Search

Aims: To (a) seek examples of nursing caring success stories and (b) identify the common contributors to these successes. By focusing on the successes of nursing care rather than critically examining failures, this research seeks to provide examples of proven and feasible approaches and processes for improving care., Design: This study used a narrative inquiry design., Methods: Data were collected through group interviews. Four interviews were conducted with a total of 20 nurse participants working in inpatient settings in South Australian hospitals. A thematic analysis approach was used to analyse the data., Results: Two dominant themes concerning the contributors to caring success were identified. These contributors were (1) the provision of holistic care and (2) the influence of the caring community, which includes family members and other patients. The findings also indicated that the definition of caring success according to nurses is not aligned with organisational performance indicators but is more closely represented by caring values., Conclusion: Success, according to nurses, is not exclusively defined by patient outcomes but includes the approach to, and process of, care delivery., Implications for the Profession And/or Patient Care: Nurses value the caring process while working in an environment that primarily values clinical and systems-level outcomes. Nurses want patients and their families, allied health professionals and hospital executives to be involved and invested in the process of care., Impact: This study addressed a gap in the current literature to identify commonalities in nursing success stories, the contributors informing these successes and how these contributors can facilitate improved patient care. Understanding nursing definitions of caring success provides an opportunity to expand upon current accepted industry definitions and perspectives such as key performance indicators., Reporting Method: Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist., Patient or Public Contribution: No direct patient or public contribution., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aim(s): To operationalize the Caring Life Course Theory (CLCT) as a framework for improving cardiac rehabilitation (CR) engagement and informing ways to address disparities in rural, low socio-economic areas., Methods: A secondary analysis of data collected from 15 CR programmes to identify CR patterns through the CLCT lens using a mixed-methods approach. All analytical processes were conducted in NVivo, coding qualitative data through thematic analysis based on CLCT constructs. Relationships among these constructs were quantitatively assessed using Jaccard coefficients and hierarchical clustering via dendrogram analysis to identify related clusters., Results: A strong interconnectedness among constructs: 'care from others', 'capability', 'care network' and 'care provision' (coefficient = 1) highlights their entangled crucial role in CR. However, significant conceptual disparities between 'care biography' and 'fundamental care' (coefficient = 0.4) and between 'self-care' and 'care biography' (coefficient = 0.384615) indicate a need for more aligned and personalized care approaches within CR., Conclusion: The CLCT provides a comprehensive theoretical and practical framework to address disparities in CR, facilitating a personalized approach to enhance engagement in rural and underserved regions., Implications: Integrating CLCT into CR programme designs could effectively address participation challenges, demonstrating the theory's utility in developing targeted, accessible care interventions/solutions., Impact: Explored the challenge of low CR engagement in rural, low socio-economic settings. Uncovered care provision, transitions and individual care biographies' relevance for CR engagement. Demonstrated the potential of CLCT to inform/transform CR services for underserved populations, impacting practices and outcomes., Reporting Method: EQUATOR-MMR-RHS., Patient Contribution: A consumer co-researcher contributed to all study phases., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

In this article, we investigate how the concept of Care Biography and related concepts are understood and operationalised and describe how it can be applied to advancing our understanding and practice of holistic and person-centred care. Walker and Avant's eight-step concept analysis method was conducted involving multiple database searches, with potential or actual applications of Care Biography identified based on multiple discussions among all authors. Our findings demonstrate Care Biography to be a novel overarching concept derived from the conjunction of multiple other concepts and applicable across multiple care settings. Concepts related to Care Biography exist but were more narrowly defined and mainly applied in intensive care, aged care, and palliative care settings. They are associated with the themes of Meaningfulness and Existential Coping, Empathy and Understanding, Promoting Positive Relationships, Social and Cultural Contexts, and Self-Care, which we used to inform and refine our concept analysis of Care Biography. In Conclusion, the concept of Care Biography, can provide a deeper understanding of a person and their care needs, facilitate integrated and personalised care, empower people to be in control of their care throughout their life, and help promote ethical standards of care., (© 2024 The Author(s). Nursing Philosophy published by John Wiley & Sons Ltd.)

