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Implementation of artificial intelligence systems for healthcare is challenging. Understanding the barriers and implementation strategies can impact their adoption and allows for better anticipation and planning. This study's objective was to create a detailed inventory of barriers to and strategies for AI implementation in healthcare to support advancements in methods and implementation processes in healthcare. A sequential explanatory mixed method design was used. Firstly, scoping reviews and systematic literature reviews were identified using PubMed. Selected studies included empirical cases of AI implementation and use in clinical practice. As the reviews were deemed insufficient to fulfil the aim of the study, data collection shifted to the primary studies included in those reviews. The primary studies were screened by title and abstract, and thereafter read in full text. Then, data on barriers to and strategies for AI implementation were extracted from the included articles, thematically coded by inductive analysis, and summarized. Subsequently, a direct qualitative content analysis of 69 interviews with healthcare leaders and healthcare professionals confirmed and added results from the literature review. Thirty-eight empirical cases from the six identified scoping and literature reviews met the inclusion and exclusion criteria. Barriers to and strategies for AI implementation were grouped under three phases of implementation (planning, implementing, and sustaining the use) and were categorized into eleven concepts; Leadership, Buy-in, Change management, Engagement, Workflow, Finance and human resources, Legal, Training, Data, Evaluation and monitoring, Maintenance. Ethics emerged as a twelfth concept through qualitative analysis of the interviews. This study illustrates the inherent challenges and useful strategies in implementing AI in healthcare practice. Future research should explore various aspects of leadership, collaboration and contracts among key stakeholders, legal strategies surrounding clinicians' liability, solutions to ethical dilemmas, infrastructure for efficient integration of AI in workflows, and define decision points in the implementation process. [ABSTRACT FROM AUTHOR]

Stress among adolescents in Western societies is becoming an issue of increasing concern of adolescent's health. The aim of this study was to gain greater knowledge about how girls and boys perceive and cope with school-related stress. Participants were 14- to 15-year-old adolescents from a medium-sized municipality in southern Sweden. The data were collected from focus group interviews. The data were subjected to qualitative content analysis. The findings show that adolescents "prioritizing the future or the present by making choices, finding their own private sphere to relax, and recovering with family and friends." There were gender differences in how these strategies were used. The findings could be used for initiating and planning health promotion interventions in school with focus on supporting girls' and boys' equal terms to cope with school-related stress in present and for the future and to give equal condition for future studies and opportunities in life.

Stress among adolescents in Western societies is becoming an issue of increasing concern, and the global trend of adolescents' health shows a gradual deterioration that is independent of national differences and increases with age. The aim of this study was to explore the main concern of adolescents and about how they cope with demands in everyday life. Participants were 14-16 years old, and data were collected from three sources. A constructivist grounded theory was used as a method for generating a model of the adolescents' description of how they cope with demands in their everyday lives. The main concern described by participants in this study was to strive to be successful and to succeed in the present and throughout their lives. We conclude that differences between girls and boys, in terms of coping with demands in their everyday lives, are important to consider in the development of health promotion initiatives targeted at adolescents.

