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Introduction Reviews of randomized clinical trials (RCTs) in dementia with Lewy bodies (DLB) are essential for informing ongoing research efforts of symptomatic therapies and potentially disease-modifying therapies (DMTs). Methods We performed a systematic review of all clinical trials conducted until September 27, 2022, by examining 3 international registries: ClinicalTrials.gov, the European Union Drug Regulating Authorities Clinical Trials Database, and the International Clinical Trials Registry Platform, to identify drugs in trials in DLB. Results We found 25 agents in 40 trials assessing symptomatic treatments and DMTs for DLB: 7 phase 3, 31 phase 2, and 2 phase 1 trials. We found an active pipeline for drug development in DLB, with most ongoing clinical trials in phase 2. We identified a recent trend towards including participants at the prodromal stages, although more than half of active clinical trials will enroll mild to moderate dementia patients. Additionally, repurposed agents are frequently tested, representing 65% of clinical trials. Conclusion Current challenges in DLB clinical trials include the need for disease-specific outcome measures and biomarkers, and improving representation of global and diverse populations.

PurposeThe purpose of this rapid review was to present current evidence on relations between resilience and self-efficacy among healthcare practitioners in the context of COVID-19 pandemic.Design/methodology/approachLiterature searches were conducted in February/2022 in the online database MEDLINE EBSCO and not date/time limited. Eligibility criteria were as follows: population – healthcare practitioners, interest – relations between resilience and self-efficacy and context – COVID-19.FindingsSix eligible studies from Italy, China, United Kingdom, India, Pakistan and Spain, published between 2020 and 2021 were included in the review. All studies used quantitative methods. The relations between resilience and self-efficacy were identified in contexts of resilience programs, measuring mental health of frontline nurses, measuring nurses' and nursing students' perception of psychological preparedness for pandemic management, perception of COVID-19 severity and mediating roles of self-efficacy and resilience between stress and both physical and mental quality of life. Findings indicated limited research on this topic and a need for more research.Practical implicationsBroader understanding of the relations between resilience and self-efficacy may help healthcare organizations' leaders/managers aiming to support resilience of their employers under challenging circumstances such as future pandemic.Originality/valueThe latest COVID-19 pandemic presented the opportunity to research relations between resilience and self-efficacy and enrich existed research in a new and extraordinary context.

PurposeThe purpose of this study is to increase knowledge and understanding of the relationship between full-time-culture and the outcome for quality and safety of care.Design/methodology/approachThe paper is a literature review with a qualitatively oriented thematic analysis concerning quality or safety outcomes for patients, or patients and staff when introducing a full-time culture.FindingsIdentified factors that could have a positive or negative impact on quality and patient safety when introducing full-time culture were length of shift, fatigue/burnout, autonomy/empowerment and system/structure. Working shifts over 12 h or more than 40 h a week is associated with increased adverse events and errors, lower quality patient care, less attention to safety concerns and more care left undone. Long shifts give healthcare personnel more flexibility and better quality-time off, but there is also an association between long shifts and fatigue or burnout. Having a choice and flexibility around shift patterns is a predictor of increased wellbeing and health.Originality/valueA major challenge across healthcare services is having enough qualified personnel to handle the increasing number of patients. One of the measures to get enough qualified personnel for the expected tasks is to increase the number of full-time employees and move towards a full-time culture. It is argued that full-time culture will have a positive effect on work environment, efficiency and quality due to a better allocation of work tasks, predictable work schedule, reduced sick leave, and continuity in treatment and care. There is limited research on how the introduction of full-time culture will affect the quality and safety for patients and staff, and few studies have been focusing on the relationship between longer shift, work schedule, and quality and safety of care.

Purpose This study aims to explore nursing home and home care managers’ strategies in handling the COVID-19 pandemic. Design/methodology/approach This study has a qualitative design with semistructured individual interviews conducted digitally by videophone (Zoom). Eight managers from nursing homes and five managers from home care services located in a large urban municipality in eastern Norway participated. Systematic text condensation methodology was used for the analysis. Findings The managers used several strategies to handle challenges related to the COVID-19 pandemic, including being proactive and thinking ahead in terms of possible scenarios that might occur, continuously training of staff in new procedures and routines and systematic information sharing at all levels, as well as providing different ways of disseminating information for staff, service users and next-of-kins. To handle staffing challenges, managers used strategies such as hiring short-term staff that were temporary laid off from other industries and bringing in students. Originality/value The COVID-19 pandemic heavily affected health-care systems worldwide, which has led to many health-care studies. The situation in nursing homes and home care services, which were strongly impacted by the pandemic and in charge of a vulnerable group of people, has not yet received enough attention in research. This study, therefore, seeks to contribute to this research gap by investigating how managers in nursing homes and home care services used different strategies to handle the COVID-19 pandemic.

Background and ObjectivesVariations in the glucocerebrosidase gene (GBA) are common risk factors for Parkinson disease (PD) and dementia in PD (PDD) and cause a reduction in the activity of the lysosomal enzyme glucocerebrosidase (GCase). It is anticipated that GCase dysfunction might contribute to a more malignant disease course and predict cognitive impairment in PD, although evidence is lacking. We aimed to discover whether CSF GCase activity is altered in newly diagnosed patients with PD and associated with future development of dementia.MethodsPatients with PD were participants of the ongoing population-based longitudinal ParkWest study in Southwestern Norway and were followed prospectively for up to 10 years. CSF was collected at diagnosis, andGBAcarrier status was obtained. Control samples were from persons without neurodegenerative disorders. GCase activity was measured using a validated assay. PD dementia diagnosis was set according to the Movement Disorder Society criteria, and parametric accelerated failure time models were applied to analyze the association of GCase activity with dementia-free survival.ResultsThis study enrolled 117 patients with PD (mean age 67.2 years, including 12GBAnon‐synonymous variant carriers) and 50 control participants (mean age 64 years). At the time of diagnosis, GCase activity was reduced in patients with PD with (mean ± SD, 0.92 ± 0.40 mU/mg, n = 12) or withoutGBAvariations (1.00 ± 0.37 mU/mg, n = 105) compared with controls (1.20 ± 0.35, n = 50). GCase activity at the time of diagnosis was lower in patients with PD who developed dementia within 10 years (0.85 ± 0.27 mU/mg, n = 41) than in those who did not (1.07 ± 0.40 mU/mg, n = 76,p= 0.001). A 0.1-unit reduction in baseline GCase activity was associated with a faster development of PDD (hazard ratio 1.15, 95% CI 1.03–1.28,p= 0.014).DiscussionThe association of early CSF GCase activity with long-term progression to PD dementia will have important implications for the design of clinical trials for GCase targeting therapies and patient management.Classification of EvidenceThis study provides Class III evidence that reduced CSF GCase activity at the time of PD diagnosis is associated with an increased risk for later development of PDD.

Symptoms of muscle dysmorphia carry significant risks for people’s health and wellbeing. A key priority is therefore to support this group in reducing their symptoms and distorted behaviors to mitigate against the development of clinically severe muscle dysmorphia. However, few interventions exist and there is a need to develop new programs urgently. In this article, we provide researchers and practitioners with evidence-based recommendations on how to effectively achieve this. Recommendations are based on the health intervention development literature and the Intervention Mapping Protocol is introduced as a valuable tool for systemizing the development process. We encourage and now call on researchers and practitioners to action this imminent and important task of developing interventions to address muscle dysmorphia symptoms.

Objective To explore the associations between sense of coherence, perceived social support, and demographic and clinical characteristics among survivors ≥80 years treated for curable colorectal cancer. Methods This exploratory, cross-sectional survey investigates 56 individuals surgically treated for stage I-III colorectal cancer between one and five years prior. Statistical analysis permitted exploration of associations between sense of coherence, perceived social support, and demographic- and clinical variables. Results Lower sense of coherence was associated with higher age, limitations in physical function, and the need for homecare nursing. Lower perceived social support was associated with re-admission, higher age at time of surgery, and male gender. No correlations were found between sense of coherence and perceived social support. Conclusion The results are important for healthcare professionals to consider when dealing with older people who underwent surgery for colorectal cancer, especially in the discharge process to facilitate optimal follow-up care and recovery. publishedVersion

The COVID-19 pandemic put emergency departments all over the world under severe and unprecedented distress. Previous methods of evaluating patient flow impact, such as in-situ simulation, tabletop studies, etc., in a rapidly evolving pandemic are prohibitively impractical, time-consuming, costly, and inflexible. For instance, it is challenging to study the patient flow in the emergency department under different infection rates and get insights using in-situ simulation and tabletop studies. Despite circumventing many of these challenges, the simulation modeling approach and hybrid agent-based modeling stand underutilized. This study investigates the impact of increased patient infection rate on the emergency department patient flow by using a developed hybrid agent-based simulation model. This study reports findings on the patient infection rate in different emergency department patient flow configurations. This study’s results quantify and demonstrate that an increase in patient infection rate will lead to an incremental deterioration of the patient flow metrics average length of stay and crowding within the emergency department, especially if the waiting functions are introduced. Along with other findings, it is concluded that waiting functions, including the waiting zone, make the single average length of stay an ineffective measure as it creates a multinomial distribution of several tendencies.

