Abstract
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Abstract
Background This scoping review systematically maps externally validated machine learning (ML)-based models in cancer patient care, quantifying their performance, and clinical utility, and examining relationships between models, cancer types, and clinical decisions. By synthesizing evidence, this study identifies, strengths, limitations, and areas requiring further research. Methods The review followed the Joanna Briggs Institute's methodology, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, and the Population, Concept, and Context mnemonic. Searches were conducted across Embase, IEEE Xplore, PubMed, Scopus, and Web of Science (January 2014-September 2022), targeting English-language quantitative studies in Q1 journals (SciMago Journal and Country Ranking > 1) that used ML to evaluate clinical outcomes for human cancer patients with commonly available data. Eligible models required external validation, clinical utility assessment, and performance metric reporting. Studies involving genetics, synthetic patients, plants, or animals were excluded. Results were presented in tabular, graphical, and descriptive form. Results From 4023 deduplicated abstracts and 636 full-text reviews, 56 studies (2018-2022) met the inclusion criteria, covering diverse cancer types and applications. Convolutional neural networks were most prevalent, demonstrating high performance, followed by gradient- and decision tree-based algorithms. Other algorithms, though underrepresented, showed promise. Lung and digestive system cancers were most frequently studied, focusing on diagnosis and outcome predictions. Most studies were retrospective and multi-institutional, primarily using image-based data, followed by text-based and hybrid approaches. Clinical utility assessments involved 499 clinicians and 12 tools, indicating improved clinician performance with AI assistance and superior performance to standard clinical systems. Discussion Interest in ML-based clinical decision-making has grown in recent years alongside increased multi-institutional collaboration. However, small sample sizes likely impacted data quality and generalizability. Persistent challenges include limited international validation across ethnicities, inconsistent data sharing, disparities in validation metrics, and insufficient calibration reporting, hindering model comparison reliability.

Abstract
The specialization of Health Human Resources (HHR) is increasingly recognized as essential for addressing evolving healthcare demands. This paper presents a comprehensive policy framework for assisting with the implementation of Clinical Nurse Specialist (CNS) roles at the national or regional level, integrating key dimensions including barriers and enablers, regulation and governance, education and training requirements, career development, workforce planning, and economic analysis. The framework was applied to the implementation of CNS roles in Portugal, resulting in the issuance of a decree-law by the government. Our findings demonstrate that the economic analysis step was critical in addressing concerns from government authorities and health system funders regarding the potential budgetary impact of CNS implementation. By providing evidence-based projections of costs and benefits, the economic analysis facilitated smoother negotiations and consensus-building among stakeholders, including nursing unions. Furthermore, the integration of workforce planning ensured the alignment of educational capacity with workforce needs, thus avoiding potential implementation bottlenecks. The application of the framework also revealed important feedback relationships between its dimensions, highlighting the interdependent nature of the implementation process. This dynamic approach, which adapts to real-time feedback and stakeholder input, underscores the necessity of a holistic and iterative strategy for successful CNS role integration. The insights gained from the Portuguese case underscore the utility of this policy framework in guiding the implementation of advanced nursing roles in diverse healthcare contexts.