French Translation, Adaptation, and Initial Validation of the Nurses' Attitudes and Perceptions of Pain Assessment in Neonatal Intensive Care Questionnaire (NAPPAQ).

PURPOSE: The purpose of this study was to translate, adapt and conduct initial psychometric validation of the French version of the Nurses' Attitudes and Perceptions of Pain Assessment in neonatal intensive care Questionnaire (NAPPAQ) developed by Polkki in 2010. BACKGROUND: Assessing nurses' perceptions, attitudes and knowledge about pain management in preterm infants is important to improve neonatal practices. METHODS: A sample of French-speaking nurses (n = 147) from Quebec and France working in neonatal intensive care was selected to validate the 46-item questionnaire. A French translation of the NAPPAQ, which includes Part I and II, was undertaken prior to its administration. The FIPM questionnaire was added as a Part III. Internal consistency and instrument structure were examined using Cronbach's alphas, inter-item and inter-scale correlations and exploratory factor analysis. RESULTS: The NAPPAQ-FIPM is divided into three parts. Part I of the French version had a Cronbach's alpha of 0.64 and was composed of five factors. Part II had good total internal consistency (0.79) and adequate structure, established by inter-item correlations. Part III had good total internal consistency (0.76), and factor analysis findings suggested the presence of five factors. CONCLUSIONS: The NAPPAQ-FIPM can be used for research purposes. Parts II and III obtained adequate psychometrics results. However, further refinement of Part I could improve its content and internal structure.

Designing, planning, and conducting systematic reviews and other knowledge syntheses: Six key practical recommendations to improve feasibility and efficiency.

BACKGROUND: Knowledge syntheses, such as systematic reviews, scoping reviews, and realist reviews, are crucial tools to guide nursing practice, policy, and research. However, conducting high-quality knowledge syntheses is a complex and time-consuming endeavor. It is imperative for nursing students, clinicians, and researchers to be aware of key practical recommendations regarding the conduct of knowledge syntheses to improve the feasibility and efficiency of such projects. AIM: The aim of this paper was to discuss key practical recommendations for designing, planning, and conducting knowledge syntheses relevant to nursing policy, practice, and research. METHODS: The recommendations discussed are based on best-practice guidance about knowledge synthesis methodology proposed by The Campbell Collaboration (Campbell systematic reviews: Policies and guidelines, 2020), Cochrane (Cochrane training, 2019), and the Joanna Briggs Institute (The Joanna Briggs Institute reviewers' manual, 2020) and on strategies used by the authors to improve the feasibility and efficiency of knowledge syntheses. RESULTS: This paper highlights six key practical recommendations that nursing students, clinicians, and researchers should take into account when deciding to embark on a knowledge synthesis project: (1) determining if (and why) knowledge synthesis should be conducted; (2) selecting the appropriate type of knowledge synthesis, as well as the associated methodological guidance and reporting standards; (3) developing a search strategy that balances sensitivity and specificity; (4) writing a protocol and obtaining feedback; (5) determining the resources required to conduct the different stages of the knowledge synthesis; and (6) keeping an audit trail. Fifteen common types of knowledge synthesis are presented with their definitions, relevant methodological guidance, and reporting standards. LINKING EVIDENCE TO ACTION: The recommendations discussed, used in conjunction with appropriate methodological guidelines, may help ensure the success of a knowledge synthesis project by providing best-practice and experience-based guidance to newcomers in the field.

Effectiveness of interventions on early neurodevelopment of preterm infants: a systematic review and meta-analysis.