Aim This study aims to describe and interpret what it is school nurses strive to achieve for themselves in order to remain in practice. Design A qualitative study with a hermeneutic approach. Method The data were collected by means of in-depth interviews with 15 Norwegian school nurses on two separate occasions and analysed using a phenomenological hermeneutic method. Results The analysis resulted in the following themes: (1) trusting your own professional ability, (2) aspiring to appreciation and (3) accomplishing self-care. These themes were reflected in the school nurses' choices and actions and were regarded as an expression of what was of value to them as a nurse. Thus, the nurses' realizing what they strived to achieve for themselves can comprehensively be understood as a good of higher value for their remaining in nursing practice.

Children born preterm with very low birthweight (VLBW) face long-lasting neurodevelopmental challenges, where multidisciplinary assessments are warranted. The International Classification of Functioning, Disability and Health (ICF) provides a framework for understanding and conceptualising these outcomes.We aimed to review clinical and neuroimaging findings from birth to adulthood in a Norwegian cohort of individuals born preterm with VLBW (gestational age 37 weeks, birthweight ≤1500 g) within the framework of ICF.We searched PubMed and Embase for articles reporting results of the Norwegian University of Science and Technology (NTNU) Low Birth Weight in a Lifetime Perspective study.We included original articles reporting proportions of adverse outcomes, mean group differences, risk factors or associations between outcomes. Data were extracted according to ICF's two-level classification. Body functions and structures comprised outcomes of brain structures, cognition, mental health, vision, pain and physical health. Activities and participation comprised motor skills, general and social functioning, education, employment, and health-related quality of life.We performed a qualitative synthesis of included articles. Where mean (SD) was reported, we calculated group differences in SD units.Fifty-eight publications were included. Within body functions and structures, increased prevalence of brain structure pathology, lower cognitive performance, mental health problems, visual and physical health impairments through childhood, adolescence and young adulthood were reported among preterm VLBW participants compared with controls. Within activities and participation, motor problems, lower general and social functioning, and lower academic attainment were found. Perinatal factors were associated with several outcomes, and longitudinal findings suggested persistent consequences of being born preterm with VLBW.Being born preterm with VLBW has long-term influences on body functions and structures, activities and participation. The ICF is appropriate for assessing general domains of functioning and guiding the management of individuals born preterm with VLBW.

Aim Service disengagement is a challenge in young individuals struggling with psychosis. Combining cognitive behavioural therapy for psychosis (CBTp) with virtual reality (VR) has proven acceptable and potentially effective for symptoms and social functioning in adults with psychosis. However, studies focusing on young adolescents are lacking. The aim of the present study was to investigate the acceptability of VR-assisted CBTp among adolescents with psychosis. Methods A qualitative study investigating the acceptability of VR during exposure-based social training among adolescents with early onset psychosis. Thematic analysis was used to identify, analyse, interpret and report patterns from the qualitative interviews. Results A total of 27 adolescents with psychosis were invited to participate, 11 declined and 16 were enrolled (59%), and all completed the study. The participants were from 13 until 18 years old, mean age 16 years. None of them had previous experience with use of VR in therapy, but 10 out of 16 participants had prior experience with VR from playing video games. Regarding acceptability, 14 out of 16 had positive expectations towards using VR in CBTp, and they would prefer using VR during exposure-based social training to real-life training only. Conclusions VR-assisted CBTp can be an acceptable intervention for adolescents with psychosis, given their comfort with technology and the opportunity to confront their fears in less threatening virtual social settings with fewer social risks. The present study yields support to continue developing VR-assisted therapy for adolescents, and focusing on VR-interventions for early onset psychosis. publishedVersion

Introduction Frailty is recognized as a clinical condition associated with increased vulnerability for developing negative health outcomes but has been little studied in patients with Parkinson's disease (PD). Here, we investigated the risk of frailty in de novo PD patients and its association with subsequent development of dementia. Methods We conducted a three-year longitudinal population-based study of 192 drug-naive newly diagnosed PD patients and 172 controls (No-PD) matched for age, sex, and education. Frailty was measured using the frailty index (FI). Logistic regression models, adjusting for potential confounders, were conducted to assess the association between frailty at the time of PD diagnosis and the subsequent odds for developing PD dementia during follow-up. Results The mean baseline FI score was higher in the PD (0.21 ± 0.10) than in the No-PD group (0.11 ± 0.07, p < 0.001). One-third of PD patients had high-FI (>0,25), compared to 5% in the no-PD group. Participants with PD had an increased risk to present frailty with an odds ratio (OR) of 6.68 (SE 2.70 IC 95% [3.15; 15.62], p-value

Klebsiella pneumoniae sequence type (ST) 17 is a global problem clone that causes multidrug-resistant (MDR) hospital infections worldwide. In 2008–2009, an outbreak of MDR ST17 occurred at a neonatal intensive care unit (NICU) in Stavanger, Norway. Fifty-seven children were colonized. We observed intestinal persistence of ST17 in all of the children for up to two years after hospital discharge. Here, we investigated the within–host evolution of ST17 in 45 of those children during long-term colonization and compared the outbreak with 254 global strains. Ninety-two outbreak-related isolates were whole-genome sequenced. They had capsule locus KL25, O locus O5 and carried yersiniabactin. During within–host colonization ST17 remained stable with few single nucleotide polymorphisms, no acquisition of antimicrobial resistance (AMR) or virulence determinants, and persistent carriage of a bla CTX-M-15-encoding IncFII(K) IncFIB(K) plasmid (pKp2177_1). The global collection included ST17 from 1993 to 2020 from 34 countries, that were from human infection (41.3%), colonization (39.3%) and respiratory specimens (7.3%), from animals (9.3%), and from the environment (2.7%). We estimate that ST17 emerged mid-to-late 19th century (1859, 95 % HPD 1763–1939) and diversified through recombinations of the K and O loci to form several sublineages, with various AMR genes, virulence loci and plasmids. There was limited evidence of persistence of AMR genes in any of these lineages. A globally disseminated sublineage with KL25/O5 accounted for 52.7 % of the genomes. It included a monophyletic subclade that emerged in the mid-1980s, which comprised the Stavanger NICU outbreak and 10 genomes from three other countries, which all carried pKp2177_1. The plasmid was also observed in a KL155/OL101 subclade from the 2000s. Three clonal expansions of ST17 were identified; all were healthcare-associated and carried either yersiniabactin and/or pKp2177_1. To conclude, ST17 is globally disseminated and associated with opportunistic hospital-acquired infections. It contributes to the burden of global MDR infections, but many diverse lineages persist without acquired AMR. We hypothesize that non-human sources and human colonization may play a crucial role for severe infections in vulnerable patients, such as preterm neonates.

Aims To explore and describe nurse educators' suggestions regarding a digital educational resource addressing quality in placement studies for first-year student nurses in nursing homes. Design A qualitative, explorative, and descriptive research design. Methods Focus group interviews with eight nurse educators and individual interviews with six nurse educators. The interviews were audio-recorded and transcribed verbatim; subsequently, data were analysed in lines with content analysis as described by Graneheim and Lundman. Results The analysis revealed three main categories: ‘Suggestions for a digital educational resource to strengthen and support nurse educators’ role in follow-up students', ‘Suggestions for a digital educational resource to complement and support interaction between stakeholders in placement’, and ‘Suggestions for a digital educational resource to facilitate student nurses' learning processes’. The categories were captured by the overarching theme, ‘A digital educational resource facilitating interaction between stakeholders and students' learning processes. Conclusion This study revealed nurse educators' suggestions regarding design elements, content, and use of a digital educational resource addressing placement studies for first-year student nurses' in nursing homes. Implications for the profession and/or patient care: Nurse educators should be involved in designing, developing, and implementing digital educational resources aiming to support student learning in nursing education placement studies. Impact This study explored nurse educators' suggestions for a digital educational resource. They suggested a digital educational resource to strengthen and support their role, support interaction between stakeholders, and facilitate student nurses' learning processes. Further, they suggested a digital educational resource to be used as a supplement rather than as a replacement for nurse educators' physical presence in placements. Reporting method The Consolidated Criteria for Reporting Qualitative Research reporting guidelines were used. No Patient or Public Contribution.