BackgroundFor children 6-12 years old, there is a shortage of electronic Health (eHealth) services that promote their participation in health care. Therefore, a digital communication tool, called Sisom, was developed to give children a voice in their health care. Children with long-term diseases want to be more involved in their health care and have the right to receive information, be listened to, express their opinions, and participate in decision making in health care. However, the outcomes of using Sisom in practice at pediatric oncology clinics have not been investigated. ObjectiveThe aim of this study was to investigate children’s participation during appointments with pediatricians at pediatric oncology clinics, with or without the use of the eHealth service Sisom. MethodsA quasiexperimental design with mixed methods was used. We analyzed 27 filmed appointments with pediatricians for 14 children (8 girls and 6 boys) aged 6-12 years (mean 8.3 years) with a cancer diagnosis. The intervention group consisted of children who used Sisom prior to their appointments with pediatricians at a pediatric oncology clinic, and the control group consisted of children who had appointments with pediatricians at 4 pediatric oncology clinics. Data from observations from the videos were quantitatively and qualitatively analyzed. The quantitative analysis included manual calculations of how many times the pediatricians spoke directly to the children, the proportion of the appointment time that the children were talking, and levels of participation by the children. For the qualitative analysis, we used directed content analysis to analyze the children’s levels of participation guided by a framework based on Shier’s model of participation. ResultsPediatricians directed a greater proportion of their discussion toward the child in the intervention group (731 occasions) than in the control group (624 occasions), but the proportion of the appointment time the children talked was almost the same for both the intervention and control groups (mean 17.0 minutes vs 17.6 minutes). The levels of participation corresponded to the first three levels of Shier’s participation model: children were listened to, children were supported to express their views, and children’s views were taken into account. The results showed an increased level of participation by the children in the intervention group. Several codes that were found did not fit into any of the existing categories, and a new category was thus formed: children received information. ConclusionsThis study shows that the eHealth service Sisom can increase children’s participation during appointments with health care professionals. Further studies employing a randomized control design focusing on the effects of eHealth services on children’s health outcomes, perceived participation, and cost-effectiveness could make a significant contribution to guiding the implementation of eHealth services in pediatric care.

BackgroundThere are large disparities between immigrants and native Norwegians in domains such as health, education, and employment. Reducing such disparities is essential for individual and societal well-being. Social capital is associated with positive effects on these domains, and mentoring programs have the potential to boost social capital. However, few studies have assessed mentoring as a social capital intervention among youth or the potential barriers and facilitators of implementing digitally augmented mentoring. ObjectiveThe goal of this paper is to describe a protocol for assessing the implementation and effectiveness of a digitally augmented mentoring program for immigrant youth as a health intervention to promote social capital. The two-stage analytical framework for a pilot study followed by a randomized controlled trial (RCT) is presented. The pilot aims to assess program fidelity and make necessary intervention adjustments before the RCT. The RCT aims to assess the effects of the implemented intervention program on social capital and the relationship between program fidelity and effects. MethodsBoth the pilot and RCT will use mixed methods with a process evaluation approach used to structure the intervention and a pre-post test survey component to measure social capital and fidelity of program implementation. Interviews will also be used to enrich the quantitative data from the survey. ResultsThe pilot study is scheduled to begin in fall 2019. Based on data analyses in spring 2020, potential adjustments will be made to the intervention, with findings used in preparation for the full-scale RCT study. ConclusionsDigitally enhanced mentoring programs may be a helpful intervention for providing immigrant youth with tools for increasing their social capital and indirectly improving health outcomes. This protocol provides new knowledge about the implementation and evaluation of such programs. International Registered Report Identifier (IRRID)PRR1-10.2196/16472

Recent studies have suggested that bone marrow cells might possess a much broader differentiation potential than previously appreciated. In most cases, the reported efficiency of such plasticity has been rather low and, at least in some instances, is a consequence of cell fusion. After myocardial infarction, however, bone marrow cells have been suggested to extensively regenerate cardiomyocytes through transdifferentiation. Although bone marrow-derived cells are already being used in clinical trials, the exact identity, longevity and fate of these cells in infarcted myocardium have yet to be investigated in detail. Here we use various approaches to induce acute myocardial injury and deliver transgenically marked bone marrow cells to the injured myocardium. We show that unfractionated bone marrow cells and a purified population of hematopoietic stem and progenitor cells efficiently engraft within the infarcted myocardium. Engraftment was transient, however, and hematopoietic in nature. In contrast, bone marrow-derived cardiomyocytes were observed outside the infarcted myocardium at a low frequency and were derived exclusively through cell fusion., Author(s): Jens M Nygren [1]; Stefan Jovinge [1, 2]; Martin Breitbach [3]; Petter Sawen [1]; Wilhelm Roll [4]; Jurgen Hescheler [5]; Jalal Taneera [1]; Bernd K Fleischmann [3]; Sten Eirik [...]