How are declarations of interest working? A cross-sectional study in declarations of interest in healthcare practice in Scotland and England in 2020/2021.

OBJECTIVE: To understand arrangements for healthcare organisations' declarations of staff interest in Scotland and England in the context of current recommendations. DESIGN: Cross-sectional study of a random selection of National Health Service (NHS) hospital registers of interest by two independent observers in England, all NHS Boards in Scotland and a random selection of Clinical Commissioning Groups (CCGs) in England. SETTING: NHS Trusts in England (NHSE), NHS Boards in Scotland, CCGs in England, and private healthcare organisations. PARTICIPANTS: Registers of declarations of interest published in a random sample of 67 of 217 NHS Trusts, a random sample of 15 CCGs of in England, registers held by all 14 NHS Scotland Boards and a purposeful selection of private hospitals/clinics in the UK. MAIN OUTCOME MEASURES: Adherence to NHSE guidelines on declarations of interests, and comparison in Scotland. RESULTS: 76% of registers published by Trusts did not routinely include all declaration of interest categories recommended by NHS England. In NHS Scotland only 14% of Boards published staff registers of interest. Of these employee registers (most obtained under Freedom of Information), 27% contained substantial retractions. In England, 96% of CCGs published a Gifts and Hospitality register, with 67% of CCG staff declaration templates and 53% of governor registers containing full standard NHS England declaration categories. Single organisations often held multiple registers lacking enough information to interpret them. Only 35% of NHS Trust registers were organised to enable searching. None of the private sector organisations studied published a comparable declarations of interest register. CONCLUSION: Despite efforts, the current system of declarations frequently lacks ability to meaningfully obtain complete healthcare professionals' declaration of interests.

A Collaborative Academic-Practice Approach to Meeting Educational and Workforce Needs.

This article describes an innovative academic-practice partnership designed to promote new nurse competency and meet employer needs for graduates with in-demand knowledge and competencies in specialty patient populations. Three practice partners identified areas of need and with the school of nursing developed specialty nursing elective courses with precepted clinical experiences.

Identifying, building, and sustaining your leadership team.

Effective leadership teams are important to the success of any organization, regardless of size or scope. This article uses the concepts of social capital and trust to shed light on team building skills and focuses on strategies that leaders can use to assemble, build, and sustain their leadership teams. Written from the perspective of someone who has had many years of experience in leadership roles, the article includes actual examples and tactics used to develop and mentor team members, foster social networks to build the team, and imbue trust to sustain the team.

A cross-sectional study of all clinicians' conflict of interest disclosures to NHS hospital employers in England 2015-2016.

OBJECTIVE: We set out to document how NHS trusts in the UK record and share disclosures of conflict of interest by their employees. DESIGN: Cross-sectional study of responses to a Freedom of Information Act request for Gifts and Hospitality Registers. SETTING: NHS Trusts (secondary/tertiary care organisations) in England. PARTICIPANTS: 236 Trusts were contacted, of which 217 responded. MAIN OUTCOME MEASURES: We assessed all disclosures for completeness and openness, scoring them for achieving each of five measures of transparency. RESULTS: 185 Trusts (78%) provided a register. 71 Trusts did not respond within the 28 day time limit required by the FoIA. Most COI registers were incomplete by design, and did not contain the information necessary to assess conflicts of interest. 126/185 (68%) did not record the names of recipients. 47/185 (25%) did not record the cash value of the gift or hospitality. Only 31/185 registers (16%) contained the names of recipients, the names of donors, and the cash amounts received. 18/185 (10%) contained none of: recipient name, donor name, and cash amount. Only 15 Trusts had their disclosure register publicly available online (6%). We generated a transparency index assessing whether each Trust met the following criteria: responded on time; provided a register; had a register with fields identifying donor, recipient, and cash amount; provided a register in a format that allowed further analysis; and had their register publicly available online. Mean attainment was 1.9/5; no NHS trust met all five criteria. CONCLUSION: Overall, recording of employees' conflicts of interest by NHS trusts is poor. None of the NHS Trusts in England met all transparency criteria. 19 did not respond to our FoIA requests, 51 did not provide a Gifts and Hospitality Register and only 31 of the registers provided contained enough information to assess employees' conflicts of interest. Despite obligations on healthcare professionals to disclose conflicts of interest, and on organisations to record these, the current system for logging and tracking such disclosures is not functioning adequately. We propose a simple national template for reporting conflicts of interest, modelled on the US 'Sunshine Act'.

Hitting the nursing faculty shortage head on: strategies to recruit, retain, and develop nursing faculty.

