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Who funds stroke trials in Europe? A survey of funding sources for randomised controlled stroke trials by the European Stroke Organisation Trials Alliance (ESOTA) network

Abstract Aims and scope Evidence from randomised controlled trials (RCTs) has transformed stroke care. There are no systematically collected data on the amount of public funding, critical to delivering trials, going into stroke RCTs. To understand the extent of stroke RCT funding by national and EU funding bodies across Europe, the European Stroke Organisation Trials Alliance (ESOTA) conducted a survey of its member nations. Methods This is an observational study of research funding in Europe. The ESOTA steering group sent an electronic survey to the leads of the 16 participating national networks from 14 countries. Structured survey questions included who the funding bodies were in each country, the number of RCT applications put forward for public national or EU funding, the number of successful and failed applications, and the amount of funding granted between 01/01/2022 and 31/12/2023. Results Responses were received from 13 of 14 participating countries. There was significant variation in the number of grant applications submitted by individual countries, ranging from 0-17 during the 24-month survey period. The median number of funded studies per country was 1 (IQR 3, range 0-9) representing a median success rate of 47.1 % (IQR 21.1-59.4%), with no RCTs granted joint European funding. Conclusions Our survey highlights significant inequities in stroke trial funding across Europe. Given the encouraging rate of successful applications overall, it is important for all member networks to submit proposals. This is particularly pertinent for multicentre trials, given the evolution of evidence base in stroke towards large trials, across diverse populations.

Clinical-grade Cuffless Blood Pressure Monitoring via Deep-tissue Diffuse Speckle Pulsatile Flowmetry

Blood pressure (BP) is a vital sign which is measured to diagnose and manage hypertension. However, current methods to measure BP use inflatable cuffs which cause discomfort and limit the frequency at which measurements can be made, or intra-arterial catheters which are invasive and pose infection risks. Here, we propose and evaluate the use of Diffuse Speckle Pulsatile Flowmetry (DSPF) as a cuffless BP measurement method to address these limitations. DSPF is a laser speckle-based technique which simultaneously records blood flow rate and blood volume (i.e. photoplethysmography or PPG) signals from relatively deep vascular tissue. Using information from these signals, we studied DSPFs effectiveness in measuring systolic BP (SBP) and diastolic BP (DBP) through an outpatient study in which 133 patients were recruited, and in measuring beat-to-beat BP waveforms through an inpatient study in which two patients were recruited. In the outpatient study, the DSPF method was able to achieve mean absolute errors (MAEs) of 4.17 mmHg and 2.42 mmHg for SBP and DBP respectively compared to conventional cuff-based methods. It was also able to fulfil the requirements of the AAMI/ESH/ISO 81060-2:2018 standard for BP measurement devices and attain an "A" grade according to the British Hypertension Society grading scheme. For the inpatient study, it produced BP waveforms which had MAEs of 2.35 mmHg and 3.06 mmHg compared to arterial-line measurements for the two patients, respectively. Compared to PPG which has been studied more extensively as a cuffless BP measurement method, we found through ablation studies that DSPF was able to reach significantly lower MAEs and hence better accuracies. DSPF augments the performance of PPG-only methods by leveraging additional information from the blood flow rate signal, and we therefore find it to be a superior cuffless BP measurement method which can potentially be used in outpatient, inpatient, and remote settings.