Introduction: Constipation is a common and significant burden on individuals and healthcare systems. Accurate assessment of constipation severity and symptom improvement are vital aspects of caring for patients with constipation. Therefore, nurses and allied healthcare professionals should possess knowledge regarding the characteristics of constipation assessment tools (ie, aim, scope, definition of constipation, content, structure, mode, administration time and context of use). However, existing reviews summarising characteristics of tools have been restricted to chronic constipation and self-reported measures. Furthermore, they have not included literature published after 2011. This scoping review aims to identify and comprehensibly map the characteristics of available tools for screening and assessment of constipation in order to manage the nursing care need related to constipation within any healthcare or research context and any patient group., Methods and Analysis: This review will include primary research articles, methodological papers and clinical guidelines using tools for constipation screening and assessment, pertinent to nursing care management. It is not limited to a specific population or healthcare setting. Databases to be searched include PubMed, Embase, CINAHL, ProQuest, ClinicalKey and Google Scholar. To identify grey literature, national health services in selected countries will be searched. Papers written in English, Nordic language or German will be included. The reviewers will independently review the retrieved citations against the inclusion criteria, and data from included papers will be extracted using a data extraction form developed for this review. The scoping review will be conducted following the Joanna Briggs Institute Guidelines. The results will be presented in a table accompanied by a narrative summary., Ethics and Dissemination: Ethical approval is not required, as no individual patient data are included. Findings will be shared and discussed with relevant stakeholders and disseminated through peer-reviewed publications and conference presentations. The protocol is registered on Open Science Framework (registration number: osf.io/h2vzd)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The commitment of nurses to their profession and workplace is closely linked to the delivery of high-quality patient care. Existing literature highlights the positive impact of commitment on care quality and patient outcomes. Conversely, a lack of commitment can lead to nurse burnout and disengagement. However, it remains unclear whether and how cultural beliefs and practices influence newly graduated nurses' commitment to the nursing profession and their workplace., Aim: To explore the cultural beliefs and practices influencing newly graduated nurses' commitment to the profession and commitment to their workplace during their first year of employment., Design: A focused ethnographic study., Methods: Data consisted of field notes from 94 h of participant observations and 10 semi-structured interviews with newly graduated nurses working in acute care settings in Denmark. Data were analysed using ethnographic content analysis. Data were collected between March and June 2022., Results: The findings reveal a major theme, termed 'A State of Transience among Newly Graduated Nurses', consisting of two themes: 'Newly Graduated Nurses' Pursuit of Professional Development and Supportive Work Environments' and 'A Lack of Formal Agreements or Conditions to Meet Expectations for Professional Development.', Conclusion: Hospitals and nurse managers need to support newly graduated nurses in their first employment after registration by providing a range of clinical experiences through job rotation opportunities within the same organization, deliver on promises for onboarding support and foster a culture of trust. These strategies will help maintain the motivation, commitment and ability of newly graduated nurses to deliver high-quality patient care, thereby reducing the likelihood of turnover., Relevance for Clinical Practice: A trusting and supportive work environment is fostered by providing diverse clinical experiences and consistent support for newly graduated nurses. To address potential high turnover associated with job rotation, hospitals need to rethink how retention is defined and measured, moving beyond hospital unit-level models and measures., Reporting Method: This study reports to the SRQR guidelines., Patient or Public Contribution: No patient or public contribution., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aim: The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice., Design: Position paper., Methods: This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice., Results: The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action-oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non-nursing tasks: reclaim and protect time to provide high-value fundamental care. Accentuate the positive: change from deficit-based to affirmative language when describing fundamental care. Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research. Advocate for interprofessional collaboration: support high-quality, transdisciplinary fundamental care delivery via strong nursing leadership., Conclusion: The ILC Maine Statement calls for ongoing action - [r]evolution - from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally., Implications for the Profession And/or Patient Care: We outline four action-oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered. Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems., Impact: Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability. This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally., Patient or Public Contribution: Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers. By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Professional caregiving relationships are central to quality healthcare but are not always developed to a consistently high standard in clinical practice. Existing literature on what constitutes high-quality relationships and how they should be developed is plagued by dyadic conceptualisations; discipline, context and condition-specific research; and the absence of healthcare recipient and informal carer voices. This study aimed to address these issues by exploring how healthcare recipients and carers conceptualise good professional caregiving relationships regardless of discipline, care setting and clinical condition., Design: A qualitative story completion approach was used. Participants completed a story in response to a hypothetical stem that described a healthcare recipient (and, in some instances, carer) developing a good relationship with a new healthcare provider. Stories were analysed using reflexive thematic analysis., Participants: Participants were 35 healthcare recipients and 37 carers (n = 72 total)., Results: Participants' stories were shaped by an overarching discourse that seeking help from new providers can elicit a range of unwanted emotions for both recipients and carers (e.g., anxiety, fear, dread). These unwanted emotions were experienced in relation to recipients' presenting health problems as well as their anticipated interactions with providers. Specifically, recipient and carer characters were fearful that providers would dismiss their concerns and judge them for deciding to seek help. Good relationships were seen to develop when healthcare providers worked to relieve or minimise these unwanted emotions, ensuring healthcare recipients and carers felt comfortable and at ease with the provider and the encounter. Participants positioned healthcare providers as primarily responsible for relieving recipients' and carers' unwanted emotions, which was achieved via four approaches: (1) easing into the encounter, (2) demonstrating interest in and understanding of recipients' presenting problems, (3) validating recipients' presenting problems and (4) enabling and respecting recipient choice. Participants' stories also routinely oriented to temporality, positioning relationships within recipients' and carers' wider care networks and biographical and temporal contexts., Conclusion: The findings expand our understanding of professional caregiving relationships beyond dyadic, static conceptualisations. Specifically, the findings suggest that high-quality relationships might be achieved via a set of core healthcare provider behaviours that can be employed across disciplinary, context and condition-specific boundaries. In turn, this provides a basis to support interprofessional education and multidisciplinary healthcare delivery, enabling different healthcare disciplines, specialties, and teams to work from the same understanding of what is required to develop high-quality relationships., Patient or Public Contribution: The findings are based on stories from 72 healthcare recipient and carer participants, providing rich insight into their conceptualisations of high-quality professional caregiving relationships., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Sleep is essential for overall health, yet various sleep disorders disrupt normal sleep patterns, affecting duration, quality, and timing. This pilot study investigate the impact of a food supplement (SPINOFF ® ) on both sleep quality and mental well-being in 41 participants (mean age: 45.3 years). Initial assessments revealed sleep disturbances (Pittsburgh Sleep Quality Index-PSQ-mean score: 8.2) and insomnia symptoms (Insomnia Severity Index-ISI- mean score: 12.7). Mental health assessments showed psychological distress (Dass-21 Depression mean score: 4.2, Anxiety mean score: 6.9, Stress mean score: 11.6, Total mean score: 22.7). This study assessed sleep continuity using Awakenings per Night (ApN) via a smartwatch (HELO HEALTH ® ) and conducted the study in two phases: baseline (T0) and after 30 days of treatment (T1) (Phase A). No placebo-control was used in this study. After 30 days (Phase B), 21 patients were selected for reassessment. Eleven continued treatment for another 30 days (T2), while ten discontinued. Following the intervention, we observed remarkable improvements in sleep quality and mental distress. The SPINOFF ® supplement significantly reduced the PSQI scores (22.4%), indicating enhanced sleep quality. Additionally, there was a 19.6% decrease in ISI scores, demonstrating a reduction in insomnia symptoms. Moreover, overall psychological distress decreased by 19.5% signifying improved psychological well-being. In the second phase, participants who continued treatment experienced more substantial improvements, with a mean decrease of 0.8 points in PSQI scores (±0.9) and a mean decrease of 0.9 points in ISI scores. Our findings suggest that the SPINOFF ® supplement has the potential to effectively address both sleep disturbances and psychological distress in our study population.