Nyere helse- og omsorgspolitiske dokumenter løfter fram livshistorier som en viktig kilde til kunnskap i eldreomsorgen, og et relevant verktøy for profesjonelt omsorgsarbeid på sykehjemmet. Men hvilke utfordringer og muligheter ligger i livshistorier som omsorgsverktøy i praksis? Denne artikkelen er basert på et tverrfaglig samarbeidsprosjekt mellom forskere innenfor praksisfeltet, sykepleierstudenter, samfunnsvitere, helsevitere og humanister. Vår hensikt er å få ny kunnskap om utbredelse av livshistorier som omsorgsverktøy på sykehjem, og hva som karakteriserer slike verktøy. Ved hjelp av en kartleggingsstudie om livshistorier som et verktøy for dokumentasjon og kommunikasjon ved sykehjem i en region på Vestlandet, fant vi stor variasjon i utforming av skjemaene som brukes til å dokumentere pasientenes livshistorie. Gjennom en komparativ nærlesning av skjemaenes stilistiske utforminger og kommunikasjonsformer, drøfter vi implikasjonene av det vi ser som en utfordrende sammenblanding av instrumentelle og relasjonelle hensikter ved bruk av livshistorier i profesjonell omsorg.

Purpose This meta-ethnography seeks to provide insight into the impact that a young family member’s problematic substance use has on family life. Background Problematic substance use (PSU) usually emerges in adolescence or young adulthood. Living with a family member with PSU is highly stressful. An understanding is needed of families’ experiences and their needs for adapted help and support, hence we have explored the impact of a young family member’s PSU on family life. Methods Systematic literature searches for qualitative research that explores the impact of PSU on family life and family relationships were conducted and the seven stages of meta-ethnography were used. Results Fifteen articles were included. The Metamorphosis was established as an overarching metaphor. Five main themes accompany this metaphor: stranger in the family; injuring chaos; no trust any more; family lock-up; and helpless societies. Conclusion The Metamorphosis reflects the all-embracing change experienced by families. Family members have felt powerless and helpless; often they wish to stay involved but do not know how. PSU at a young age can develop into lifelong chronic health challenges. Family-oriented help must be readily available in this phase as parents and siblings become deeply involved. Family involvement is seldom incorporated into routine treatment practices; such incorporation is therefore needed.

Background This study analyzed mortality after radiotherapy for bone metastases (287 courses). Endpoints such as treatment in the last month of life and death within 30, 35 and 40 days from start of radiotherapy were evaluated. Methods Different baseline parameters including but not limited to blood test results and patterns of metastases were assessed for association with early death. After univariate analyses, multi-nominal logistic regression was employed. Results Of 287 treatment courses, 42 (15%) took place in the last month of life. Mortality from start of radiotherapy was 13% (30-day), 15% (35-day) and 18% (40-day), respectively. We identified three significant predictors of 30-day mortality (performance status (≤ 50, 60–70, 80–100), weight loss of at least 10% within 6 months (yes/no), pleural effusion (present/absent)) and employed these to construct a predictive model with 5 strata and mortality rates of 0–75%. All predictors of 30-day mortality were also associated with both, 35- and 40-day mortality. Conclusion Early death was not limited to the first 30 days after start of radiotherapy. For different cut-off points, similar predictive factors emerged. A model based on three robust predictors was developed.

Background Meibomian gland dysfunction (MGD) reduces quality-of-life and hinders work productivity of millions of patients, with high direct and indirect societal costs. Thickened meibum obstructs the glands and disrupts ocular surface health. Heating the eyelids to soften and express meibum from the glands can be beneficial. The most accessible method for eyelid warming uses heated, wet towels. However, the efficacy of this treatment is reliant on the methodology, and evidence-based best-practice recommendations are needed. Purpose To evaluate the literature on hot towels in MGD treatment and recommend a best-practice protocol for future research and patient treatment. Methods Studies were identified through PubMed on the May 28, 2021, with the search terms: (warm* OR heat* OR thermal* OR towel OR wet towel) AND (meibomian OR MGD OR eyelid OR “dry eye” OR DED). All relevant original articles with English full-text were included. Results The search yielded 903 results, of which 22 met the inclusion criteria. Across studies, hot towels were found to be effective at reducing ocular symptoms. However, without reheating, the temperature quickly fell below the therapeutic range, which was deemed to be between 40 °C and 47 °C. Towels heated to around 45 °C and reheated every-two minutes were most effective at increasing eyelid temperature, comparable or better than several commercially available eyelid warming devices. No adverse effects were reported in the studies. Conclusion Hot towel treatment effectively warms the eyelids and reduces ocular symptoms, but must be standardized, and towels reheated to achieve maximum benefit. Future research should assess patient satisfaction with different hot towel treatment methods that reheat or replace the towel at least every-two minutes, to establish which methods yield the greatest compliance. Guidelines or clinical recommendations that do not mention the need for regular reheating during hot towel compress treatment should be updated to include this. Keywords Hot towels Eyelid warming Dry eye disease Meibomian gland dysfunction Evaporative dry eye

In this paper we use the concept of the person to examine person-centred dialogue and show how person-centred dialogue is different from and significantly more than transfer of information, which is the dominant notion in health care. A further motivation for the study is that although person-centredness as an idea has a strong heritage in nursing and the broader healthcare discourse, person-centred conversation is usually discussed as a distinct and unitary approach to communication, primarily related to the philosophy of dialogue—the philosophy of Martin Buber. In this paper we start with the concept of person to critically reflect on theoretical perspectives on communication to understand person-centred conversations in the context of nursing and health. We position the concept of the person through the use of Paul Ricoeur's philosophy and follow by distinguishing four theoretical perspectives on communication before reflecting on the relevance of each of these for person-centred communication. These perspectives are: a linear view of communication as transfer of information, communication as a relation in the sense of philosophy of dialogue, practice-based communication on constructionist grounds, and communication as a practice to create social community. In relation to the concept of the person, we do not find transfer of information relevant as a theoretical underpinning for person-centred conversations. From the other three perspectives that are relevant we distinguish five types of person-centred conversations pertinent to nursing and health: problem identifying conversations, instructive conversations, guiding and supportive conversations, caring and existential conversations, and therapeutic conversations. Through this analysis it is argued that person-centred communication and conversations are substantially different to transfer of information. We also discuss the significance of communication adjusted to specific situations, including emphasis on how we speak in relation to the aim or topic of a conversation.

Background Approximately 3-8% of all newborns do not breathe spontaneously at birth, and require time critical resuscitation. Resuscitation guidelines are mostly based on best practice, and more research on newborn resucitation is highly sought for. Methods The NewbornTime project will develop artificial intelligence (AI) based solutions for activity recognition during newborn resuscitations based on both visible light spectrum videos and infrared spectrum (thermal) videos. In addition, time-of-birth detection will be developed using thermal videos from the delivery rooms. Deep Neural Network models will be developed, focusing on methods for limited supervision and solutions adapting to on-site environments. A timeline description of the video analysis output enables objective analysis of resuscitation events. The project further aims to use machine learning to find patterns in large amount of such timeline data to better understand how newborn resuscitation treatment is given and how it can be improved. The automatic video analysis and timeline generation will be developed for on-site usage, allowing for data-driven simulation and clinical debrief for health-care providers, and paving the way for automated real-time feedback. This brings added value to the medical staff, mothers and newborns, and society at large. Discussion The project is a interdisciplinary collaboration, combining AI, image processing, blockchain and cloud technology, with medical expertise, which will lead to increased competences and capacities in these various fields. Trial registration ISRCTNregistry, number ISRCTN12236970

AI systems are quickly being adopted in radiology and, in general, in healthcare. A myriad of systems is being proposed and developed on a daily basis for high-stake decisions that can lead to unwelcome and negative consequences. AI systems trained under the supervised learning paradigm greatly depend on the quality and amount of data used to develop them. Nevertheless, barriers in data collection and sharing limit the data accessibility and potential ethical challenges might arise due to them leading, for instance, to systems that do not offer equity in their decisions and discriminate against certain patient populations or that are vulnerable to appropriation of intellectual property, among others. This paper provides an overview of some of the ethical issues both researchers and end-users might meet during data collection and development of AI systems, as well an introduction to the current state of transparency, interpretability and explainability of the systems in radiology applications. Furthermore, we aim to provide a comprehensive summary of currently open questions and identify key issues during the development and deployment of AI systems in healthcare, with a particular focus on the radiology area.

