Approximately one quarter of patients undergoing breast conserving therapy for breast cancer will require a second operation to achieve adequate clearance of the margins. A number of techniques to assess margins intraoperatively have been reported. This systematic review examines current intraoperative methods for assessing margin status. The final pathology status, statistical measures including accuracy of tumour margin assessment, average time impact on the procedure and second operation rate, were used as criteria for comparison between studies. Although pathological methods, such as frozen section and imprint cytology performed well, they added on average 20-30 min to operation times. An ultrasound probe allows accurate examination of the margins and delivers results in a timely manner, yet it has a limited role with DCIS where calcification is present and in multifocal cancer. Further research is required in other intraoperative margin assessment techniques, such as mammography, radiofrequency spectroscopy and optical coherence tomography.

In the years prior to the COVID-19 pandemic, there was considerable innovation in designing and implementing teaching and learning with technology in fully online, face-to-face and blended modes. To provide an overview of technology-enhanced learning in higher education, we conducted a systematic literature review following PRISMA guidelines of digital innovations in learning designs between 2014 and 2019, prior to emergency remote teaching responses to the COVID-19 pandemic. From 130 publications, we identified eight overlapping categories of digital technologies being deployed across higher education fields: simulation and augmented or virtual reality; Web 2.0; learning management systems; mobile learning; gamification and serious games; various technologies in classrooms; massive open online courses; and other software, websites, applications and cloud computing. We use these publications, supplemented with findings from selected meta-analyses and systematic reviews of specific technologies, as examples to guide educators designing technology-enhanced learning activities in changing circumstances that may require blended or fully online delivery. As the 130 publications had mixed perceived quality, levels of evidence and details of learning designs and evaluation presented, we suggest educators share their innovations following reporting guidelines relevant to their research methodologies, enabling others to consider transferability to other contexts and to build on their work. Implications for practice or policy: Leaders and administrators should support staff development of technological pedagogical content knowledge and teaching as design for student learning. Educators and instructional designers, in designing learning experiences, should consider adult learning theories, inclusive practices and digital equity and leverage multiple technologies to facilitate students learning their curricula. In educational research or scholarship of teaching and learning, researchers should provide sufficient detail to enable readers to assess transferability to their own contexts.

Background: The COVID-19 pandemic has accelerated the uptake of digital health innovations due to the availability of various technologies and the urgent health care need for treatment and prevention. Although numerous studies have investigated digital health adoption and the associated challenges and strategies during the pandemic, there is a lack of evidence on the impact on the nursing workforce. Objective: This study aims to identify the impact of digital health transformation driven by COVID-19 on nurses. Methods: The online software Covidence was used to follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Relevant scientific health and computing databases were searched for papers published from January 2020 to November 2021. Using the 8D sociotechnical approach for digital health in health care systems, the papers were analyzed to identify gaps in applying digital health in nursing practice. Results: In total, 21 papers were selected for content analysis. The analysis identified a paucity of research that quantifies the impact of the digital health transformation on nurses during the pandemic. Most of the initiatives were teleconsultation, followed by tele–intensive care unit (tele-ICU), and only 1 (5%) study explored electronic medical record (EMR) systems. Among the sociotechnical elements, the human-related factor was the most explored and the system measurement was the least studied item. Conclusions: The review identified a significant gap in research on how implementing digital health solutions has impacted nurses during the COVID-19 pandemic. This gap needs to be addressed by further research to provide strategies for empowering the nursing workforce to be actively involved in digital health design, development, implementation, use, and evaluation.

This paper presents a thematic analysis and critical review of leadership behaviors during the novel coronavirus pandemic, drawn from the 138 publications on COVID-19 in higher education, published between 1 January 2020 and 30 June 2020, and available as an open access database. The aim is to provide a critical understanding of specific leadership behaviors that influence educational technology adoption and implementation in the higher education sector, by adopting and using iterative examination approach from Braun and Clarke’s framework. This analysis resulted in 20 publications from the open access database that met our criteria, with results indicating an interplay between leadership styles and leadership environment. The leadership styles emerging in our thematic analysis include authentic leadership, servant leadership, leader-member exchange (LMX), situational leadership, distributed leadership, and ineffective forms of leadership. The intersectionality of these styles with components of leadership environment, like social networks and financial management, provides a greater understanding of the types of leadership behaviors that, if developed in higher educational leaders, could support greater preparedness for future periods of uncertainty and change. This paper highlights the importance of targeted leadership development for increasing educational technology efficacy in the higher education sector.