Aim: To explore factors influencing newly graduated nurses' delivery of direct care in acute care hospital settings., Design: Qualitative study using focused ethnography., Methods: During the period from March to June 2022, a total of ten newly graduated nurses were purposively sampled, and data were collected through 96 h of participant observation as well as ten semi-structured interviews. This research took place in a large hospital located in Denmark. Data were analysed using LeCompte and Schensul's ethnographic content analysis., Results: Three main structures were developed from the data: 'Contrasting Intentions and Actions for care delivery', 'Organizational Constraints Block Interpersonal Aspects of Nursing Care' and 'Newly Graduated Nurses' Suppressed Need for Support Constitutes Delay in Care Actions'., Conclusion: Newly graduated nurses were committed to delivering high-quality care but were aware they sometimes provided compromised care. The paradox between a commitment to care and compromised care delivery was borne out of tensions between newly graduated nurses' professional beliefs and nursing values, a desire to integrate patients' needs and preferences, and organizational constraints on everyday practices where newly graduated nurses often worked alone without the support of a more experienced nurse. Critical reflection on cultural, social and political forces that influence direct care delivery might support newly graduated nurses to deliver direct patient care more intentionally., Relevance to Clinical Practice: Establishment of onboarding programs and other support activities for newly graduated nurses to cope with contrasting intentions and actions that must address organizational constraints is essential. These development programs should include how critical reflection competency is supported to address value inconsistencies and emotional distress to ensure high-quality patient care., Reporting Method: The reporting adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: 'No Patient or Public Contribution'., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aim: To summarize existing research syntheses reporting newly graduated registered nurses' experiences of providing direct care in hospital settings., Design: Umbrella review., Data Sources: An extensive search of all relevant databases was conducted for research syntheses. Initial key terms included "new* nurse", "nursing care" and "hospital setting" in combination with index terms to find relevant literature., Methods: Critical appraisal, data extraction and summary were performed independently by two reviewers according to the Joanna Briggs Institute guidelines for undertaking umbrella reviews., Results: Nine research syntheses published between 2010 and 2019 and representing 173 studies were included following critical appraisal. The evidence was summarized in narrative form with supporting tables. Twenty-six sub-branches and seven main-branches were organized in a coding tree showing the structure of three overlapping themes: "Feeling a lack of competency", "Sense of emotional distress" and "In need of support"., Conclusions: Evidence demonstrates that newly graduated registered nurses' experiences of a lack of competency, emotional distress and need for support emerged as essential requirements for the provision of competent and safe direct care for the patient., Impact: Newly graduated registered nurses face multiple challenges in the transition from student nurse to practicing nurse. Unmet expectations of being a newly graduated nurse might lead to low levels of job satisfaction, high attrition rates or missed nursing care. Nurse educators, leaders and policy makers should be mindful that newly graduated registered nurses' perceptions of professional and personal identity and degree of support influences newly graduated registered nurses' direct care provision., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Qualitative story completion (QSC) is an innovative research method that offers researchers a range of unique opportunities for generating and analysing data. Participants are asked to write a 'story' in response to a hypothetical 'story stem', often in the third-person and involving fictional characters, rather than reporting on their direct experiences. QSC is being developed and increasingly taken up by researchers working across a range of fields; but it has been little used in health research, especially in the fields of nursing, health services research, medicine, and allied health. This means that health researchers have few examples to draw on when considering what QSC can offer them and how to rigorously design, conduct, and report a QSC study within health-related fields. We aim to address this gap and contribute to existing QSC literature by promoting increased use of QSC by health researchers and supporting them to produce rigorous QSC research. We outline three case examples illustrating how we have used QSC to conduct multidisciplinary health research relevant to nursing, medicine and nutrition. Drawing on these case examples, we reflect on challenges that we encountered, describe decision-making processes, and offer recommendations for conducting rigorous health research using QSC.

Aims: To investigate nursing and allied health professional perceptions of the interrelationship between avoidable hospital readmissions and fundamental care delivery., Design: A qualitative, exploratory study using a critical realist approach., Method: One-to-one semi-structured interviews with 14 nursing and allied health professionals conducted between May and September 2019., Results: Several tensions and contradictions were identified in the data, which demonstrated clinicians' perceptions about the priority of both fundamental care and two avoidable readmission conditions (aspiration pneumonia and constipation). These tensions are illustrated in two major themes: Avoidable versus inevitable; and everyone versus no one. The first theme demonstrates clinicians' perceptions that readmissions for aspiration pneumonia and constipation are not common, despite acknowledging that they generally lacked knowledge on readmission rates; and that these conditions may not be preventable in acute settings. The second theme demonstrates clinicians' perception that preventing readmissions is everyone's responsibility, however, this was coupled with a lack of articulation around how this multidisciplinary approach could be achieved, leading to a distinct lack of agency for care delivery., Conclusion: Articulating the tensions described in the results provides vital knowledge for understanding how clinicians may respond to initiatives designed to reduce avoidable readmissions. Avoidable hospital readmissions may be usefully understood as a wicked problem: one that is complex and requires adaptive, not linear, solutions. Wicked problems pose a challenge for leaders and managers in healthcare because top-down, hierarchical strategies are unlikely to be successful. Effective prevention of avoidable readmissions requires leaders to enable facilitator-led change through relational leadership strategies., Impact: Avoidable hospital readmissions are a global problem increasingly addressed via funding changes and the introduction of penalties to hospitals. This study provides insights on clinicians' perspectives of avoidable hospital readmissions and their prevention, demonstrating the complexity of this challenge and the need for healthcare leaders to enable individual and organizational readiness for change., (© 2022 John Wiley & Sons Ltd.)