More than ever before, schools of nursing are challenged with finding qualified faculty to teach growing numbers of undergraduate and graduate students. Qualified applicants by the thousands are being turned away, in large part because of an insufficient pipeline of faculty. This article describes how one school hit the shortage head on by creating alternate models for employing and growing new faculty, and then instituting a variety of strategies to develop and keep them.

Attention, uncertainty, and free-energy.

We suggested recently that attention can be understood as inferring the level of uncertainty or precision during hierarchical perception. In this paper, we try to substantiate this claim using neuronal simulations of directed spatial attention and biased competition. These simulations assume that neuronal activity encodes a probabilistic representation of the world that optimizes free-energy in a Bayesian fashion. Because free-energy bounds surprise or the (negative) log-evidence for internal models of the world, this optimization can be regarded as evidence accumulation or (generalized) predictive coding. Crucially, both predictions about the state of the world generating sensory data and the precision of those data have to be optimized. Here, we show that if the precision depends on the states, one can explain many aspects of attention. We illustrate this in the context of the Posner paradigm, using the simulations to generate both psychophysical and electrophysiological responses. These simulated responses are consistent with attentional bias or gating, competition for attentional resources, attentional capture and associated speed-accuracy trade-offs. Furthermore, if we present both attended and non-attended stimuli simultaneously, biased competition for neuronal representation emerges as a principled and straightforward property of Bayes-optimal perception.

Building bridges in academic nursing and health care practice settings.

The purpose of this article is to describe the development and implementation of a shared position with a focus on evidence-based practice (EBP) between the Visiting Nurse Service of New York and the Lienhard School of Nursing, Pace University. A preexisting relationship between the two institutions in providing student experiences in a community setting paved the way for the evolution a new collaborative effort. The shared position was initially conceived by two of the authors as an outcome of research they were conducting in the home care setting, which tested a model of mentoring frontline nurses in the EBP process on health care professional and patient outcomes. An initial conception of the new role provided a working document for discussions between the two institutions and the creation of a workable contract. The implementation of several initiatives has already provided support for the position, and each partner has benefited from building this bridge between nursing education and service. Benefits include advancing knowledge of and implementing EBP in both settings and promoting collaborative, clinically related scholarship.

Evidence for smoking cessation: Implications for gender-specific strategies.

BACKGROUND: Facilitating smoking cessation requires an evidence-based approach. The Lienhard School of Nursing Institute for Healthy Aging in the United States, whose focus is providing health information to aging baby boomers, developed an interest in studying strategies for smoking cessation in women. APPROACH: Studies were reviewed and critiqued related to the question: What is the relative efficacy of first-line smoking cessation interventions for women versus men in the 40- to 65-year-old age group? This article first discusses the procedure used to construct an integrative framework for finding the evidence on smoking cessation, including a literature search and refinement of the problem to be studied, and then a summary of the evidence gathered on the selected variable (gender) and interventions (counseling, pharmacotherapy, nicotine replacement therapy). FINDINGS: Evidence was found that supports the general efficacy of three first-line smoking cessation interventions: counseling, bupropion-sustained release (BSR), and nicotine replacement therapy (NRT). What the evidence does not show, however, is which of these interventions may be more effective for women versus men in general or specifically in the 40- to 65-year-old age group. RECOMMENDATIONS: Recommendations include the development of a clinical trial and the inclusion from the outset of gender as a major variable in all future intervention studies. IMPLICATIONS: Practice implications include the fact that since effective treatments already exist for assisting clients to stop smoking, all health-care providers should offer an intervention that has been found effective to any client who expresses a desire to quit smoking. Further studies of efficacy are needed to develop more focused implications.

Gender's effect on the efficacy of smoking cessation interventions.

Evidence-based guidelines and subsequent studies support the effectiveness of counselling and pharmacotherapy as first-line smoking cessation interventions. Gender is one of many factors that may have an impact on the efficacy of smoking cessation interventions. There is only very limited evidence, however, to answer the question of how gender influences the effectiveness of smoking cessation interventions. Research does suggest that concern about weight gain is related to women's confidence in their ability to stop smoking and this should be kept in mind when designing interventions. In the meantime, any client who indicates a desire to stop smoking should be offered one of the smoking cessation interventions that are already available.

Strategies for building faculty research programs in institutions that are not research intensive.

Colleges and universities without the resources of research-intensive universities face a special challenge to support faculty research. If doctorally prepared faculty are to assume. leadership roles in developing nursing science, deans must be responsive to faculty members' individual and collective responsibility to be active researchers. This article describes efforts on the part of two nursing programs, one in a private and one in a public university, to create an environment that nurtures scholarship of nursing faculty members at these institutions.