Background There are few long-term data on the incidence, baseline predictors, and outcomes of dementia in Parkinson’s disease (PD) from prospective community-based incident cohorts. Methods The PINE study prospectively identified all incident PD patients in Aberdeen along with age–sex-matched, community-based controls who consented to standardized annual life-long follow-up. Each year, a clinical expert reviewed the diagnosis of PD and the presence of dementia according to DSM-IV-based criteria. Age–sex stratified incidence rates for dementia in PD and controls were calculated and compared with hazard ratios (HR) adjusted for age, sex, education, and socioeconomic status. Cox proportional-hazard modelling was used to assess baseline predictors for PD dementia and the influence of dementia on survival and institutionalization. Results 201 patients (mean age 72.6yrs) and 260 controls (mean age 75.4yrs) were followed for median 9.5 years. The incidence of dementia was 7.4 (PD) versus 2.1 (controls) per 100 person-years (adjusted HR 6.0, 95%CI 4.1–8.7), with a sixfold increase from under 60 to over 80 years in PD but no sex difference. Independent baseline predictors of PD dementia were older age at diagnosis, self-reported cognitive symptoms, dream enactment, lower MMSE scores, worse motor UPDRS scores, and the ApoE genotype. PD dementia increased the rates of subsequent death and institutionalization (32.0 and 26.9 per 100 person-years, respectively). Conclusion The incidence of dementia in PD is high, increases markedly with age, is increased in those with baseline subjective cognitive symptoms as well as other established risk factors, and is associated with high rates of death and institutionalization.

Aims and objectives To develop and psychometrically test a self-assessment tool that measures undergraduate nursing and midwifery students’ perceptions of spiritual care competence in health care practice. Background Spiritual care is part of nurses/midwives’ responsibility. There is a need to better benchmark students’ competency development in spiritual care through their education. The EPICC Spiritual Care Education Standard served as groundwork for the development of the EPICC Spiritual Care Competency Self-Assessment Tool. Design Cross sectional, mixed methods design. A STROBE checklist was used. Methods The Tool (available in English, Dutch and Norwegian) was developed by an international group. It was tested between July–October 2020 with a convenience sample of 323 nursing/midwifery students at eight universities in five countries. The Tool was tested for validity using Kaiser–Meyer–Olkin (KMO) test, exploratory and confirmatory factor analysis, one-way ANOVA and independent samples t test. The reliability was tested by Cronbach's alpha coefficient. Qualitative data were analysed using thematic analysis. Results The KMO test for sampling adequacy was 0.90. All, but two, items were related to the same factor. Cronbach's alpha coefficient for the Tool was 0.91. Students found the Tool easy to use, and they gained new insights by completing it. However, students felt that some questions were repetitive and took time to complete. Conclusions The Tool has construct and discriminant validity, and high internal consistency (is reliable). In addition, students found the Tool useful, especially in early stages of education. Relevance to clinical practice The Tool affords student nurses and midwives the opportunity to self-evaluate their knowledge, skills and attitudes about spirituality and spiritual care. The Tool offers students, educators and preceptors in clinical practice a tangible way of discussing and evaluating spiritual care competency.

While DNA methylation is established as a major regulator of gene expression in the nucleus, the existence of mitochondrial DNA (mtDNA) methylation remains controversial. Here, we characterized the mtDNA methylation landscape in the prefrontal cortex of neurological healthy individuals (n=26) and patients with Parkinson’s disease (n=27), using a combination of whole-genome bisulphite sequencing (WGBS) and bisulphite-independent methods. Accurate mtDNA mapping from WGBS data required alignment to an mtDNA reference only, to avoid misalignment to nuclear mitochondrial pseudogenes. Once correctly aligned, WGBS data provided ultra-deep mtDNA coverage (16,723 ± 7,711) and revealed overall very low levels of cytosine methylation. The highest methylation levels (5.49 ± 0.97%) were found on CpG position m.545, located in the heavy-strand promoter 1 region. The m.545 methylation was validated using a combination of methylation-sensitive DNA digestion and quantitative PCR analysis. We detected no association between mtDNA methylation profile and Parkinson’s disease. Interestingly, m.545 methylation correlated with the levels of mtDNA transcripts, suggesting a putative role in regulating mtDNA gene expression. In addition, we propose a robust framework for methylation analysis of mtDNA from WGBS data, which is less prone to false-positive findings due to misalignment of nuclear mitochondrial pseudogene sequences. publishedVersion

Background Parents are a resource that can be of considerable importance in supporting their adolescents' recovery and shared decision-making processes. However, involving both adolescents and their parents in treatment creates challenges. Understanding the roles of all decision stakeholders is vital to the implementation of shared decision-making and delivery of high-quality healthcare services. Objective The aim of this study is to explore parents' experiences with adolescents' participation in mental health treatment and how parents perceive being involved in decision-making processes. Design This was a qualitative study with a phenomenological, inductive design. Content analysis of data from qualitative interviews was performed. Setting and Participants This study took place in a Norwegian public healthcare setting. Twelve parents of adolescents who received treatment for severe mental illness participated. Results Four themes were identified: (1) self-determined treatment, but within limits; (2) the essential roles of parents; (3) the need for information and support; and (4) the fight for individualized treatment and service coordination. Conclusion User participation is vital in adolescent mental healthcare and parents play essential roles regarding the shared decision-making process. However, user participation and shared decision-making pose several dilemmas. Parental involvement in treatment decisions may be necessary when adolescents are mentally ill, but could simultaneously hinder those adolescents' empowerment and recovery. Cooperation among parents, adolescents and healthcare professionals can improve treatment engagement and adherence, but may be challenged by divergent interests. Health services should provide family-oriented services to utilize the potential of parents as a resource and minimize conflicting interests. Patient or Public Contribution Two adolescent user representatives participated in designing the study.

Background/Aim: The aim of this study was to analyze the toxicity of locoregional adjuvant breast cancer radiotherapy after implementation of this service in a rural healthcare region with long travel distance. Patients and Methods: This was a retrospective single-institution analysis of 87 consecutive female patients (the initial cohort), managed with conventionally fractionated 3-D conformal radiotherapy with or without boost, including both post mastectomy and breast conservation scenarios. Treatment was administered in line with comprehensive national guidelines. Intensity-modulated techniques were not utilized. Results: The median follow-up time was 4 years. None of the patients developed any grade IV side-effects. According to Radiation Therapy Oncology Group criteria, acute grade 2b or 3 skin toxicity was observed in 16%. In addition, 35% developed acute grade 2a skin reactions. A trend was observed regarding grade 2-3 skin toxicities and administration of a boost (p=0.058). There was a significant association between the clinical target volume of the breast and grade 2-3 skin reactions in women who had breast-conserving surgery (p=0.016). Five patients (6%) developed grade 1 pneumonitis, unrelated to dosimetric or other baseline parameters. Conclusion: The toxicity profile after a median follow-up of 4 years was in accordance with published data. Recently, intensity-modulated techniques have been implemented at the study center, which may reduce radiotherapy toxicity in patients with large clinical target volume due to better dose homogeneity.