Aim: To investigate the strategies used by nurse leaders to facilitate fundamental care delivery in their clinical area., Design: An interpretative qualitative design study reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ)., Methods: Twenty-four self-identified nurse leaders from across Australia were interviewed between November 2020 and April 2021 to discuss their strategies for facilitating fundamental care. Data was analysed using inductive thematic analysis., Results: Nurse leaders' experience of facilitating fundamental care produced two major themes, delivery of fundamental care (comprising three sub-themes: valuing fundamental care, understanding and developing staff capacity and supportive relationships), and monitoring of fundamental care (including three sub-themes: visibility in the clinical area, embedding fundamental care in the practice setting and specific direct actions)., Conclusion: Facilitating fundamental care delivery is complex. This study highlighted the importance of nurse leaders' individual characteristics, and nurse leaders' ability to establish and maintain relationships alongside the role of informal and formal monitoring of fundamental care delivery., Impact: Findings from this study build on existing research into fundamental care and contribute to our understanding of the role, characteristics and actions of nurse leaders to facilitate fundamental care. The results demonstrate the complexity and intricacy of nursing leadership to facilitate fundamental care, and that a dynamic 'thinking and linking' approach is required. The results show individualized practice which may create challenges for new nurse leaders seeking guidance, and for monitoring nurse leader activity. Further research is advocated to explore insights and tools to optimize nurse leaders' endeavours in facilitating fundamental care., Patient or Public Contribution: This study was designed using insights generated from patient and public involvement in nursing leadership and fundamental care., (© 2022 John Wiley & Sons Ltd.)

Aims: To explore the role of ward-based nurse managers in supporting nurses to undertake high-quality fundamental care., Design: A qualitative study guided by the principles of interpretive description. Reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ)., Methods: Nurse managers in three urban, publicly funded hospitals in Australia, Denmark and New Zealand, were invited to participate in group interviews to discuss how they support fundamental care in their clinical areas. Six group interviews were conducted between February 2017 and March 2020 involving 31 participants., Results: Six interrelated themes were identified: Difficulty expressing how to support the nurse-patient relationship; Establishing expectations for care delivery without clear strategies for how this can be achieved; Role modelling desired behaviours; Significance of being present to support care quality; The importance of engaging and supporting staff in their work; and Recognizing the challenges of prioritizing care needs., Conclusion: This study indicates that nurse managers are not universally clear in explaining how they support their staff to provide fundamental care. If fundamental care is not clearly understood and communicated in the nursing team, then there are risks that fundamental care will not be prioritized, with potential negative consequences for patient care. Nurse managers may benefit from additional resources and guidance to help them to support fundamental care delivery in their clinical areas., Impact: Previous research exploring fundamental care and missed care highlights the importance of the role of the nurse manager in influencing nursing care. This study demonstrates that though nurse managers have a passion for supporting their staff to deliver fundamental care, clear strategies to achieve this are not always evident. This study suggests that scholarship around leadership to promote and facilitate fundamental care is crucial to improving nursing practice and patient outcomes., (© 2022 John Wiley & Sons Ltd.)

Background: Infectious disease outbreaks disrupt inpatient clinical care and have an impact on staff and patients' ability to communicate with each other and with the wider community. Digital technology may offer opportunities for communication in the inpatient setting during infectious disease outbreaks. Aim: This scoping review aimed to investigate the use of digital technology in the inpatient setting to promote communication in the early stages of an infectious disease outbreak. Methods: There were three aspects to this scoping review: (1) a database search of Ovid MEDLINE (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Association for Computing Machinery Digital Library (ACM) and IEEE Xplore (IEEE) exploring peer-reviewed articles, (2) a gray literature search, and (3) a media search. Results: Results focused on the early stages of the COVID-19 pandemic. Thirty-eight peer-reviewed articles were extracted from the database search. There were three main areas of investigation: study characteristics, technology features, and benefits and barriers. Forty-four websites were searched for the gray literature search focusing on policy and guidance. Eighteen media articles were retrieved focusing on patients' use of technology and community involvement. Conclusion: Results demonstrate the diverse use of digital technology in the inpatient setting to facilitate communication during the early stages of the COVID-19 pandemic. However, the articles provide limited data to allow readers to fully understand and reproduce described actions. Furthermore, there was limited guidance to support clinicians to communicate using digital technology to create trusting therapeutic relationships. Areas for future development include standard reporting process for technology hardware, software, and content; and structured reporting and evaluation of the implementation of technologies.

We present MedicDeepLabv3+, a convolutional neural network that is the first completely automatic method to segment cerebral hemispheres in magnetic resonance (MR) volumes of rats with ischemic lesions. MedicDeepLabv3+ improves the state-of-the-art DeepLabv3+ with an advanced decoder, incorporating spatial attention layers and additional skip connections that, as we show in our experiments, lead to more precise segmentations. MedicDeepLabv3+ requires no MR image preprocessing, such as bias-field correction or registration to a template, produces segmentations in less than a second, and its GPU memory requirements can be adjusted based on the available resources. We optimized MedicDeepLabv3+ and six other state-of-the-art convolutional neural networks (DeepLabv3+, UNet, HighRes3DNet, V-Net, VoxResNet, Demon) on a heterogeneous training set comprised by MR volumes from 11 cohorts acquired at different lesion stages. Then, we evaluated the trained models and two approaches specifically designed for rodent MRI skull stripping (RATS and RBET) on a large dataset of 655 MR rat brain volumes. In our experiments, MedicDeepLabv3+ outperformed the other methods, yielding an average Dice coefficient of 0.952 and 0.944 in the brain and contralateral hemisphere regions. Additionally, we show that despite limiting the GPU memory and the training data, our MedicDeepLabv3+ also provided satisfactory segmentations. In conclusion, our method, publicly available at https://github.com/jmlipman/MedicDeepLabv3Plus , yielded excellent results in multiple scenarios, demonstrating its capability to reduce human workload in rat neuroimaging studies., (© 2022. The Author(s).)

