Brain reward function in people who use cannabis: a systematic review.

Rationale: Cannabis is one of the most widely used psychoactive substances globally. Cannabis use can be associated with alterations of reward processing, including affective flattening, apathy, anhedonia, and lower sensitivity to natural rewards in conjunction with higher sensitivity to cannabis-related rewards. Such alterations have been posited to be driven by changes in underlying brain reward pathways, as per prominent neuroscientific theories of addiction. Functional neuroimaging (fMRI) studies have examined brain reward function in cannabis users via the monetary incentive delay (MID) fMRI task; however, this evidence is yet to be systematically synthesised. Objectives: We aimed to systematically integrate the evidence on brain reward function in cannabis users examined by the MID fMRI task; and in relation to metrics of cannabis exposure (e.g., dosage, frequency) and other behavioural variables. Method: We pre-registered the review in PROSPERO and reported it using PRISMA guidelines. Literature searches were conducted in PsycINFO, PubMed, Medline, CINAHL, and Scopus. Results: Nine studies were included, comprising 534 people with mean ages 16-to-28 years, of which 255 were people who use cannabis daily or almost daily, and 279 were controls. The fMRI literature to date led to largely non-significant group differences. A few studies reported group differences in the ventral striatum while participants anticipated rewards and losses; and in the caudate while participants received neutral outcomes. A few studies examined correlations between brain function and withdrawal, dosage, and age of onset; and reported inconsistent findings. Conclusions: There is emerging but inconsistent evidence of altered brain reward function in cannabis users examined with the MID fMRI task. Future fMRI studies are required to confirm if the brain reward system is altered in vulnerable cannabis users who experience a Cannabis Use Disorder, as postulated by prominent neuroscientific theories of addiction.

Co-designing with adults with acquired neurological disability in the community: a scoping review protocol.

INTRODUCTION: Co-designing healthcare research and health services is becoming increasingly prominent. Co-design invites people with disability to leverage their lived experience knowledge to improve service provision, as well as ensuring meaningful and relevant research. Given the emerging nature of the use of co-design with adults with neurological disability, well-defined guidelines on best practice are yet to be developed. The aim of this scoping review is to synthesise available peer-reviewed literature which investigates the use of co-design in research and/or service development with adults who have an acquired neurological disability and live within the community. The findings of this review will help to guide future co-design practice, ensuring people with acquired neurological disability are best supported and engaged in the process. METHODS AND ANALYSIS: This review will follow methodology proposed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews. Systematic electronic database searches will be conducted between the years 2000 and 2022, via MEDLINE, CINAHL, PsycINFO, Scopus and Embase. Article screening and selection will follow the five-stage framework of Arksey and O'Malley, using Covidence software to support review of each retrieved article by two independent reviewers. Final selected qualitative and/or mixed-methods studies that meet the inclusion criteria will be charted, data collated, summarised and reported. Thematic synthesis will be applied to the qualitative data extracted from these studies. ETHICS AND DISSEMINATION: Ethics approval will not be required to conduct this scoping review. It is the authors' intention for the findings of this scoping review to be made available to relevant stakeholders through open-access peer-reviewed publication and disseminated with other healthcare and research networks via translation pieces, including the development of short video summaries and practice resources.

Aged Care Assessment Service practitioners: a review of current practice for assessment of cognition of older people of culturally and linguistically diverse backgrounds in Victoria.

AIM: This paper describes current practices and gaps identified by Aged Care Assessment Service (ACAS) clinicians in the assessment of cognition of clients of culturally and linguistically diverse (CALD) background in Victoria. METHOD: A web-based survey, exploring practices and challenges faced by clinicians in assessing CALD clients and their families, was sent to all Victorian ACAS managers to distribute to their teams. Three focus groups were also conducted with ACAS clinicians to further explore these issues. RESULTS: Seventy-nine web-based surveys were returned and 21 ACAS clinicians attended a focus group. Challenges reported included the availability and quality of interpreters, and variability in training received and confidence in assessing cognitive impairment in CALD clients. CONCLUSION: ACAS clinicians reported that assessment of cognition for those of CALD background was challenging. Based on this feedback, practice tip sheets were developed as educational aids to assist ACAS staff.