A presaccadic perceptual impairment at the postsaccadic location of the blindspot.

Saccadic eye movements are preceded by profound changes in visual perception. These changes have been linked to the phenomenon of 'forward remapping', in which cells begin to respond to stimuli that appear in their post-saccadic receptive field before the eye has moved. Few studies have examined the perceptual consequences of remapping of areas of impaired sensory acuity, such as the blindspot. Understanding the perceptual consequences of remapping of scotomas may produce important insights into why some neurovisual deficits, such as hemianopia are so intractable for rehabilitation. The current study took advantage of a naturally occurring scotoma in healthy participants (the blindspot) to examine pre-saccadic perception at the upcoming location of the blindspot. Participants viewed stimuli monocularly and were required to make stimulus-driven vertical eye-movements. At a variable latency between the onset of saccade target (ST) and saccade execution a discrimination target (DT) was presented at one of 4 possible locations; within the blindspot, contralateral to the blindspot, in post-saccadic location of the blindspot and contralateral to the post-saccadic location of the blindspot. There was a significant perceptual impairment at the post-saccadic location of the blindspot relative to the contralateral post-saccadic location of the blindspot and the post-saccadic location of the blindspot in a no-saccade control condition. These data are consistent with the idea that the visual system includes a representation of the blindspot which is remapped prior to saccade onset.

Nurses' experiences in voluntary error reporting: An integrative literature review.

OBJECTIVE: This integrative review aimed to examine and understand nurses' experiences of voluntary error reporting (VER) and elucidate factors underlying their decision to engage in VER. METHOD: This is an integrative review based on Whittemore & Knafl five-stage framework. A systematic search guided by the PRISMA 2020 approach was performed on four electronic databases: CINAHL, Medline (PubMed), Scopus, and Embase. Peer-reviewed articles published in the English language from January 2010 to December 2020 were retrieved and screened for relevancy. RESULTS: Totally 31 papers were included in this review following the quality appraisal. A constant comparative approach was used to synthesize findings of eligible studies to report nurses' experiences of VER represented by three major themes: nurses' beliefs, behavior, and sentiments towards VER; nurses' perceived enabling factors of VER and nurses' perceived inhibiting factors of VER. Findings of this review revealed that nurses' experiences of VER were less than ideal. Firstly, these negative experiences were accounted for by the interplays of factors that influenced their attitudes, perceptions, emotions, and practices. Additionally, their negative experiences were underpinned by a spectrum of system, administrative and organizational factors that focuses on attributing the error to human failure characterized by an unsupportive, blaming, and punitive approach to error management. CONCLUSION: Findings of this review add to the body of knowledge to inform on the areas of focus to guide nursing management perspectives to strengthen institutional efforts to improve nurses' recognition, reception, and contribution towards VER. It is recommended that nursing leaders prioritize and invest in strategies to enhance existing institutional error management approaches to establish a just and open patient safety culture that would promote positivity in nurses' overall experiences towards VER.

Is Capacity Building Training Effective for Changing Attitudes toward Health Inequalities? Experience from a Norway Grants Project in Lithuania.

BACKGROUND AND OBJECTIVES: In 2014⁻2017, the Lithuanian University of Health Sciences and partners implemented the project, 'Development of the Model for the Strengthening of the Capacities to Identify and Reduce Health Inequalities', which was financed by The Norwegian Financial Mechanism 2009⁻2014 Public Health Initiatives Program. One of objectives of this project was to increase the awareness about public health and related specialist knowledge and skills in the field of health inequalities. This paper evaluates the effectiveness of capacity-training sessions on capacity building regarding increasing the awareness and knowledge that is needed for addressing health inequalities. MATERIALS AND METHODS: Participants attending capacity-building seminars were asked to complete the same questionnaires before and after these training sessions. A total of 145 questionnaires were received (response rate 71.8%). The evaluation of changes in the pre-survey and post-survey responses in relation to a nonparametric analysis of two related samples was performed using the Wilcoxon test. RESULTS: Respondents were asked to identify the general importance of health inequalities to the national public health agenda. The pre-training median of the survey was nine (minimum four; maximum 10), and post-training was 10 [minimum five; maximum 10] (p < 0.001). Unemployed, low-paid, and low-educated people were identified as the most vulnerable groups of society in terms of health inequalities. A more effective tobacco and alcohol control was identified as the most important inequality measure needed. An absolute majority of participants emphasized the need for intersectoral collaboration for the effective reduction of health inequalities. CONCLUSION: The findings from our study suggest that capacity-building sessions can be effective measures for increasing awareness of health inequalities. It is expected that the outcomes of these training opportunities will act as facilitators for further engagement and ongoing approaches to addressing health inequalities.