Background: There are limited opportunities for surgeons to engage in active learning programs once they achieve Fellowship, especially for non-technical skills such as communication. This study aims to address this gap by evaluating a peer-based coaching program in non-technical skill using video-recorded patient consultations from a routine outpatient clinic., Methods: Standard outpatient consultations between consultant surgeons and patients were video recorded. The surgeon viewed the videos with a peer-coach (senior surgeon) who helped identify areas of strength and areas for improvement. To test the effect of the coaching session, outpatient consultations were recorded roughly 1 month later. Pre and post-coaching videos were assessed using the Maastricht History-Taking and Advice Scoring - Global Rating List (MAAS), a common tool for evaluating non-technical skills in clinicians., Results: A total of 12 surgeons consented to participate. Coaching significantly improved MAAS scores (mean difference = -0.61; 95% CI (-0.88, -0.33); P < 0.0001). Surgeons were generally positive about the experience. All found the method of learning suitable, and most thought the process improved their skills. Most thought that coaching would improve patient outcomes and the majority thought they would participate in ongoing coaching as part of their employment., Conclusion: This supports the concept of surgical coaching as an effective tool to improve communication skills and the quality of surgical consultation. The next step is to expand beyond a voluntary cohort and link surgical coaching to improved patient outcomes., (© 2022 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

It is necessary to develop reliable biomarkers for epileptogenesis and cognitive impairment after traumatic brain injury when searching for novel antiepileptogenic and cognition-enhancing treatments. We hypothesized that a multiparametric magnetic resonance imaging (MRI) analysis along the septotemporal hippocampal axis could predict the development of post-traumatic epilepsy and cognitive impairment. We performed quantitative T 2 and T 2 * MRIs at 2, 7 and 21 days, and diffusion tensor imaging at 7 and 21 days after lateral fluid-percussion injury in male rats. Morris water maze tests conducted between 35-39 days post-injury were used to diagnose cognitive impairment. One-month-long continuous video-electroencephalography monitoring during the 6th post-injury month was used to diagnose epilepsy. Single-parameter and regularized multiple linear regression models were able to differentiate between sham-operated and brain-injured rats. In the ipsilateral hippocampus, differentiation between the groups was achieved at most septotemporal locations (cross-validated area under the receiver operating characteristic curve (AUC) 1.0, 95% confidence interval 1.0-1.0). In the contralateral hippocampus, the highest differentiation was evident in the septal pole (AUC 0.92, 95% confidence interval 0.82-0.97). Logistic regression analysis of parameters imaged at 3.4 mm from the contralateral hippocampus's temporal end differentiated between the cognitively impaired rats and normal rats (AUC 0.72, 95% confidence interval 0.55-0.84). Neither single nor multiparametric approaches could identify the rats that would develop post-traumatic epilepsy. Multiparametric MRI analysis of the hippocampus can be used to identify cognitive impairment after an experimental traumatic brain injury. This information can be used to select subjects for preclinical trials of cognition-improving interventions.

Objective: This study was undertaken to identify prognostic biomarkers for posttraumatic epileptogenesis derived from parameters related to the hippocampal position and orientation., Methods: Data were derived from two preclinical magnetic resonance imaging (MRI) follow-up studies: EPITARGET (156 rats) and Epilepsy Bioinformatics Study for Antiepileptogenic Therapy (EpiBioS4Rx; University of Eastern Finland cohort, 43 rats). Epileptogenesis was induced with lateral fluid percussion-induced traumatic brain injury (TBI) in adult male Sprague Dawley rats. In the EPITARGET cohort, T 2 ∗ -weighted MRI was performed at 2, 7, and 21 days and in the EpiBioS4Rx cohort at 2, 9, and 30 days and 5 months post-TBI. Both hippocampi were segmented using convolutional neural networks. The extracted segmentation mask was used for a geometric construction, extracting 39 parameters that described the position and orientation of the left and right hippocampus. In each cohort, we assessed the parameters as prognostic biomarkers for posttraumatic epilepsy (PTE) both individually, using repeated measures analysis of variance, and in combination, using random forest classifiers., Results: The extracted parameters were highly effective in discriminating between sham-operated and TBI rats in both the EPITARGET and EpiBioS4Rx cohorts at all timepoints (t; balanced accuracy > .9). The most discriminating parameter was the inclination of the hippocampus ipsilateral to the lesion at t = 2 days and the volumes at t ≥ 7 days after TBI. Furthermore, in the EpiBioS4Rx cohort, we could effectively discriminate epileptogenic from nonepileptogenic animals with a longer MRI follow-up, at t = 150 days (area under the curve = .78, balanced accuracy = .80, p = .0050), based on the orientation of both hippocampi. We found that the ipsilateral hippocampus rotated outward on the horizontal plane, whereas the contralateral hippocampus rotated away from the vertical direction., Significance: We demonstrate that assessment of TBI-induced hippocampal deformation by clinically translatable MRI methodologies detects subjects with prior TBI as well as those at high risk of PTE, paving the way toward subject stratification for antiepileptogenesis studies., (© 2022 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Background: Patient safety is a major concern for health care systems in both high-income and low- and middle-income countries (LMICs). Nurses play a key role in ensuring patient safety. Existing research on nurses' perception of patient safety is limited to high-income countries and there is a relative scarcity of evidence on the perceptions of nurses from LMICs. Therefore, the aim of this study was to explore nurses' perceptions and experiences of the provision of patient care and its impact on patient safety, and nurses' own health and wellbeing., Methods: An exploratory descriptive qualitative study using in-depth semi-structured interviews was conducted in two hospitals' medical and surgical units in Amhara Regional State, Ethiopia. Purposeful sampling was used for the selection of participants. Thirteen nurses were interviewed. Thematic analysis was conducted using NVivo 12., Results: Three major themes were identified: nurses are concerned about patient safety and quality of care provided; nurses' own health and wellbeing; and lack of support for nursing practice from hospital administration. Nurses reported that their working units were not suitable to ensure safe and quality patient care. Their level of concern differed from one unit to another. Inadequate nurse staffing and material resources, unfavourable work environment, and lack of appropriate leadership support for nursing practice were among the main challenges reported by nurses., Conclusions: Nurses described that they were committed to providing high-quality nursing care. However, they did not feel that their work environment was conducive to facilitating this care. Ensuring a favourable work environment for nurses would help to improve the quality of patient care, and in the reduction of nurses' turnover., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The Fundamentals of Care Framework is an evidence-based, theory-informed framework that conceptualises high-quality fundamental care. The Framework places the nurse-patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse-patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality of nurse-patient relationship instruments by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty-seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring 'focus', 'anticipate' and 'evaluate'. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse-patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework., (© 2021 John Wiley & Sons Ltd.)