BACKGROUND: As preterm infants' neurodevelopment is shaped by NICU-related factors during their hospitalization, it is essential to evaluate which interventions are more beneficial for their neurodevelopment at this specific time. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of interventions initiated during NICU hospitalization on preterm infants' early neurodevelopment during their hospitalization and up to two weeks corrected age (CA). METHODS: This systematic review referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO (CRD42017047072). We searched CINAHL, MEDLINE, PubMed, EMBASE (OVID), Cochrane Systematic Reviews, CENTRAL, and Web of Science from 2002 to February 2020 and included randomized controlled/clinical trials conducted with preterm infants born between 24 and 366/7 weeks of gestation. All types of interventions instigated during NICU hospitalization were included. Two independent reviewers performed the study selection, data extraction, assessment of risks of bias and quality of evidence. RESULTS: Findings of 12 studies involving 901 preterm infants were synthesized. We combined three studies in a meta-analysis showing that compared to standard care, the NIDCAP intervention is effective in improving preterm infants' neurobehavioral and neurological development at two weeks CA. We also combined two other studies in a meta-analysis indicating that parental participation did not significantly improve preterm infants' neurobehavioral development during NICU hospitalization. For all other interventions (i.e., developmental care, sensory stimulation, music and physical therapy), the synthesis of results shows that compared to standard care or other types of comparators, the effectiveness was either controversial or partially effective. CONCLUSIONS: The overall quality of evidence was rated low to very low. Future studies are needed to identify interventions that are the most effective in promoting preterm infants' early neurodevelopment during NICU hospitalization or close to term age. Interventions should be appropriately designed to allow comparison with previous studies and a combination of different instruments could provide a more global assessment of preterm infants' neurodevelopment and thus allow for comparisons across studies. TRIAL REGISTRATION: Prospero CRD42017047072 .

Nurturing and quiet intervention (NeuroN-QI) on preterm infants' neurodevelopment and maternal stress and anxiety: A pilot randomized clinical trial protocol.

OBJECTIVES: Primary objective of this pilot study is to evaluate the feasibility and acceptability of the NeuroN-QI and the study procedures. Secondary objectives are to assess the feasibility and acceptability of the NeuroN-QI by the nurses, assess the nurses' training needs about the components of the NeuroN-QI, and estimate the preliminary effects of the NeuroN-QI on infants' neurodevelopment as well as maternal stress and anxiety at infants' 36 weeks of gestational age. DESIGN: A two-group pilot parallel randomized clinical trial stratified by center. METHODS: The pilot study will be conducted in two neonatal intensive care units (NICUs). A sample of 24 mother-infant dyads born between 26 and 316/7 gestational age will be randomized into an experimental or control group. Fifty nurses will be recruited. The NeuroN-QI consists of four 2-hour skin-to-skin contact sessions/week with a 15-minute auditory stimulation by mothers with controlled ambient levels of light and noise. A 1-hour quiet period will follow where infants will rest in their incubator/crib with their mother's milk for olfactory stimulation and where the light and noise control will be continued. In the control group, mother-infant dyads will do four skin-to-skin contacts per week and receive standard care. Acceptability and feasibility of the NeuroN-QI in addition to maternal stress and anxiety will be measured through questionnaires, while infants' neurodevelopment will be assessed with Assessment of Preterm Infant Behaviour and General Movement Assessment. CONCLUSIONS: This pilot trial will address knowledge gaps and generate evidence in neonatal care by evaluating the feasibility and acceptability of a multi-component developmental care intervention. IMPACT: This project is an innovative step towards optimizing the neurodevelopmental trajectory of infants in NICUs and consequently promoting their long-term health outcomes. TRIAL REGISTRATION: NCT04593095.

Acceptability to nurses of reducing NICU light and noise levels during skin-to-skin care: A pilot study.

INTRODUCTION: Light and noise levels may influence preterm infants and their mothers when they are experiencing skin-to-skin contact [SSC] in the Neonatal Intensive Care Unit [NICU]. METHODS: A pilot randomized controlled trial [RCT] of an intervention aiming at reducing light and noise levels during SSC was conducted. Twenty-one neonatal nurses from a level III NICU completed questionnaires assessing their acceptability of NICU light and noise levels reduction during SSC, whether it interfered with their care delivery, in addition to acceptability of specific interventions reducing these levels. FINDINGS: The majority of nurses considered that the reduction of NICU light and noise levels during SSC was acceptable in general, did not interfere with their care delivery, and that the nine selected interventions were also acceptable. CONCLUSION AND RESEARCH IMPLICATIONS: Nurses found it acceptable to reduce NICU light and noise levels during SSC. These findings support the conduct of a full-scale RCT to evaluate the effect of such an intervention on preterm infants and mothers' well-being.