Systematic review of the evidence related to mandated nurse staffing ratios in acute hospitals.

Objective The purpose of this systematic review was to evaluate and summarise available research on nurse staffing methods and relate these to outcomes under three overarching themes of: (1) management of clinical risk, quality and safety; (2) development of a new or innovative staffing methodology; and (3) equity of nursing workload. Methods The PRISMA method was used. Relevant articles were located by searching via the Griffith University Library electronic catalogue, including articles on PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medline. Only English language publications published between 1 January 2010 and 30 April 2016 focusing on methodologies in acute hospital in-patient units were included in the present review. Results Two of the four staffing methods were found to have evidenced-based articles from empirical studies within the parameters set for inclusion. Of the four staffing methodologies searched, supply and demand returned 10 studies and staffing ratios returned 11. Conclusions There is a need to develop an evidence-based nurse-sensitive outcomes measure upon which staffing for safety, quality and workplace equity, as well as an instrument that reliability and validly projects nurse staffing requirements in a variety of clinical settings. Nurse-sensitive indicators reflect elements of patient care that are directly affected by nursing practice In addition, these measures must take into account patient satisfaction, workload and staffing, clinical risks and other measures of the quality and safety of care and nurses' work satisfaction. i. What is known about the topic? Nurse staffing is a controversial topic that has significant patient safety, quality of care, human resources and financial implications. In acute care services, nursing accounts for approximately 70% of salaries and wages paid by health services budgets, and evidence as to the efficacy and effectiveness of any staffing methodology is required because it has workforce and industrial relations implications. Although there is significant literature available on the topic, there is a paucity of empirical evidence supporting claims of increased patient safety in the acute hospital setting, but some evidence exists relating to equity of workload for nurses. What does this paper add? This paper provides a contemporary qualitative analysis of empirical evidence using PRISMA methodology to conduct a systematic review of the available literature. It demonstrates a significant research gap to support claims of increased patient safety in the acute hospital setting. The paper calls for greatly improved datasets upon which research can be undertaken to determine any associations between mandated patient to nurse ratios and other staffing methodologies and patient safety and quality of care. What are the implications for practitioners? There is insufficient contemporary research to support staffing methodologies for appropriate staffing, balanced workloads and quality, safe care. Such research would include the establishment of nurse-sensitive patient outcomes measures, and more robust datasets are needed for empirical analysis to produce such evidence.

The implementation of problem-based learning in health service management training programs.

Purpose Strengthening management capacity within the health care sector could have a significant impact on population health. However, many training programs in this area are still delivered using a classic lecture-based approach. The purpose of this paper is to evaluate and better understand the feasibility of using a problem-based learning (PBL) approach in health services management training programs. Design/methodology/approach A PBL teaching approach (based on the Maastricht University model) was tested with second-year postgraduate students from the Master in Public Health Management program at the Lithuanian University of Health Sciences. Students' opinions about PBL were investigated using a questionnaire with eight open-ended questions. Thematic content analysis was chosen to reflect the search for patterns across the data. Findings Respondents stated that the main advantage of PBL was that it was a more interesting and effective way of learning: "It is easier to remember, when you study by yourself and discuss with all peers". In addition, it was mentioned that PBL initiated a rapid exchange of ideas and sharing of personal experience. Students stressed that PBL was a good tool for developing other skills as well, such as "public speaking, communication, logic thinking". All students recommended delivering all other courses in the health services management program using PBL methodologies. Originality/value Findings from our study suggest that PBL may be an effective approach to teaching health services management. Potential problems in implementation are noted.

Healthcare and aging: do European Union countries differ?