Registration-based methods are commonly used in the automatic segmentation of magnetic resonance (MR) brain images. However, these methods are not robust to the presence of gross pathologies that can alter the brain anatomy and affect the alignment of the atlas image with the target image. In this work, we develop a robust algorithm, MU-Net-R, for automatic segmentation of the normal and injured rat hippocampus based on an ensemble of U-net-like Convolutional Neural Networks (CNNs). MU-Net-R was trained on manually segmented MR images of sham-operated rats and rats with traumatic brain injury (TBI) by lateral fluid percussion. The performance of MU-Net-R was quantitatively compared with methods based on single and multi-atlas registration using MR images from two large preclinical cohorts. Automatic segmentations using MU-Net-R and multi-atlas registration were of excellent quality, achieving cross-validated Dice scores above 0.90 despite the presence of brain lesions, atrophy, and ventricular enlargement. In contrast, the performance of single-atlas segmentation was unsatisfactory (cross-validated Dice scores below 0.85). Interestingly, the registration-based methods were better at segmenting the contralateral than the ipsilateral hippocampus, whereas MU-Net-R segmented the contralateral and ipsilateral hippocampus equally well. We assessed the progression of hippocampal damage after TBI by using our automatic segmentation tool. Our data show that the presence of TBI, time after TBI, and whether the hippocampus was ipsilateral or contralateral to the injury were the parameters that explained hippocampal volume., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 De Feo, Hämäläinen, Manninen, Immonen, Valverde, Ndode-Ekane, Gröhn, Pitkänen and Tohka.)

Aims: The aim of this study was to measure the level of missed nursing care and determine its relationship with nurse staffing and patient safety outcomes in acute care settings in Ethiopia., Background: Missed nursing care in hospitals increases the likelihood of patient adverse events, complications, disability and death. However, little is known about the level of missed nursing care and its impact on patient outcomes in low-income countries., Methods: An observational study was conducted comprising of a survey of nurses at two time points (n = 74 and 80, respectively) and a medical record review of 517 patients in four units across two hospitals between September 2018 and March 2019., Results: The level of missed nursing care in the study units was very high. The hospital type and hours nurses worked during the last week were significantly associated with missed nursing care. A unit increase in missed nursing care score increased the incidence of adverse patient outcomes by 10%., Conclusion: There was a higher level of missed nursing care in the study units compared with similar studies from high-income countries. Higher level of missed nursing care was significantly associated with higher incidence of adverse patient safety outcomes., (© 2021 John Wiley & Sons Australia, Ltd.)

Aim: To present the first iteration of the caring life-course theory., Background: Despite requiring care from birth to death, a person's universal or fundamental care needs and the subsequent care provision, either by self or others, has yet to be presented within a life-course perspective. Accurately describing the care people require across their lifespan enables us to identify who, what type, how and where this care should be provided. This novel perspective can help to legitimise a person's care needs and the support they require from wider care systems and contexts., Design: Discussion paper outlines theory development. We adopted an inductive approach to theory development, drawing upon existing literature and the team's diverse experiences. Our theoretical insights were refined through a series of collaborative meetings to define the theory's constructs, until theoretical saturation was reached., Discussion: Fourteen constructs are identified as essential to the theory. We propose it is possible, using these constructs, to generate caring life-course trajectories and predict divergences in these trajectories. The novel contribution of the theory is the interplay between understanding a person's care needs and provision within the context of their lifespan and personal histories, termed their care biography, and understanding a person's care needs and provision at specific points in time within a given care network and socio-political context., Impact for Nursing: The caring life-course theory can provide a roadmap to inform nursing and other care industry sectors, providing opportunities to integrate and deliver care from the perspective of the person and their care history, trajectories and networks, with those of professional care teams. It can help to shape health, social and economic policy and involve individuals, families and communities in more constructive ways of talking about the importance of care for improved quality of life and healthy societies., (© 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Rationale: The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear., Objectives: The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs., Methods: We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis., Results: A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults' self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life., Conclusion: This synthesis provides an overview of theories used in research on older adults' LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Accurate detection and quantification of unruptured intracranial aneurysms (UIAs) is important for rupture risk assessment and to allow an informed treatment decision to be made. Currently, 2D manual measures used to assess UIAs on Time-of-Flight magnetic resonance angiographies (TOF-MRAs) lack 3D information and there is substantial inter-observer variability for both aneurysm detection and assessment of aneurysm size and growth. 3D measures could be helpful to improve aneurysm detection and quantification but are time-consuming and would therefore benefit from a reliable automatic UIA detection and segmentation method. The Aneurysm Detection and segMentation (ADAM) challenge was organised in which methods for automatic UIA detection and segmentation were developed and submitted to be evaluated on a diverse clinical TOF-MRA dataset. A training set (113 cases with a total of 129 UIAs) was released, each case including a TOF-MRA, a structural MR image (T1, T2 or FLAIR), annotation of any present UIA(s) and the centre voxel of the UIA(s). A test set of 141 cases (with 153 UIAs) was used for evaluation. Two tasks were proposed: (1) detection and (2) segmentation of UIAs on TOF-MRAs. Teams developed and submitted containerised methods to be evaluated on the test set. Task 1 was evaluated using metrics of sensitivity and false positive count. Task 2 was evaluated using dice similarity coefficient, modified hausdorff distance (95 th percentile) and volumetric similarity. For each task, a ranking was made based on the average of the metrics. In total, eleven teams participated in task 1 and nine of those teams participated in task 2. Task 1 was won by a method specifically designed for the detection task (i.e. not participating in task 2). Based on segmentation metrics, the top two methods for task 2 performed statistically significantly better than all other methods. The detection performance of the top-ranking methods was comparable to visual inspection for larger aneurysms. Segmentation performance of the top ranking method, after selection of true UIAs, was similar to interobserver performance. The ADAM challenge remains open for future submissions and improved submissions, with a live leaderboard to provide benchmarking for method developments at https://adam.isi.uu.nl/., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