Factor Structure of the Postpartum Bonding Questionnaire in a US-Based Cohort of Mothers.

As research efforts in the field of pediatrics are oriented toward a better understanding of the synergistic relationship between different facets of early relational health (ERH) and child development and wellbeing, it is essential to focus on the quality of research instruments available for measuring different components of ERH. This study investigates the measurement characteristics of a widely used parent/caregiver-reported measure of bonding, the Postpartum Bonding Questionnaire (PBQ), in a US-based sample (n=610) of English-speaking biological mothers who completed the PBQ at 4 months postpartum. To evaluate the factor structure of the PBQ, confirmatory and exploratory statistical techniques were employed. The current study failed to replicate the PBQ's original 4-factor structure. Exploratory factor analysis results supported the creation of a 14-item abbreviated measure, the PBQ-14. The PBQ-14 showed evidence of good psychometric properties, including high internal consistency (ω=.87) and correlation with depression (r=.44, p<.001) assessed using the Patient Health Questionnaire (PHQ-9), as would be expected. The new unidimensional PBQ-14 is suitable for use in the US as a measure of general postnatal parent/caregiver-to-infant bonding.

Advancing early relational health: a collaborative exploration of a research agenda.

Here, we introduce the Early Relational Health (ERH) Learning Community's bold, large-scale, collaborative, data-driven and practice-informed research agenda focused on furthering our mechanistic understanding of ERH and identifying feasible and effective practices for making ERH promotion a routine and integrated component of pediatric primary care. The ERH Learning Community, formed by a team of parent/caregiver leaders, pediatric care clinicians, researchers, and early childhood development specialists, is a workgroup of Nurture Connection-a hub geared toward promoting ERH, i.e., the positive and nurturing relationship between young children and their parent(s)/caregiver(s), in families and communities nationwide. In response to the current child mental health crisis and the American Academy of Pediatrics (AAP) policy statement promoting ERH, the ERH Learning Community held an in-person meeting at the AAP national headquarters in December 2022 where members collaboratively designed an integrated research agenda to advance ERH. This agenda weaves together community partners, clinicians, and academics, melding the principles of participatory engagement and human-centered design, such as early engagement, co-design, iterative feedback, and cultural humility. Here, we present gaps in the ERH literature that prompted this initiative and the co-design activity that led to this novel and iterative community-focused research agenda, with parents/caregivers at the core, and in close collaboration with pediatric clinicians for real-world promotion of ERH in the pediatric primary care setting.

Improving the recognition and management of hemorrhage: A scoping review of nursing and midwifery education.

BACKGROUND: Hemorrhage is a frequent complication that nurses and midwives must recognize and manage to avoid life-threatening consequences for patients. There is currently no synthesis of evidence on educational interventions in nursing and midwifery regarding hemorrhage, thus limiting the definition of best practices. OBJECTIVE: To map the literature on nursing and midwifery education regarding the recognition and management of hemorrhage. DESIGN: Scoping review based on the Joanna Briggs Institute guidelines. DATA SOURCES: Quantitative studies evaluating the effect of educational interventions with students, nurses, or midwives published in English or French, with no time limit. REVIEW METHODS: Study selection, data extraction, and quality assessment were conducted by two independent reviewers. We characterized educational interventions based on the Guideline for Reporting Evidence-Based Practice Educational Interventions and Teaching. We categorized learning outcomes using the New World Kirkpatrick Model. Methodological quality appraisal was performed with tools from the Joanna Briggs Institute. Findings were synthesized using descriptive statistics and graphical methods RESULT: Most of the 38 studies used a single-group design (n = 26, 68%) and were conducted with professionals (n = 28, 74%) in hospital settings (n = 20, 53%). Most were of low (n = 14; 37%) or moderate (n = 18, 47%) methodological quality. Most interventions focused on postpartum hemorrhage (n = 34, 89%) and combined two or more teaching strategies (n = 25, 66%), often pairing an informational segment (e.g., lecture, readings) with a practical session (e.g., workshop, simulation). Learning outcomes related to the management (n = 27; 71%) and recognition of hemorrhage (n = 19, 50%), as well as results for patients and organizations (n = 9, 24%). CONCLUSION: Considerable heterogeneity in interventions and learning outcomes precluded conducting a systematic review of effectiveness. High-quality, controlled studies are needed, particularly in surgery and trauma. Reflection on the contribution of nurses and midwives to the detection, monitoring, and management of hemorrhage could enrich the content and expected outcomes of hemorrhage education.

