivity traits and emotions for different levels of gambling severity.

Voucher-based contingency management to promote treatment engagement in comorbid alcohol use disorder and alcohol-related liver disease: A pilot theory-informed qualitative study with service users.

Effective interventions for the management of alcohol-related liver disease (ARLD) remain a gap in clinical practice, and patients' engagement with alcohol services is suboptimal. Based upon the principles of operant conditioning, contingency management (CM) is a psychosocial intervention th at involves gradual, increasing incentives upon completion of treatment-related goals such as treatment attendance. A pilot feasibility trial was conducted with 30 adult patients recruited from an inpatient clinical setting. Consecutive sampling was used to recruit patients presenting comorbid alcohol use disorder (AUD) and ARLD. Participants were randomized to integrated liver care (ILC), receiving hepatology and AUD care, or ILC with a voucher-based CM intervention (intervention arm). A longitudinal qualitative approach was adopted to explore anticipated (Stage 1) and experienced acceptability (Stage 2). The Theoretical Framework of Acceptability (TFA) guided semi-structured in-depth interviews and deductive analysis. Thirty participants were enrolled in the pilot trial, and interviews were conducted with 24 participants at Stage 1 and seven at Stage 2. Over half of the cohort (54.2%, n = 13) presented decompensated liver disease, and an average of 179 units of alcohol were consumed per week. Overall positive views toward voucher-based CM were noted, and explanatory data emerged across five TFA domains (intervention coherence, ethicality, self-efficacy, perceived effectiveness, and affective attitude). The core aspects of the voucher-based CM intervention matched participants' preferences and needs. Participants regarded CM as having a symbolic value and strengthening the therapeutic alliance with healthcare providers. The data support the scope of voucher-based CM intervention to promote engagement with treatment services, and its potential to address the gaps in the care continuum in ARLD. The findings are of practical significance for developing person-centered, tailored interventions for this clinical population. The outcomes of this investigation can inform decision-making among stakeholders and healthcare providers and improve health outcomes for this clinical population.

The acquisition of a new social norm, the social conditioning, and the subjective role of structural and functional personality profile. Pilot study

Introduction: Social norms represent the system of expectations of a community at a given point in time. Based on the education received and lived life experiences, everyone reacts to social norms with conformity or rebellion. Whether or not one adapts to a new social norm depends on many factors, which have been studied in the social-anthropological fi eld but not yet fully explored in scientifi c literature. Method: The clinical population sample (CG) that was selected for this pilot study consisted of 60 Italian participants (30 males; 30 females), aged 18 to 77 years (M: 47.5; SD: 17.0). Through a clinical interview and administration of the Perrotta Integrative Clinical Interviews, version TA-3 (PICI-TA-3), the included adult patients were analyzed, based on the experiment described in the protocol. A control group (Cg) with the same characteristics was constructed, in the absence of positive clinical data for a personality disorder identifi ed by the PICI-TA-3, for a total of 120 participants (60 males; 60 females). Results: In the clinical group (CG), subjects in the neurotic subgroup (pure anxious, phobic-obsessive and manic) responded to the acquisition of the new social rule within the third positive reinforcement stimulus, while subjects in the psychotic subgroup (paranoid-delusional, dissociated and schizophrenic spectrum) in some cases responded within the second stimulus while others hyperactivated and stopped the experiment; fi nally, subjects in the dramatic subgroup (depressive, bipolar, borderline, narcissistic-histrionic, antisocial-psychopathic) partly responded after the third stimulus or with attitudes of rebellion or contrariness, seeking clarifi cation, explanation, or resistance in the social group. Conclusions: The research data showed that the acquisition of a new social rule is conditioned by several subjective factors, including structural and functional personality profi les. Keywords: Social rule, acquisition of a new social rule, conformity, rebellion, society, personality disorders. Abbreviations/acronyms: Perrotta Integrative Clinical Interviews (PICI-C-3), Clinical group (CG), Control group (Cg).

TMS and tDCS as potential tools for the treatment of cognitive deficits in Parkinson's disease: a meta-analysis.

Cognitive deficits are common nonmotor symptoms in Parkinson's disease (PD). Non-Invasive Brain Stimulation (NIBS) could be a potential aid to prevent or delay dementia progression in this clinical population. However, previous studies reported controversial results concerning their efficacy on cognitive symptoms of PD. Hence, the present meta-analysis aims to systematically examine the effects of NIBS as possible treatments for PD cognitive impairments. Understanding NIBS' impact on these symptoms may be of outstanding importance to implement new therapeutic strategies and improve the patients' quality of life. EMBASE, Scopus, and PubMed databases were systematically searched for consecutive studies published from 2000 to March 2023 describing Randomized Controlled Trials studies evaluating the effect of NIBS on PD cognitive symptoms. From the included studies, data concerning neuropsychological tests were extracted and grouped into six cognitive domains, separately analyzed. Hedge's method was computed as the effect size measure of the extracted data; heterogeneity among studies and publication bias were also assessed. The Cochrane's RoB2 tool was used to evaluate the risk of bias for each of the included studies. After database searching and screening of texts, sixteen studies met the inclusion criteria. No significant results emerged from any investigated cognitive domain when comparing NIBS and sham treatments. Several factors may have contributed to the lack of effects; among these, methodological choices, the small sample of studies, the high heterogeneity of data and stimulation protocols pose the need for more controlled studies to highlight the potentiality of NIBS as a future treatment for PD cognitive impairments.

Finger-specific effects of age on tapping speed and motor fatigability.