(1) Background: Transfer learning refers to machine learning techniques that focus on acquiring knowledge from related tasks to improve generalization in the tasks of interest. In magnetic resonance imaging (MRI), transfer learning is important for developing strategies that address the variation in MR images from different imaging protocols or scanners. Additionally, transfer learning is beneficial for reutilizing machine learning models that were trained to solve different (but related) tasks to the task of interest. The aim of this review is to identify research directions, gaps in knowledge, applications, and widely used strategies among the transfer learning approaches applied in MR brain imaging; (2) Methods: We performed a systematic literature search for articles that applied transfer learning to MR brain imaging tasks. We screened 433 studies for their relevance, and we categorized and extracted relevant information, including task type, application, availability of labels, and machine learning methods. Furthermore, we closely examined brain MRI-specific transfer learning approaches and other methods that tackled issues relevant to medical imaging, including privacy, unseen target domains, and unlabeled data; (3) Results: We found 129 articles that applied transfer learning to MR brain imaging tasks. The most frequent applications were dementia-related classification tasks and brain tumor segmentation. The majority of articles utilized transfer learning techniques based on convolutional neural networks (CNNs). Only a few approaches utilized clearly brain MRI-specific methodology, and considered privacy issues, unseen target domains, or unlabeled data. We proposed a new categorization to group specific, widely-used approaches such as pretraining and fine-tuning CNNs; (4) Discussion: There is increasing interest in transfer learning for brain MRI. Well-known public datasets have clearly contributed to the popularity of Alzheimer's diagnostics/prognostics and tumor segmentation as applications. Likewise, the availability of pretrained CNNs has promoted their utilization. Finally, the majority of the surveyed studies did not examine in detail the interpretation of their strategies after applying transfer learning, and did not compare their approach with other transfer learning approaches.

Skull-stripping and region segmentation are fundamental steps in preclinical magnetic resonance imaging (MRI) studies, and these common procedures are usually performed manually. We present Multi-task U-Net (MU-Net), a convolutional neural network designed to accomplish both tasks simultaneously. MU-Net achieved higher segmentation accuracy than state-of-the-art multi-atlas segmentation methods with an inference time of 0.35 s and no pre-processing requirements. We trained and validated MU-Net on 128 T2-weighted mouse MRI volumes as well as on the publicly available MRM NeAT dataset of 10 MRI volumes. We tested MU-Net with an unusually large dataset combining several independent studies consisting of 1782 mouse brain MRI volumes of both healthy and Huntington animals, and measured average Dice scores of 0.906 (striati), 0.937 (cortex), and 0.978 (brain mask). Further, we explored the effectiveness of our network in the presence of different architectural features, including skip connections and recently proposed framing connections, and the effects of the age range of the training set animals. These high evaluation scores demonstrate that MU-Net is a powerful tool for segmentation and skull-stripping, decreasing inter and intra-rater variability of manual segmentation. The MU-Net code and the trained model are publicly available at https://github.com/Hierakonpolis/MU-Net., (Copyright © 2021. Published by Elsevier Inc.)

Objective: The objective of this review was to determine the effect of nurse staffing on patient and nurse workforce outcomes in acute care settings within low- and middle-income countries., Introduction: Health care systems in low- and middle-income countries experience a high proportion of the global burden of disease, which is aggravated by several health care constraints. The high rates of both communicable and non-communicable diseases, low numbers in the workforce, poor distribution of qualified professionals, and constraints in medical supplies and resources make the provision of quality health care challenging in low- and middle-income countries. Health care systems in low- and middle-income countries, however, are still expected to address universal health care access and provide high-quality health care. Systematic reviews examining nurse staffing and its effect on patient and nurse workforce outcomes are largely from the perspective of high-income countries. There is a need to understand the evidence on nurse staffing and its impact in the context of low- and middle-income countries., Inclusion Criteria: Empirical studies that addressed acute care nurse staffing levels, such as nurse-to-patient ratio or nurses' qualifications, experience, and skill mix, and their influence on patient and nurse workforce outcomes were included in the review. Studies conducted in a low- or middle-income country were included. Outcomes must have been measured objectively using validated tools., Methods: Studies published until July 2019 were identified from CINAHL, PubMed, Scopus, Embase, PsycINFO, Cochrane Library, Web of Science, and ProQuest Dissertations and Theses. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis was used for this review. Narrative synthesis was conducted due to high heterogeneity of included studies. The level of evidence was determined using GRADEpro., Results: Twenty-seven studies were included in this review and the level of evidence was low, mainly due to the design of included studies. Low nurse-to-patient ratio or high nurse workload was associated with higher rates of in-hospital mortality, hospital-acquired infection, medication errors, falls, and abandonment of treatment. Findings on the effect of nurse staffing on length of hospital stay and incidence of pressure ulcers were inconsistent. Extended work hours, less experience, and working night or weekend shifts all significantly increased medication errors. Higher nurse workload was linked to higher levels of nurses' burnout, needlestick and sharps injuries, intent to leave, and absenteeism., Conclusions: Lower nurse-to-patient ratios and higher nurse workload are linked to in-hospital mortality, hospital-acquired infections, and medication errors among patients, and high levels of burnout, needlestick and sharps injuries, absenteeism, and intention to leave their job among nurses in low- and middle-income countries. The results of this review show similarities with the evidence from high-income countries regarding poor outcomes for patients and nurses. These findings should be considered in light of the lower nurse-to-patient ratios in most low- and middle-income countries., Systematic Review Registration Number: PROSPERO CRD42018119428., Competing Interests: The authors declare that they have no conflict of interest. RW is an associate editor for JBI Evidence Synthesis and was not involved in the editorial processing of this manuscript., (Copyright © 2021 JBI.)