Comprehensive mapping of NICU developmental care nursing interventions and related sensitive outcome indicators: a scoping review protocol.

INTRODUCTION: Neurodevelopmental outcomes of preterm infant are still a contemporary concern. To counter the detrimental effects resulting from the hospitalisation in the neonatal intensive care unit (NICU), developmental care (DC) interventions have emerged as a philosophy of care aimed at protecting and enhancing preterm infant's development and promoting parental outcomes. In the past two decades, many authors have suggested DC models, core measures, practice guidelines and standards of care but outlined different groupings of interventions rather than specific interventions that can be used in NICU clinical practice. Moreover, as these DC interventions are mostly implemented by neonatal nurses, it would be strategic and valuable to identify specific outcome indicators to make visible the contribution of NICU nurses to DC. OBJECTIVES: The overarching objective of this review is to identify the nature, range, and extent of the literature regarding DC nursing interventions for preterm infants in the NICU. The secondary twofold objectives are to highlight interventions that fall into identified categories of DC interventions and suggest nursing-sensitive outcome indicators related to DC interventions in the NICU. INCLUSION CRITERIA: Papers reporting on or discussing a DC nursing intervention during NICU hospitalisation will be included. METHODS AND ANALYSIS: The Joanna Briggs Institute's methodology for scoping reviews will be followed. CINAHL, MEDLINE, Embase, PubMed, Web of Science, Scopus, ProQuest and PsycInfo databases from 2009 to the present will be searched. Any type of paper, published in English or French, will be considered. Study selection and data extraction will be conducted by pairs of two review authors independently. A qualitative content analysis will be conducted. ETHICS AND DISSEMINATION: No Institutional Review Board ethical approbation is needed. Results of this review will be presented in scientific meetings and published in refereed papers.

PhD nursing students' changing needs relative to the comprehensive doctoral examination.

Most doctoral curriculums in Canada and in the United States include a mandatory comprehensive examination (CE) meant to evaluate, after a year, the students' ability to conduct research. Although the format differs between faculties, the CE has nevertheless been described by students as anxiety provoking because in most cases, a failure terminates doctoral training. A lack of scientific literature on the experiences of PhD nursing students with the CE motivated us to explore these experience and the students' needs with regard to this exam. For that purpose, a descriptive qualitative research study was conducted at a nursing faculty in Canada. Focus groups and individual semi-directed interviews were conducted with 15 PhD nursing students. Data analysis suggests that PhD nursing students' needs evolve throughout their doctoral studies. Initially, their needs focus on understanding the general process of the CE, such as its purpose and the possible outcomes. These needs gradually shift toward specific issues, such day-to-day organization during the CE. Finally, participants express frustration about variability in the support received and in the evaluation process. Results offer insights into strategies that can be implemented to optimize PhD nursing students' experience and to develop a feeling of support regarding the CE.

Neurodevelopmental outcomes of preterm infants who have experienced procedural pain in the neonatal intensive care unit: a systematic review protocol.