Purpose The purpose of this paper is to evaluate socio-economic inequalities in the use, accessibility and satisfaction with health services amongst 60-84 year old people from seven European urban communities. Design/methodology/approach Data for this study were collected in 2009. The target population was people aged 60-84 years from Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden). The total sample comprised 4,467 respondents with a mean response rate across these countries of 45.2 per cent. Findings The study demonstrated that the majority of respondents had contact with a health care provider within the last 12 months. The highest percentages were reported by respondents from Spain (97.8 per cent) and Portugal (97.7 per cent). The results suggest that 13.0 per cent of respondents had refrained from seeking care services. The highest rates were amongst seniors from Lithuania (24.0 per cent), Germany (16.2 per cent) and Portugal (15.4 per cent). Logistic regression suggests that seniors who refrained from seeking health care was statistically significant associated with those with higher levels of education (odds ratios (OR)=1.21; 95 per cent confidence intervals (CI)=1.01-1.25) and financial strain (OR=1.26; 95 per cent CI=1.16-1.37). Furthermore, the majority of respondents were satisfied with health care services. Originality/value The findings from the "Elder Abuse: a multinational prevalence survey" study indicate the existence of significant variations in use, accessibility and satisfaction with health services by country and for socio-economic factors related to organizing and financing of care systems.

The prevalence of self-reported underuse of medications due to cost for the elderly: results from seven European urban communities.

BACKGROUND: The aim of this study was to evaluate the prevalence of self-reported underuse of medications due to procurement costs amongst older persons from seven European urban communities. METHODS: The data were collected in a cross-sectional study ("ABUEL, Elder abuse: A multinational prevalence survey") in 2009. Randomly selected people aged 60-84 years (n = 4,467) from seven urban communities: Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden) were interviewed. Response rate - 45.2%. Ethical permission was received in each country. RESULTS: The results indicate that 3.6% (n = 162) of the respondents self-reported refraining from buying prescribed medications due to cost. The highest prevalence of this problem was identified in Lithuania (15.7%, n = 99) and Portugal (4.3%, n = 28). Other countries reported lower percentages of refraining from buying medications (Germany - 2.0%, Italy - 1.6%, Sweden - 1.0%, Greece - 0.6%, Spain - 0.3%). Females refrained more often from buying medications than males (2.6% vs. 4.4%, p < 0.0001). The prevalence of this refraining tended to increase with economic hardship. DISCUSSION: These differences between countries can be only partly described by the financing of health-care systems. In spite of the presence of cost reimbursement mechanisms, patients need to make co-payments (or in some cases to pay the full price) for prescribed medications. This indicates that the purchasing power of people in 10.1186/s12913-015-1089-4 the particular country can play a major role and be related with the economic situation in the country. Lithuania, which has reported the highest refrain rates, had the lowest gross domestic product (at the time of conducting this study) of all participating countries in the study. CONCLUSIONS: Refraining from buying the prescribed medications due to cost is a problem for women and men in respect to ageing people in Europe. Prevalence varies by country, sex, and economic hardship.

How best practices are copied, transferred, or translated between health care facilities: A conceptual framework.

INTRODUCTION: In spite of significant investment in quality programs and activities, there is a persistent struggle to achieve quality outcomes and performance improvements within the constraints and support of sociopolitical parsimonies. Equally, such constraints have intensified the need to better understand the best practice methods for achieving quality improvements in health care organizations over time.This study proposes a conceptual framework to assist with strategies for the copying, transferring, and/or translation of best practice between different health care facilities. PURPOSE: Applying a deductive logic, the conceptual framework was developed by blending selected theoretical lenses drawn from the knowledge management and organizational learning literatures. FINDINGS: The proposed framework highlighted that (a) major constraints need to be addressed to turn best practices into everyday practices and (b) double-loop learning is an adequate learning mode to copy and to transfer best practices and deuteron learning mode is a more suitable learning mode for translating best practice. We also found that, in complex organizations, copying, transferring, and translating new knowledge is more difficult than in smaller, less complex organizations. We also posit that knowledge translation cannot happen without transfer and copy, and transfer cannot happen without copy of best practices. Hence, an integration of all three learning processes is required for knowledge translation (copy best practice-transfer knowledge about best practice-translation of best practice into new context). In addition, the higher the level of complexity of the organization, the more best practice is tacit oriented and, in this case, the higher the level of K&L capabilities are required to successfully copy, transfer, and/or translate best practices between organizations. PRACTICE IMPLICATIONS: The approach provides a framework for assessing organizational context and capabilities to guide copy/transfer/translation of best practices. A roadmap is provided to assist managers and practitioners to select appropriate learning modes for building success and positive systemic change.