Background Virtually all living organisms, including microbes and humans, depend on iron to survive and grow. During an infection, the plasma level of iron and several iron-related proteins change substantially. We hypothesized that iron and iron-related proteins could predict short- and long-term outcomes in community-acquired pneumonia. Methods Blood samples from a prospective cohort of 267 in-patients with community-acquired pneumonia were analysed for hepcidin, ferritin, iron, transferrin, transferrin saturation, and soluble transferrin receptor at admission and 6-weeks post-discharge. Adverse short-term outcome was defined as admission to intensive care unit or death within 30 days, and long-term outcome was assessed as 5-year overall mortality. Logistic regression, Kaplan Meier survival curves, and Cox regression models with cut-offs at median for the potential biomarkers were used for statistical evaluation. Results Low admission levels of hepcidin predicted 5-year overall mortality, independently of age, sex, comorbid conditions, and anaemia. Low levels of ferritin at admission as well as low levels of iron and transferrin saturation and high levels of soluble transferrin receptor at the 6-week follow-up were predictors of 5-year overall mortality in univariable, but not in multivariable analyses. Neither of these potential biomarkers predicted adverse short-term outcomes. Conclusions In hospitalized patients with community-acquired pneumonia, low levels of hepcidin at admission predicted 5-year overall mortality, but not short-term adverse outcome. publishedVersion

A high frequency of mental health challenges and injuries in professional dancers necessitate a better understanding of the complexity of such symptoms, and to explore differences according to sex, academic year and performance levels. Professional dance students were recruited to evaluate symptoms of depression and anxiety (SCL-10), resilience (RSA), self-esteem (RSS), perfectionism (CAPS), body appreciation (BAS-2), and symptoms of low energy availability (LEA, LEAF-q) and eating disorders (ED) (EDE-q). Totally 20–54% of the dancers had symptoms of anxiety or depression, LEA (in females), ED and/or injuries, and 12% had a self-reported history with ED. In females, 44% of the variability in SCL-10 was explained by CAPS and RSS; 15% of variability in LEA was explained by EDE-q and training volume; while BMI, academic year and LEA increased the odds ratio of an injury. In all, BAS-2 reduced the odds ratio of EDE-q by -3.33. Totally 50% reported that they could identify personal mental health problems, still

Background Dementia with Lewy bodies (DLB) includes various core clinical features that result in different phenotypes. In addition, Alzheimer’s disease (AD) and cerebrovascular pathologies are common in DLB. All this increases the heterogeneity within DLB and hampers clinical diagnosis. We addressed this heterogeneity by investigating subgroups of patients with similar biological, clinical, and demographic features. Methods We studied 107 extensively phenotyped DLB patients from the European DLB consortium. Factorial analysis of mixed data (FAMD) was used to identify dimensions in the data, based on sex, age, years of education, disease duration, Mini-Mental State Examination (MMSE), cerebrospinal fluid (CSF) levels of AD biomarkers, core features of DLB, and regional brain atrophy. Subsequently, hierarchical clustering analysis was used to subgroup individuals based on the FAMD dimensions. Results We identified 3 dimensions using FAMD that explained 38% of the variance. Subsequent hierarchical clustering identified 4 clusters. Cluster 1 was characterized by amyloid-β and cerebrovascular pathologies, medial temporal atrophy, and cognitive fluctuations. Cluster 2 had posterior atrophy and showed the lowest frequency of visual hallucinations and cognitive fluctuations and the worst cognitive performance. Cluster 3 had the highest frequency of tau pathology, showed posterior atrophy, and had a low frequency of parkinsonism. Cluster 4 had virtually normal AD biomarkers, the least regional brain atrophy and cerebrovascular pathology, and the highest MMSE scores. Conclusions This study demonstrates that there are subgroups of DLB patients with different biological, clinical, and demographic characteristics. These findings may have implications in the diagnosis and prognosis of DLB, as well as in the treatment response in clinical trials.

Introduction: Early markers of neurodegeneration provide an opportunity to detect, monitor, and initiate interventions in individuals who have an increased risk of developing dementia. Here, we investigated whether the Timed Up and Go (TUG) test is associated with early brain neurodegeneration and whether the TUG test could be a marker of cognitive decline in people with subjective cognitive decline (SCD). Methods: This is a longitudinal analysis of the Dementia Disease Initiation Study, a prospective, community-based, cohort study from Norway, designed to investigate early markers of cognitive impairment and dementia. Participants were classified as SCD and healthy controls (HC). The main studied variables were the TUG test and cognition as measured by the Mini-Mental State Examination and the Consortium to Establish a Registry for Alzheimer’s Disease memory composite score. Additionally, we investigated the cross-sectional association of brain morphology with the TUG using 1.5T-MRI. Results: The sample included 45 participants (SCD = 21, HC = 24) followed during a mean time of 1.50 ± 0.70 years. At baseline, the cognitive performance did not differ between the groups, but TUG was longer in SCD. Slower baseline TUG was associated with a faster cognitive decline in both groups and it was also associated with reduced cortical thickness especially in motor, executive, associative, and somatosensory cortical regions in people with SCD. Discussion/Conclusion: TUG predicted cognitive change in individuals with SCD, and there was a negative association between TUG and cortical thickness. TUG is a promising cheap and noninvasive marker of early cognitive decline and may help initiate interventions in individuals who have an increased risk of dementia.

In this work we explore a recently proposed biphasic cell-fluid chemotaxis-Stokes model which is able to represent two competing cancer cell migration mechanisms reported from experimental studies. Both mechanisms depend on the fluid flow but in a completely different way. One mechanism depends on chemical signaling and leads to migration in the downstream direction. The other depends on mechnical signaling and triggers cancer cells to go upstream. The primary objective of this paper is to explore an alternative numerical discretization of this model by borrowing ideas from [Qiao et al. (2020), M3AS 30]. Numerical investigations give insight into which parameters that are critical for the ability to generate aggressive cancer cell behavior in terms of detachment of cancer cells from the primary tumor and creation of isolated groups of cancer cells close to the lymphatic vessels. The secondary objective is to propose a reduced model by exploiting the fact that the fluid velocity field is largely dictated by the draining fluid from the leaky tumor vasculature and collecting peritumoral lymphatics and is more weakly coupled to the cell phase. This suggests that the fluid flow equations to a certain extent might be decoupled from the cell phase equations. The resulting model, which represents a counterpart of the much studied chemotaxis-Stokes model model proposed by [Tuval, et al. (2005), PNAS 102], is explored by numerical experiments in a one-dimensional tumor setting. We find that the model largely coincides with the original as assessed through numerical solutions computed by discrete schemes. This model might be more amenable for further explorations and analysis. We also investigate how to exploit the weaker coupling between cell phase dynamics and fluid dynamics to do more efficient calculations with fewer updates of the fluid pressure and velocity field.

The novel coronavirus (nCOV) is a new strain that needs to be hindered from spreading by taking effective preventive measures as swiftly as possible. Timely forecasting of COVID-19 cases can ultimately support in making significant decisions and planning for implementing preventive measures. In this study, three common machine learning (ML) approaches via linear regression (LR), sequential minimal optimization (SMO) regression, and M5P techniques have been discussed and implemented for forecasting novel coronavirus disease-2019 (COVID-19) pandemic scenarios. To demonstrate the forecast accuracy of the aforementioned ML approaches, a preliminary sample-study has been conducted on the first wave of the COVID-19 pandemic scenario for three different countries including the United States of America (USA), Italy, and Australia. Furthermore, the contributions of this study are extended by conducting an in-depth forecast study on COVID-19 pandemic scenarios for the first, second, and third waves in India. An accurate forecasting model has been proposed, which has been constructed on the basis of the results of the aforementioned forecasting models of COVID-19 pandemic scenarios. The findings of the research highlight that LR is a potential approach that outperforms all other forecasting models tested herein in the present COVID-19 pandemic scenario. Finally, the LR approach has been used to forecast the likely onset of the fourth wave of COVID-19 in India.

Background: The problem of a lack of nurses is expected to worsen in the future. With an ever-increasing number of elderly patients with multimorbidity and a shortage of healthcare professionals, primary care must innovatively organise their services to offer more sustainable healthcare services. Organising healthcare services in a community virtual ward has been found to improve the quality of life for vulnerable elderly populations. Aim: The aim of the study was to explore healthcare professionals' experiences of interprofessional collaboration in care for patients with multimorbidity in a community virtual ward in the Norwegian context. Methods: Focus group interviews were conducted in this qualitative exploratory study. A purposive sample of 17 healthcare professionals working in a community virtual ward in Norway was interviewed. Data were analysed using thematic analysis. Results: The study results show that healthcare professionals recognise a need for patient involvement in the community virtual ward to offer more sustainable healthcare services at home. Furthermore, the results show how healthcare professionals experience the use of assessment tools and whiteboard meetings as useful tools for facilitating interprofessional collaboration. The study results also describe how interprofessional and holistic follow-up with patients with multimorbidity contributes to increased focus on health promotion in the community virtual ward. Conclusion: We found that interprofessional collaboration in community virtual wards may be a sustainable way of organising healthcare services for patients with multimorbidity living at home. Interprofessional collaboration with a patient-centred and health promotion approach, seems to increase the quality of the follow-up for patients with multimorbidity living at home. Additionally, mutual interprofessional trust and respect seems to be essential for making use of the unique expertise of different professions in the follow-up for patients with multimorbidity. In the future, both the patient's voice and opinion of their next of kin should be considered in the development of more sustainable homecare services.