OBJECTIVE: This systematic review will assess the association between painful procedures performed on preterm infants while hospitalized in the neonatal intensive care unit and short-, mid-, and long-term neurodevelopmental outcomes. INTRODUCTION: Preterm infants hospitalized in the neonatal unit undergo many painful procedures. The repetition of these painful procedures in a preterm infant with an immature nervous system can have consequences for their neurodevelopment. INCLUSION CRITERIA: Prospective and retrospective observational study designs will be included in this review. Studies of preterm infants (less than 37 weeks of gestation) hospitalized in the neonatal intensive care unit who have undergone painful procedures, with or without skin breaking, will be considered for inclusion in this review. Our main variable will be neurodevelopment, measured in the short, medium, and long term. METHODS: A comprehensive database search will be undertaken in CINAHL, PubMed, MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. We will limit the search to articles published in English or French. Study selection, data extraction, and critical appraisal will be conducted by two independent reviewers. If possible, meta-analysis will be performed; otherwise the results will be presented by descriptive synthesis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020189762.

Efficacy of Serious Games in Healthcare Professions Education: A Systematic Review and Meta-analysis.

SUMMARY STATEMENT: Serious games (SGs) are interactive and entertaining software designed primarily with an educational purpose. This systematic review synthesizes evidence from experimental studies regarding the efficacy of SGs for supporting engagement and improving learning outcomes in healthcare professions education. Randomized controlled trials (RCTs) published between January 2005 and April 2019 were included. Reference selection and data extraction were performed in duplicate, independently. Thirty-seven RCTs were found and 29 were included in random-effect meta-analyses. Compared with other educational interventions, SGs did not lead to more time spent with the intervention {mean difference 23.21 minutes [95% confidence interval (CI) = -1.25 to 47.66]}, higher knowledge acquisition [standardized mean difference (SMD) = 0.16 (95% CI = -0.20 to 0.52)], cognitive [SMD 0.08 (95% CI = -0.73 to 0.89)], and procedural skills development [SMD 0.05 (95% CI = -0.78 to 0.87)], attitude change [SMD = -0.09 (95% CI = -0.38 to 0.20)], nor behavior change [SMD = 0.2 (95% CI = -0.11 to 0.51)]. Only a small SMD of 0.27 (95% CI = 0.01 to 0.53) was found in favor of SGs for improving confidence in skills.

Systematic review and meta-analysis of olfactive stimulation interventions to manage procedural pain in preterm and full-term neonates.

BACKGROUND: Preterm and full-term neonates undergo many painful procedures during their hospitalization in the neonatal intensive care unit. Unrelieved and repeated pain can have important repercussions on their motor and intellectual development. Still, pain management interventions are limited for neonates. OBJECTIVE: This systematic review aimed to evaluate the effectiveness of olfactive stimulation interventions on the pain response of preterm and full-term infants during painful procedures. DESIGN: Systematic review and meta-analysis. DATA SOURCES: An electronic search was conducted from inception to August 2019 in PubMed, MEDLINE, Embase, CINAHL, PsycINFO, Web of Sciences, CENTRAL, Scopus and ProQuest. REVIEW METHODS: Study selection, data extraction, assessment of risk of bias and quality of evidence were performed by two independent reviewers. RESULTS: 3311 studies were screened. Of the 14 studies included studies (n = 1028 infants), results from 10 were combined in meta-analysis. The latter demonstrated that olfactive stimulation interventions using a familiar odor were effective compared to standard care on pain reactivity (SMD -0.69; 95% CI -0.93 to -0.44; I2 = 20%, p < 0.00001), pain regulation (SMD -0.40; 95% CI -0.66 to -0.14; I2 = 13%, p = 0.002), crying duration during (SMD -0.42; 95% CI -0.73 to -0.10; I2 = 47%, p = 0.009) and after the procedure (SMD -0.37; 95% CI -0.68 to -0.07; I2 = 0%, p = 0.01), heart rate after the procedure (MD -3.87; 95% CI -7.36 to -0.38; I2 = 99%, p = 0.03), oxygen saturation during (MD -0.47; 95% CI -0.86 to -0.08; I2 = 91%, p = 0.02) and after the procedure (MD -0.56; 95% CI -0.99 to -0.13; I2 = 99%, p = 0.01). No adverse event was reported. CONCLUSION: These findings are based on low to very low quality of evidence limiting our confidence in effect estimates. More rigorous trials with a larger sample size are needed to enhance the comprehension of the mechanisms underlying olfactive stimulation interventions and the interventions' efficacy.