Factors associated with refraining from buying prescribed medications among older people in Europe.

AIM: To evaluate the associations between refraining from buying prescribed medications and selected factors among older persons. METHODS: A total of 4467 people aged 60-84 years from seven European countries answered a questionnaire (response rate 45.2%). Refraining from buying prescribed medications was measured with the question: 'Have you ever refrained from buying prescribed medication and care?' RESULTS: About 11.9% of older people refrained from buying prescribed medications. The multiple regression analysis showed that ages 60-64 (odds ratio (OR) = 2.08; 95% confidence interval (95%CI): 1.38-3.13) and 65-69 (OR = 1.73; 95%CI: 1.16-2.57) years, experience of financial strain (OR = 1.59; 95%CI: 1.27-2.01), as well as exposure to abuse (OR = 1.64; 95%CI: 1.31-2.06) when taking into account country of participant were independently associated with refraining from buying medications, while an opposite association was observed for being male (OR = 0.72; 95%CI: 0.58-0.91). CONCLUSIONS: The study found that refraining from buying prescription medications is a problem among older people and identified a number of factors associated with this.

Evaluation of leadership competencies of executives in Lithuanian public health institutions.

BACKGROUND AND OBJECTIVE. Lithuanian and international public health experts emphasize the importance of leadership in public health. The aim of this study was to explore the self-assessed level of leadership competencies of executives in Lithuanian public health institutions. MATERIAL AND METHODS. Data were collected in a cross-sectional survey of executives of Lithuanian public health institutions in 2010. The total number of returned questionnaires was 55 (response rate, 58.5%). Respondents were asked about their competencies in leadership, teamwork, communication, and conflict management. The evaluation was carried out by analyzing the answers provided in the survey, which used a 5-point rating scale. In addition, the Belbin Team-Role Self-Perception Inventory and the Thomas-Kilmann Conflict Mode Instrument were used. RESULTS. The results showed that respondents were reserved or limited in their individual capacities through this evaluation of their leadership competencies. The mean score was 3.47 (SD, 0.71). Skills in competency areas of communication, teamwork, and conflict management were scored higher (3.73 [SD, 0.67], 3.73 [SD, 0.62], and 3.53 [SD, 0.63], respectively). Most of executives preferred to choose action-oriented roles (76.2%). The most common role was "implementer" (69.1%). "Avoiding" (52.7%) was the most common conflict solving strategy. The results showed that 89.1% of executives wanted to improve teamwork; 83.6%, leadership competencies; 81.8%, communication; and 80.0%, conflict management. CONCLUSIONS. The study results suggest that the executives of Lithuanian public health institutions evaluate their leadership competencies moderately. These results indicate the value of leadership training for public health executives.

Somatic complaints and refrain from buying prescribed medications. Results from a cross-sectional study on people 60 years and older living in Kaunas (Lithuania).

BACKGROUND: The use of medicines by elderly people is a growing area of concern in social pharmacy. A significant proportion of older people do not follow the recommendations from physicians and refrain from buying prescribed medications. The aim of this study is to evaluate associations between self-rated health, somatic complaints and refraining from buying prescribed medications by elderly people. FINDINGS: Data was collected in a cross-sectional study in 2009. We received 624 completed questionnaires (response rate - 48.9%) from persons aged 60-84 years living in Kaunas (Lithuania). Somatic complaints were measured with the 24 item version of the Giessen Complaint List (GBB-24). Logistic regression (Enter model) was used for evaluation of the associations between refraining from buying medications and somatic complaints. These associations were measured using odds ratio (OR) and calculating the 95% confidence interval (CI).The mean scores in total for the GBB scale and sub-scales (exhaustion, gastrointestinal and cardiovascular) were lowest among respondents who did not refrain from buying prescribed medications (means for GBB-24 scale: 21.04 vs. 24.82; p=0.001). Logistic regression suggests that somatic complaints were associated with a increased risk of refraining from buying prescribed medications (OR=1.35, 95% CI=1.15-1.60). CONCLUSIONS: Somatic complaints were significantly associated with the decision to refrain from buying prescribed medications.