Masked Image Modelling (MIM) has been shown to be an efficient self-supervised learning (SSL) pre-training paradigm when paired with transformer architectures and in the presence of a large amount of unlabelled natural images. The combination of the difficulties in accessing and obtaining large amounts of labeled data and the availability of unlabelled data in the medical imaging domain makes MIM an interesting approach to advance deep learning (DL) applications based on 3D medical imaging data. Nevertheless, SSL and, in particular, MIM applications with medical imaging data are rather scarce and there is still uncertainty. around the potential of such a learning paradigm in the medical domain. We study MIM in the context of Prostate Cancer (PCa) lesion classification with T2 weighted (T2w) axial magnetic resonance imaging (MRI) data. In particular, we explore the effect of using MIM when coupled with convolutional neural networks (CNNs) under different conditions such as different masking strategies, obtaining better results in terms of AUC than other pre-training strategies like ImageNet weight initialization., To be published in the Northern Lights Conference Proceedings 2023

Background The number of people with noncommunicable diseases is increasing. Noncommunicable diseases are the major cause of disability and premature mortality worldwide, associated with negative workplace outcomes such as sickness absence and reduced work productivity. There is a need to identify scalable interventions and their active components to relieve disease and treatment burden and facilitate work participation. eHealth interventions have shown potential in clinical and general populations to increase well-being and physical activity and could be well suited for workplace settings. Objective We aimed to provide an overview of the effectiveness of eHealth interventions at the workplace targeting employee health behaviors and map behavior change techniques (BCTs) used in these interventions. Methods A systematic literature search was performed in PubMed, Embase, PsycINFO, Cochrane CENTRAL, and CINAHL in September 2020 and updated in September 2021. Extracted data included participant characteristics, setting, eHealth intervention type, mode of delivery, reported outcomes, effect sizes, and attrition rates. Quality and risk of bias of the included studies were assessed using the Cochrane Collaboration risk-of-bias 2 tool. BCTs were mapped in accordance with the BCT Taxonomy v1. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Results In total, 17 randomized controlled trials met the inclusion criteria. The measured outcomes, treatment and follow-up periods, content of eHealth interventions, and workplace contexts had high heterogeneity. Of the 17 studies, 4 (24%) reported unequivocally significant findings for all primary outcomes, with effect sizes ranging from small to large. Furthermore, 53% (9/17) of the studies reported mixed results, and 24% (4/17) reported nonsignificant results. The most frequently targeted behavior was physical activity (15/17, 88% of the studies); the least frequently targeted behavior was smoking (2/17, 12% of the studies). Attrition varied greatly across the studies (0%-37%). Risk of bias was high in 65% (11/17) of the studies, with some concerns in the remaining 35% (6/17). Interventions used various BCTs, and the most frequently used were feedback and monitoring (14/17, 82%), goals and planning (10/17, 59%), antecedents (10/17, 59%), and social support (7/17, 41%). Conclusions This review suggests that, although eHealth interventions may have potential, there are still unanswered questions regarding their effectiveness and what drives the mechanism behind these effects. Low methodological quality, high heterogeneity and complexity, the characteristics of the included samples, and often high attrition rates challenge the investigation of the effectiveness and the making of sound inferences about the effect sizes and significance of the results. To address this, new studies and methods are needed. A megastudy design in which different interventions are evaluated in the same population over the same period on the same outcomes may solve some of the challenges. Trial Registration PROSPERO CRD42020202777; https://www-crd-york-ac-uk/prospero/display_record.php?RecordID=202777

Background Evidence-based practice (EBP) is essential in improving the quality of healthcare and of importance for all health care personnel. No study in Norway has investigated attitudes, skills and use related to EBP among chiropractors. The aim of this study was to describe Norwegian chiropractors’ attitudes, skills, and use of EBP, as well as the barriers and facilitators to their use of EBP. Methods A national cross-sectional survey, the online version of the Evidence Based practice Attitudes & Utilisation SurvEy (EBASE), was sent by email to 770 Norwegian practicing chiropractors, all members of the Norwegian Chiropractic Association. Three EBASE sub-scores were generated (Attitudes, Skills and Use), and the demographic characteristics of the sample were reported. Linear regression analyses were conducted to examine the association between responses of the three sub-scores and demographic characteristics. Information on main barriers and facilitators of EBP was collected and described. Results A total of 312 (41%) chiropractors responded to the survey, and 95% agreed that EBP is necessary for chiropractic practice. While overall use of EBP activities was low participants were interested in learning and improving their skills to incorporate EBP into practice. Chiropractors’ attitudes, skills, and use of EBP were positively associated with being female and having spent more than one hour per week on research, but negatively associated with having practiced more than 10 years. Main barriers of EBP were lack of skills to critically evaluate, interpret, and apply research findings to practice. Main facilitators of EBP included access to the internet and free online databases in the workplace. Conclusion Although chiropractors in Norway reported positive attitudes and moderate skills in EBP, their use of EBP activities was limited. The main barriers and facilitators to EBP were primarily related to perceived skills deficits, whilst enablers of EBP were mostly related to infrastructure requirements.

The maturation of regional brain volumes from birth to preadolescence is a critical developmental process that underlies emerging brain structural connectivity and function. Regulated by genes and environment, the coordinated growth of different brain regions plays an important role in cognitive development. Current knowledge about structural network evolution is limited, partly due to the sparse and irregular nature of most longitudinal neuroimaging data. In particular, it is unknown how factors such as mother’s education or sex of the child impact the structural network evolution. To address this issue, we propose a method to construct evolving structural networks and study how the evolving connections among brain regions as reflected at the network level are related to maternal education and biological sex of the child and also how they are associated with cognitive development. Our methodology is based on applying local Fréchet regression to longitudinal neuroimaging data acquired from the RESONANCE cohort, a cohort of healthy children (245 females and 309 males) ranging in age from 9 weeks to 10 years. Our findings reveal that sustained highly coordinated volume growth across brain regions is associated with lower maternal education and lower cognitive development. This suggests that higher neurocognitive performance levels in children are associated with increased variability of regional growth patterns as children age.

Background Recently, the palliative appropriateness criteria (PAC) score, a novel metric to aid clinical decision-making between different palliative radiotherapy fractionation regimens, has been developed. It includes baseline parameters including but not limited to performance status. The researchers behind the PAC score analyzed the percent of remaining life (PRL) on treatment. The latter was accomplished by calculating the time between start and finish of palliative radiotherapy (minimum 1 day in case of a single-fraction regimen) and dividing it by overall survival in days from start of radiotherapy. The purpose of the present study was to validate this novel metric. Patients and methods The retrospective validation study included 219 patients (287 courses of palliative radiotherapy). The methods were identical to those employed in the score development study. The score was calculated by assigning 1 point each to several factors identified in the original study and using the online calculator provided by the PAC developers. Results Median survival was 6 months and death within 30 days from start of radiotherapy was recorded in 13% of courses. PRL on treatment ranged from 1 to 23%, median 8%. Significant associations were confirmed between online-calculated PAC score, observed survival, and risk of death within 30 days from the start of radiotherapy. Patients with score 0 had distinctly better survival than all other groups. The score-predicted median risk of death within 30 days from start of radiotherapy was 22% in our cohort. A statistically significant correlation was found between predicted and observed risk (p Conclusion This study supports the dual strategy of PRL and risk of early death calculation, with results stratified for fractionation regimen, in line with the original PAC score study. When considering multifraction regimens, the PAC score identifies patients who may benefit from shorter courses. Additional work is needed to answer open questions surrounding the underlying components of the score, because the original and validation study were only partially aligned.