A guided participation nursing intervention to theraupeutic positioning and care (GP_Posit) for mothers of preterm infants: protocol of a pilot randomized controlled trial.

BACKGROUND: In the NICU, interventions intended to enhance maternal sensitivity are indicated in order to optimize preterm infant development and long-term mother-infant attachment. A novel nursing intervention was developed following a theory-oriented methodology and is based upon the guided participation theory for mothers to participate in their preterm infant's therapeutic POSITioning and care (GP_Posit). The primary objective of this study is to evaluate the feasibility and acceptability of (i) the study design; and (ii) the experimental GP_Posit nursing intervention during NICU hospitalization. The secondary objective is to estimate the preliminary effects of GP_Posit on maternal and preterm infant outcomes. METHODS: A pilot parallel-group randomized clinical trial (RCT) was designed where mother-preterm infant dyads are being recruited and randomized to a control group (usual care) or experimental group (GP_Posit intervention). Data collection includes feasibility and acceptability data as well as preliminary effects on maternal sensitivity and infant neurodevelopment. Ethical approval from the University Hospital ethical board was obtained in January 2018 (2017-1540). DISCUSSION: Data collection for this pilot study is expected to end in 2020. Results of this pilot study will inform about the feasibility and acceptability of the study design and GP_Posit intervention, a nursing intervention having the potential to favor maternal sensitivity and infant neurodevelopment in the NICU and guide the elaboration of a large-scale RCT. TRIAL REGISTRATION: clinicaltrial.gov, NCT03677752. Registered 19 September 2018.

Characterization of the phenotype with cognitive impairment and protein mislocalization in SCA34.

OBJECTIVE: To better characterize the neurologic and cognitive profile of patients with spinocerebellar ataxia 34 (SCA34) caused by ELOVL4 mutations and to demonstrate the presence of ELOVL4 cellular localization and distribution abnormalities in skin-derived fibroblasts. METHODS: We investigated a 5-generation French-Canadian kindred presenting with a late-onset cerebellar ataxia and recruited age- and education-matched controls to evaluate the presence of neurocognitive impairment. Immunohistochemistry of dermal fibroblasts derived from a patient's skin biopsy was performed. RESULTS: Patients had a late-onset slowly progressive cerebellar syndrome (mean age at onset 47 years; range 32-60 years) characterized by truncal and limb ataxia, dysarthria, hypometric saccades, and saccadic pursuits. No patient had past or current signs of erythrokeratodermia variabilis, which had previously been reported. MRI revealed cerebellar atrophy, with pontine atrophy (4 of 6 patients), and cruciform hypersignal in the pons (2 of 6 patients). Fluorodeoxyglucose-PET showed diffuse cerebellar hypometabolism in all 5 tested patients with subtle parietal hypometabolism in 3. Significant cognitive deficits were found in executive functioning, along with apparent visuospatial, attention, and psychiatric involvement. Immunohistochemistry of dermal fibroblasts showed mislocalization of the ELOVL4 protein, which appeared punctate and aggregated, supporting a dominant negative effect of the mutation on protein localization. CONCLUSIONS: Our findings support the pathogenicity of ELOVL4 mutations in cerebellar dysfunction and provide a detailed characterization of the SCA34 phenotype, with neurocognitive changes typical of the cerebellar cognitive-affective syndrome.

CE: Gestational Hypertension, Preeclampsia, and Peripartum Cardiomyopathy: A Clinical Review.

Gestational hypertension, preeclampsia, and peripartum cardiomyopathy are among the most common and often severe pregnancy-specific cardiovascular diseases (CVDs) and causes of complications in pregnancy. This clinical review provides nurses with an overview of pregnancy-specific CVDs, outlines their pathophysiology, and discusses risk factors and assessment. It describes management interventions according to timing: the antepartum, intrapartum, and postpartum phases are each addressed.

Communicating Science in the Digital and Social Media Ecosystem: Scoping Review and Typology of Strategies Used by Health Scientists.