Increased motor fatigability is a symptom of many neuromuscular and neurodegenerative disorders. However, it is difficult to pinpoint pathological motor fatigability, since the phenomena has not yet been fully characterized in the healthy population. In this study, we investigate how motor fatigability differs across age. Given that many disorders involve supraspinal components, we characterize motor fatigability with a paradigm that has previously been associated with supraspinal mechanisms. Finger tapping at maximal speed results in a rapid decrease in movement speed, which is a measure of motor fatigability. We collected finger tapping data in a field experiment from the general population with a smartphone app, and we investigated age differences in maximal tapping speed, as well as the decrease in tapping speed for the index, middle, and little fingers. We found that the maximal tapping speed differed significantly between young (18-30 years, n = 194) and aged (50-70 years, n = 176), whereas the fatigability-induced relative decrease in movement speed did not differ between the age groups (average decrease: 17.0% ± 6.9% (young) vs. 16.5% ± 7.5% (aged) decrease). Furthermore, tapping speed and motor fatigability depended on which finger was used. These findings might relate to dexterity, with more dexterous movements being more resistant to fatigue. In this study, we provide a characterization of motor fatigability in the general population which can be used as a comparison for clinical populations in the future.

EXAMINING CLINICAL STUDIES ABOUT CUPPING THERAPY IN TURKEY: A SYSTEMATIC REVIEW AND BIBLIOMETRIC ANALYSIS

There is insufficient quantitative data available on the characteristics of research conducted on cupping therapy. This insufficiency complicates our ability to achieve a more profound understanding of the subject. The primary aim of this work was to assess the outcome of clinical studies outputs in cupping therapy and discuss methodological gaps. Six databases PubMed, Cochrane Library, Medline, TUBITAK ULAKBIM DergiPark, Science Direct, and Google Scholar, were systematically searched from their inception to January 2024. Performance analysis was made in the study. Frequency and distributions were analyzed with SPSS 24. The software Wordclouds software was used to generate visualization. Within the scope of the research, 26 studies that met the selection criteria were accessed. It was determined that the majority of the studies (46.16%) were written in 2019-2021. The most used technique was 3 S (73.07%), and the most preferred point was du 14 point. While the top two variables are oxidative stress and heavy metal levels, the co-word analysis of keywords showed that "wet cupping therapy" was the largest single node. The findings from this bibliometric study provide the current status and productivity in clinical research of cupping therapy over the past ten years. It is seen that despite the challenges facing the field of cupping research, which include standardization, legal, and reporting quality, there has been an increase in publications to mitigate disease-related symptoms in clinical populations.

Agreement of Doppler Ultrasound and Visual Sphygmomanometer Needle Oscillation with Invasive Blood Pressure in Anaesthetised Dogs.

Visual sphygmomanometer needle oscillation (SNO) can occur before audible return of pulsatile flow (ARPF) when measuring blood pressure by Doppler ultrasound. The aim was to assess the agreement of SNO and ARPF with invasive blood pressure (iABP) in a clinical population of anaesthetised dogs. A total of 35 dogs undergoing surgery in dorsal recumbency necessitating arterial cannulation were included. Paired measurements of iABP and SNO, and iABP and ARPF, were collected. The agreement of non-invasive blood pressure (NIBP) and iABP measurements was analysed with concordance correlation coefficients (CCCs) and Bland-Altman plots. The proportions of SNO and ARPF measurements between 10 and 20 mmHg of iABP were compared. Both SNO and ARPF demonstrated greater agreement with invasive systolic (iSAP) than invasive mean (iMAP) pressures, and SNO demonstrated greater agreement with iSAP than ARPF measurements. The mean differences (95% limits of agreement) for SNO and APRF were -9.7 mmHg (-51.3-31.9) and -13.1 mmHg (-62.2-35.9), respectively. The CCC (95% CI) for SNO was 0.5 (0.36-0.64) and ARPF was 0.4 (0.26-0.54). A significantly greater proportion of SNO measurements were within 20 mmHg of iSAP compared to ARPF. Both NIBP techniques performed more poorly than veterinary consensus recommendations for device validation. Caution should be used clinically when interpreting values obtained by Doppler ultrasound in anaesthetised dogs.

“Everyone’s brains are different…you can’t just have one therapy plan to suit everyone” – A qualitative investigation of community-based rehabilitation services following traumatic brain injury

Purpose To examine the lived experiences of adults who have received community-based rehabilitation (CBR) services in Australia or New Zealand for cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) and their support people. Participants’ recommendations for future models of care were also explored to enhance rehabilitation services for people with TBI. Method A qualitative descriptive approach grounded in phenomenology was used, whereby semi-structured interviews were conducted with each participant. A total of 28 interviews were completed, four in-person and 24 via video conferencing. Two participant groups were recruited: Adults with TBI; and their support people. Sixteen adults with a self-reported diagnosis of cognitive-communication disorder (CCD) following TBI who had received CBR and 12 support people were included. Interviews were analysed using reflexive thematic analysis. Result Four themes were identified by the participant groups indicating the core pillars of CBR models of care. They included the importance of: (a) accessible and inclusive CBR services; (b) specialised clinical skills and treatment approaches; the acknowledgment that (c) knowledge is power; and the significance of (d) peer networks and support. Conclusion This study further advances the evidence base of how services can be optimised to meet the complex needs of adults with CCDs following a TBI. Clinicians, researchers, and service providers should endeavour to incorporate the four core pillars outlined to enhance future CBR models of care for this clinical population.