Brain tumors are usually fatal diseases with low life expectancies due to the organs they affect, even if the tumors are benign. Diagnosis and treatment of these tumors are challenging tasks, even for experienced physicians and experts, due to the heterogeneity of tumor cells. In recent years, advances in deep learning (DL) methods have been integrated to aid in the diagnosis, detection, and segmentation of brain neoplasms. However, segmentation is a computationally expensive process, typically based on convolutional neural networks (CNNs) in the UNet framework. While UNet has shown promising results, new models and developments can be incorporated into the conventional architecture to improve performance. In this research, we propose three new, computationally inexpensive, segmentation networks inspired by Transformers. These networks are designed in a 4-stage deep encoder-decoder structure and implement our new cross-attention model, along with separable convolution layers, to avoid the loss of dimensionality of the activation maps and reduce the computational cost of the models while maintaining high segmentation performance. The new attention model is integrated in different configurations by modifying the transition layers, encoder, and decoder blocks. The proposed networks are evaluated against the classical UNet network, showing that our networks have differences of up to an order of magnitude in the number of training parameters. Additionally, one of the models outperforms UNet, achieving training in significantly less time and with a Dice Similarity Coefficient (DSC) of up to 94%, ensuring high effectiveness in brain tumor segmentation.

Background The COVID-19 pandemic had a major impact on healthcare systems around the world, and lack of resources, lack of adequate preparedness and infection control equipment have been highlighted as common challenges. Healthcare managers’ capacity to adapt to the challenges brought by the COVID-19 pandemic is crucial to ensure safe and high-quality care during a crisis. There is a lack of research on how these adaptations are made at different levels of the homecare services system and how the local context influences the managerial strategies applied in response to a healthcare crisis. This study explores the role of local context for managers’ experiences and strategies in homecare services during the COVID-19 pandemic. Methods A qualitative multiple case study in four municipalities with different geographic locations (centralized and decentralized) across Norway. A review of contingency plans was performed, and 21 managers were interviewed individually during the period March to September 2021. All interviews were conducted digitally using a semi-structured interview guide, and data was subjected to inductive thematic analysis. Results The analysis revealed variations in managers’ strategies related to the size and geographical location of the homecare services. The opportunities to apply different strategies varied among the municipalities. To ensure adequate staffing, managers collaborated, reorganized, and reallocated resources within their local health system. New guidelines, routines and infection control measures were developed and implemented in the absence of adequate preparedness plans and modified according to the local context. Supportive and present leadership in addition to collaboration and coordination across national, regional, and local levels were highlighted as key factors in all municipalities. Conclusion Managers who designed new and adaptive strategies to respond to the COVID-19 pandemic were central in ensuring high-quality Norwegian homecare services. To ensure transferability, national guidelines and measures must be context-dependent or -sensitive and must accommodate flexibility at all levels in a local healthcare service system.

Background Training prehospital personnel in identifying patients with acute stroke is key to providing rapid treatment. This study aimed to investigate whether game-based digital simulation training is a feasible alternative to standard in-person simulation training. Methods Second-year paramedic bachelor students at Oslo Metropolitan University in Norway were invited to participate in a study to compare game-based digital simulation (intervention) to standard in-person training (control). For 2 months, students were encouraged to practice the NIHSS, and both groups logged their simulations. Then, they performed a clinical proficiency test, and their results were assessed using a Bland-Altman plot with corresponding 95% limits of agreement (LoA). Results Fifty students participated in the study. Individuals in the game group (n = 23) spent an average (SD) of 42:36 min (36) on gaming and performed 14.4 (13) simulations on average, whereas the control group (n = 27) spent 9:28 min (8) simulating and performed 2.5 (1) simulations. Comparing time variables collected during the intervention period, the mean time for each simulated assessment was significantly shorter in the game group (2:57 min vs. 3:50 min, p = 0.004). In the final clinical proficiency test, the mean difference from the true NIHSS score was 0.64 (LoA: − 1.38 to 2.67) in the game group and 0.69 (LoA: − 1.65 to 3.02) in the control group. Conclusion Game-based digital simulation training is a feasible alternative to standard in-person simulation training to acquire competence in NIHSS assessment. Gamification seemed to give an incentive to simulate considerably more and to perform the assessment faster, with equal accuracy. Trial registration The study was approved by the Norwegian Centre for Research Data (reference no. 543238).

It has been claimed that various discourses related to competence influence higher education, but there is limited understanding of the discourses underlying competence development. The specific aim of this study was to explore epistemic discourses concerning the development of competence of health professionals with a master’s degree in health science. Accordingly, the study was qualitative and adopted discourse analysis. Twelve participants, all of whom were Norwegian health professionals aged between 29 and 49 years, participated in this study. Four participants were in the final stage of study for their master’s degree with three months left before completion, four had completed their degree two weeks before their participation, and four had been working for one year after the completion of their degree. Data were collected in three group interviews. Three epistemic discourses were revealed: (1) a critical thinking competencies discourse, (2) a scientific thinking competencies discourse, and (3) a competence-in-use discourse. The former two discourses were considered the dominant discourses and indicated that a knowing “that” discourse connected the specialized competence of different health professionals with a wider field of competence. This wider field transcended the boundaries of various health disciplines and represented a novel competence developed through a synergizing process between critical and scientific thinking competencies, which seems to drive continued competence development. A competence-in-use discourse was formed in the process. This discourse can be viewed as a unique outcome that contributes to health professionals’ specialized competence and suggests that a knowing “how” discourse was also an underlying background discourse.

BAKGRUNN Forskning viser at det er økt risiko for alkoholbrukslidelser etter fedmekirurgi. Hensikten med studien var å få innsikt i hva fedmeopererte i rusbehandling selv tenker om mulige årsaker til utvikling av problematisk alkoholbruk etter fedmekirurgi. MATERIALE OG METODE Ti dybdeintervju med pasienter i rusbehandling i 2020 som tidligere hadde gjennomgått fedmekirurgi (seks menn og fire kvinner), ble gjennomført. Materialet ble transkribert og analysert ved hjelp av en stegvis deduktiv-induktiv (SDI) metode. RESULTATER Deltakerne opplevde problematisk alkoholbruk først etter fedmeoperasjonen. De beskrev nye intense rusopplevelser og at kroppen responderte annerledes på alkohol. Alkohol fikk nye funksjoner, som appetittvekker, smertedemper og materstatter. De fleste hadde positive erfaringer fra den første tiden etter operasjonen, men deltakerne beskrev samtidig en ambivalent kroppsomstilling og økt psykisk sårbarhet i årene etter. FORTOLKNING Alkoholens nye virkning og funksjon etter inngrepet kan ha gjort deltakerne mer sårbare for utvikling av problematisk alkoholbruk. HOVEDFUNN Et problematisk forhold til alkohol utviklet seg først etter fedmekirurgi. Studiedeltakere beskrev nye og intense rusopplevelser ved alkoholinntak etter operasjonen. Alkohol fikk nye funksjoner knyttet til appetitt, smerter, erstatning for mat og psykiske helseutfordringer.

Aim To develop a conceptual framework describing nursing care from the anaesthesia nurse's perspective in the perioperative context. Background Surgical patients find themselves in a vulnerable situation in need of advanced treatment and care. Nurse anaesthetists have a central role in reducing harm and enhance patient safety, in which person-centred care has been identified as a key component. However, they are challenged by productivity and efficiency demands leading to a potential risk to patient safety. Design Noblit and Hare's interpretative meta-ethnography, directed by the eMERGe reporting guidance. Methods A comprehensive systematic search of nine databases without year limitation. Fifteen studies published between 2002 and 2021 were found eligible for inclusion. Quality appraisal was performed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Results Four themes were identified: being vigilant to keep safe from harm, strengthening patients' confidence, expressing courage to act and speak up, and endorsing team collaboration to achieve best practice. The themes were synthesised into the metaphor, ‘Continuously assessing and acting according to the patients' needs in a holistic perspective’. A conceptual framework was developed, illustrating the interconnection between the different nursing expressions, as the nurse anaesthetists seek to care for the patient as a whole person. Conclusions Nurse anaesthetists aim to deliver holistic nursing care. Nursing care is expressed at two levels, foregrounding and backgrounding anaesthetic nursing, in line with the philosophy of person-centred care. Nursing care in anaesthesia is a matter of how and why it is performed, expressed in attitudes toward the recipients of care. Relevance to clinical practice The framework may be used to inform educational programs and clinical practice in nurse anaesthesia and to promote person-centred care as a shared value across all levels involved in perioperative patient care. No patient or public contribution Data were retrieved from already published literature.