BACKGROUND: The public's understanding of science can be influential in a wide range of areas related to public health, including policy making and self-care. Through the digital and social media ecosystem, health scientists play a growing role in public science communication (SC). OBJECTIVE: This review aimed to (1) synthesize the literature on SC initiated by health scientists targeting the public in the digital and social media ecosystem and (2) describe the SC strategies and communication channels used. METHODS: This scoping review was based on the Joanna Briggs Institute Methodological Framework. A systematic search was performed in 6 databases (January 2000 to April 2018). Title and abstract screening, full-text review, data charting, and critical appraisal were performed independently by two review authors. Data regarding included studies and communication channels were synthesized descriptively. A typology of SC strategies was developed using a qualitative and inductive method of data synthesis. RESULTS: Among 960 unique publications identified, 18 met inclusion criteria. A third of publications scored good quality (6/18, 33%), half scored moderate quality (9/18, 50%), and less than a fifth scored low quality (3/18, 16%). Overall, 75 SC strategies used by health scientists were identified. These were grouped into 9 types: content, credibility, engagement, intention, linguistics, planification, presentation, social exchange, and statistics. A total of 5 types of communication channels were identified: social networking platforms (eg, Twitter), content-sharing platforms (eg, YouTube), digital research communities (eg, ResearchGate), personal blogs and websites (eg, WordPress), and social news aggregation and discussion platforms (eg, Reddit). CONCLUSIONS: Evidence suggests that multiple types of SC strategies and communication channels are used by health scientists concurrently. Few empirical studies have been conducted on SC by health scientists in the digital and social media ecosystem. Future studies should examine the appropriateness and effectiveness of SC strategies for improving public health-related outcomes and identify the barriers, facilitators, and ethical considerations inherent to the involvement of health scientists in the digital and social media ecosystem.

Effect of implementation interventions on nurses' behaviour in clinical practice: a systematic review, meta-analysis and meta-regression protocol.

BACKGROUND: Practitioner-level implementation interventions such as audit and feedback, communities of practice, and local opinion leaders have shown potential to change nurses' behaviour in clinical practice and improve patients' health. However, their effectiveness remains unclear. Moreover, we have a paucity of data regarding the use of theory in implementation studies with nurses, the causal processes-i.e. mechanisms of action-targeted by interventions to change nurses' behaviour in clinical practice, and the constituent components-i.e. behaviour change techniques-included in interventions. Thus, our objectives are threefold: (1) to examine the effectiveness of practitioner-level implementation interventions in changing nurses' behaviour in clinical practice; (2) to identify, in included studies, the type and degree of theory use, the mechanisms of action targeted by interventions and the behaviour change techniques constituting interventions and (3) to examine whether intervention effectiveness is associated with the use of theory or with specific mechanisms of action and behaviour change techniques. METHODS: We will conduct a systematic review based on the Cochrane Effective Practice and Organization of Care (EPOC) Group guidelines. We will search six databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science) with no time limitation for experimental and quasi-experimental studies that evaluated practitioner-level implementation interventions aiming to change nurses' behaviour in clinical practice. We will also hand-search reference lists of included studies. We will perform screening, full-text review, risk of bias assessment, and data extraction independently with the Covidence systematic review software. We will assess the quality of evidence using the GRADEpro software. We will code included studies independently for theory use (Theory Coding Scheme), mechanisms of action (coding guidelines from Michie) and behaviour change techniques (Behaviour Change Technique Taxonomy v1) with QSR International's NVivo qualitative data analysis software. Meta-analyses will be performed using the Review Manager (RevMan) software. Meta-regression analyses will be performed with IBM SPSS Statistics software. DISCUSSION: This review will inform knowledge users and researchers interested in designing, developing and evaluating implementation interventions to support nurses' behaviour change in clinical practice. Results will provide key insights regarding which causal processes-i.e. mechanisms of action-should be targeted by these interventions, and which constituent components-i.e. behaviour change techniques-should be included in these interventions to increase their effectiveness. SYSTEMATIC REVIEW REGISTRATION: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019130446).