Women's involvement in decision-making around antenatal care is an issue of ongoing debate and discussion. Most research on the topic has used interview and focus group methods to examine women's perspectives. The present study uses a different kind of evidence. By analyzing recordings of actual antenatal consultations, this paper presents a preliminary exploration of model-of-care talk in a hospital setting where a policy of woman-centered care underpinned practice. Conversation Analysis was used to examine how model-of-care pathways were introduced by midwives and discussed with women in consultations. Drawing on interactional work on deontic (i.e., the rights and responsibilities of speakers to determine courses of action) and epistemic (i.e., speakers' claims to knowledge) orientations, this paper offers an account of how woman-centered care is accomplished in a hospital setting. The findings demonstrate how midwives routinely relied on their epistemic knowledge regarding women's health to invoke a "normal" categorization that worked to position midwifery-led care as an appropriate pathway. Examination of model-of-care talk also demonstrated how authority to choose a pathway was typically managed so as to reside with the woman. Talk that topicalized epidural forms of pain management were also examined, as institutional policy around where birth could occur in the hospital system under study restricted women's options (a planned epidural precluded woman access to midwifery-led care during delivery). The findings demonstrate the various ways in which midwives created opportunities for woman-centered care in an institutional setting in which there were logistical restrictions on women's choices.

Despite its prevalence, men's anxiety is arguably under-researched and poorly understood. The present study explores the reasoning provided by male posters to an online discussion forum about the source of their anxiety. Posts were collected from an Australian anxiety online discussion forum. This study utilises discursive psychology, informed by principles of membership categorisation analysis, to describe how age, occupation and family-related identities can be invoked within common sense reasoning about the source of male anxiety. References to various identity categories were routinely employed by male forum posters in their representations of themselves, in order to describe the source of their anxiety in terms of a contrast between how they are, and how they should be. In examining accounts of anxiety and responses to those accounts, we can trace cultural knowledge about issues regarding men, masculinity and anxiety that those accounts make relevant. Findings illustrate how men's descriptions of the source of their anxiety should be understood as culturally bound and related to expectations and obligations associated with their social context and category memberships. By enhancing understandings of how men describe the source of their anxiety, this study offers insight into improving the identification and engagement of men experiencing anxiety in health services., (© 2021 Foundation for Sociology of Health & Illness.)

We present a fully convolutional neural network (ConvNet), named RatLesNetv2, for segmenting lesions in rodent magnetic resonance (MR) brain images. RatLesNetv2 architecture resembles an autoencoder and it incorporates residual blocks that facilitate its optimization. RatLesNetv2 is trained end to end on three-dimensional images and it requires no preprocessing. We evaluated RatLesNetv2 on an exceptionally large dataset composed of 916 T2-weighted rat brain MRI scans of 671 rats at nine different lesion stages that were used to study focal cerebral ischemia for drug development. In addition, we compared its performance with three other ConvNets specifically designed for medical image segmentation. RatLesNetv2 obtained similar to higher Dice coefficient values than the other ConvNets and it produced much more realistic and compact segmentations with notably fewer holes and lower Hausdorff distance. The Dice scores of RatLesNetv2 segmentations also exceeded inter-rater agreement of manual segmentations. In conclusion, RatLesNetv2 could be used for automated lesion segmentation, reducing human workload and improving reproducibility. RatLesNetv2 is publicly available at https://github.com/jmlipman/RatLesNetv2., Competing Interests: As disclosed in the affiliation section, ASh is a full-time payroll employee of the Charles River Discovery Services, Finland—a commercial pre-clinical contract research organization (CRO), which participated in the project and provided raw data as a part of company's R&D initiative. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Valverde, Shatillo, De Feo, Gröhn, Sierra and Tohka.)

Background: The widely adopted integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework identifies facilitation as a 'core ingredient' for successful implementation. Indeed, most implementation scientists agree that a certain degree of facilitation is required to translate research into clinical practice; that is, there must be some intentional effort to assist the implementation of evidence-based approaches and practices into healthcare. Yet understandings of what constitutes facilitation and how to facilitate effectively remain largely theoretical and, therefore, provide scant practical guidance to ensure facilitator success. Implementation Science theories and frameworks often describe facilitation as an activity accomplished in, and through, formal and informal communication amongst facilitators and those involved in the implementation process (i.e. 'recipients'). However, the specific communication practices that constitute and enable effective facilitation are currently inadequately understood., Aim: In this debate article, we argue that without effective facilitation-a practice requiring significant interactional and interpersonal skills-many implementation projects encounter difficulties. Therefore, we explore whether and how the application of Conversation Analysis, a rigorous research methodology for researching patterns of interaction, could expand existing understandings of facilitation within the Implementation Science field. First, we illustrate how Conversation Analysis methods can be applied to identifying what facilitation looks like in interaction. Second, we draw from existing conversation analytic research into facilitation outside of Implementation Science to expand current understandings of how facilitation might be achieved within implementation., Conclusion: In this paper, we argue that conversation analytic methods show potential to understand and refine facilitation as a critical, and inherently interactional, component of implementation efforts. Conversation analytic investigations of facilitation as it occurs in real-time between participants could inform mechanisms to (1) improve understandings of how to achieve successful implementation through facilitation, (2) overcome difficulties and challenges in implementation related to interpersonal communication and interaction, (3) inform future facilitator training and (4) inform refinement of existing facilitation theories and frameworks (e.g. i-PARIHS) currently used in implementation interventions.