Background Introducing new technologies into healthcare practices may challenge professionals' traditional care cultures. The aim of this review was to map how the ‘ethics of care’ theoretical framework informs empirical studies of technology-mediated healthcare. Method A scoping review was performed using eight electronic databases: CINAHL with full text, Academic Search Premier, MEDLINE, the Philosopher's Index, SocINDEX with Full Text, SCOPUS, APA PsycInfo and Web of Science. This was followed by citation tracking, and articles were assessed against the inclusion criteria. Results Of the 443 initial articles, 18 met the criteria and were included. We found that nine of the articles used the concept of ‘ethics of care’ (herein used interchangeably with the terms ‘feminist ethics’ or ‘relational ethics’) insubstantially. The remaining nine articles deployed care ethics (or its equivalent) substantially as an integrated theoretical framework and analytical tool. We found that several articles suggested an expansion of ethics of care to encompass technologies as part of contemporary care. Furthermore, ethics of care contributed to the empirical research by recognising both new relationships between patients and healthcare professionals as well as new ethical challenges. Conclusion Ethics of care is sparsely used as a theoretical framework in empirical studies of technology-mediated healthcare practices. The use of ethics of care in technology-mediated care brings new dilemmas, relational tensions and vulnerabilities to the foreground. For ethics of care to be used more explicit in empirical studies, it is important that it is recognised by research community as an adequate, universal ethical theory.

Measuring the level of steroid and thyroxine hormones is key to understanding organism health conditions. Liquid chromatography coupled with tandem mass spectrometry has become the method of choice for such hormone analyses in clinical laboratories. Detection of hormones at low levels typically requires a time-consuming sample preparation, such as liquid-liquid extraction followed by solvent evaporation and re-solubilization of the sample extract. Instead, we applied salting-out assisted liquid-liquid extraction (SALLE) for the extraction of thyroxine, testosterone, cortisone, and cortisol from human serum and fish plasma samples. SALLE allowed direct injection of sample extracts. Sodium chloride and ammonium sulfate were evaluated as salting-out reagents together with four different organic solvents. High extraction recovery and reduced matrix interference were achieved by using ammonium sulfate together with 10% methanol in acetonitrile. Limits of quantification were in the range of 0.1–0.2 ng/mL and signal responses were linear (R2 > 0.997) up to at least 100 ng/mL for all hormones. The method was applied for hormone measurements in fish plasma. In conclusion, SALLE combines the simplicity of crude protein precipitation with the high analyte enrichment of a liquid-liquid extraction. Here we have presented it as a novel sample preparation method for clinical laboratories where mass spectrometry is utilized in the field of endocrinology.

Introduction: The aim of this study was to investigate the prevalence of traumatic experiences and symptoms of posttraumatic stress disorder (PTSD) in treatment-seeking individuals with ongoing substance use disorder (SUD) compared to individuals who have recovered from SUD. Methods: Patients with SUD recruited from the STAYER study (N = 114) underwent an examination of alcohol and drug use, childhood trauma, negative life events and PTSD symptomatology. In this study, only participants with 12-month concurrent polysubstance use was included. Using historical data from the STAYER study, alcohol and drug trajectories were dichotomised as (1) current SUD (current SUD) or (2) recovered from substance use disorder (recovered SUD). Crosstabs and chi-tests were used to measure differences between groups. Results: Childhood maltreatment, traumatic experiences later in life and symptoms of concurrent PTSD were highly prevalent in the study population. We found no significant difference between the current and recovered SUD groups. Recovered women reported a lower prevalence of physical neglect ( p = 0.031), but a higher prevalence of multiple lifetime traumas ( p = 0.019) compared to women with current SUD. Both women with current SUD and recovered women reported a significantly higher prevalence of sexual aggression than men ( p < 0.001 and p < 0.001, respectively). In addition, men who have recovered from SUD reported a lower prevalence of PTSD symptoms over cut-off 38 ( p = 0.017), of re-experiencing ( p = 0.036) and of avoidance ( p = 0.015), compared to recovered women. Conclusion: Reported trauma did not differ between persons with current SUD and those who had recovered from SUD. Gender differences discovered in this study indicate the importance of developing individualised and gender-specific treatment models for comorbid PTSD/SUD.

Background Theories of learning are of clear importance to resilience in healthcare since the ability to successfully adapt and improve patient care is closely linked to the ability to understand what happens and why. Learning from both positive and negative events is crucial. While several tools and approaches for learning from adverse events have been developed, tools for learning from successful events are scarce. Theoretical anchoring, understanding of learning mechanisms, and establishing foundational principles for learning in resilience are pivotal strategies when designing interventions to develop or strengthen resilient performance. The resilient healthcare literature has called for resilience interventions, and new tools to translate resilience into practice have emerged but without necessarily stipulating foundational learning principles. Unless learning principles are anchored in the literature and based on research evidence, successful innovation in the field is unlikely to occur. The aim of this paper is to explore: What are key learning principles for developing learning tools to help translate resilience into practice? Methods This paper reports on a two-phased mixed methods study which took place over a 3-year period. A range of data collection and development activities were conducted including a participatory approach which involved iterative workshops with multiple stakeholders in the Norwegian healthcare system. Results In total, eight learning principles were generated which can be used to help develop learning tools to translate resilience into practice. The principles are grounded in stakeholder needs and experiences and in the literature. The principles are divided into three groups: collaborative, practical, and content elements. Conclusions The establishment of eight learning principles that aim to help develop tools to translate resilience into practice. In turn, this may support the adoption of collaborative learning approaches and the establishment of reflexive spaces which acknowledge system complexity across contexts. They demonstrate easy usability and relevance to practice.

Background Depressive symptoms frequently affect patients with neurocognitive disorders. In cross-sectional studies, patients with Lewy body dementia (DLB) showed higher levels of depressive symptoms than those with Alzheimer's disease (AD). We here describe the 5 year course of depressive symptoms in patients with DLB and AD. Methods Secondary analysis of a dementia study in Western Norway (DemVest) longitudinal cohort study. Setting This multicenter study was conducted in memory clinics in Western Norway. 187 patients newly diagnosed with AD (n = 111) and DLB (n = 76) were followed up annually for 5 years. Depressive symptoms were assessed using the Montgomery Åsberg Depression Rating Scale (MADRS). MADRS subclusters dysphoria, retardation, vegetative, anhedonia were analyzed. The impact of proximity of death and the role of risk factors for depression and dementia on the course of depressive symptoms were evaluated. Results We observed continuously increasing mean levels of depressive symptoms in DLB, while patients with AD showed a delayed increase at later follow-up visits. Increase in MADRS total score was mainly driven by increases in the anhedonia and retardation subclusters. Proximity to death was associated with an increase in depressive symptoms in DLB, while it tended to decrease in AD. Previous smoking and hearing loss were associated with higher MADRS scores during follow-up in the total sample. Limitations Yearly assessment of depressive symptoms might be too infrequent. Conclusion Depressive symptom load was consistently higher in DLB compared to AD during five years after diagnosis, but tended to become more similar at later stages.

Objective To evaluate the effectiveness of communication and coordination combined with designing a progressive and individualised sport-specific training program for reducing injury prevalence in youth female and male football and handball players transitioning to a sports academy high school. An additional aim was to investigate the characteristics of the reported injuries. Methods Forty-two Norwegian athletes were randomised into an intervention or control group. Mean age, height, weight and BMI was 15.5 ± 0.5 years, 178.6 cm ± 6.3 cm, 71.3 ± 9.8 kg, 22.3 ± 2.7 BMI for the intervention group (IG) ( n = 23), and 15.4 ± 0.5 years, 175.6 cm ± 6.6 cm, 67.1 ± 9.8 kg, 21.7 ± 2.4 BMI for the control group (CG) ( n = 19). During the summer holiday, the intervention group received weekly progressive, individualised sport-specific training programs and weekly follow-up telephone calls from the researchers. All athletes completed a baseline questionnaire and a physical test battery. Training data and injuries were recorded prospectively for 22 weeks using the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). A two-way chi-square ( χ 2 ) test of independence was conducted to examine the relationship between groups and injury. Results Average weekly prevalence of all injuries was 11% (95% CI: 8%–14%) in IG and 19% (95% CI: 13%–26%) in CG. Average weekly prevalence of substantial injuries was 7% (95% CI: 3%–10%) in IG and 10% (95% CI: 6%–13%) in CG. The between-group difference in injuries was significant: χ 2 (1, N = 375) = 4.865, p = .031, φ = .114, with 1.8 times higher injury risk in CG vs. IG during the first 12 weeks after enrolment. Conclusions For student athletes transitioning to a sports academy high school, progressive individualised, sport-specific training programs reduced the prevalence of all-complaint injuries following enrolment. Clubs and schools should prioritise time and resources to implement similar interventions in periods where student athletes have less supervision, such as the summer holidays, to facilitate an optimal transition to a sports academy high school.