Cognitive Impairment among Veterans in Outpatient Vision Rehabilitation.

SIGNIFICANCE: Outpatient vision rehabilitation improves function in veterans with vision impairment, but the prevalence of cognitive impairment and the degree to which it may affect rehabilitation outcomes in the Veterans Affairs system are unknown. PURPOSE: The purpose of this study was to determine the prevalence of cognitive impairment among veterans receiving outpatient vision rehabilitation in the Veterans Affairs system and compare the benefits of rehabilitation in veterans with and without cognitive impairment. METHODS: We conducted cognitive assessments and a nested longitudinal cohort study in veterans with eye disorders at two outpatient rehabilitation sites. Cognition was assessed with the Modified Telephone Interview for Cognitive Status administered in person. Eligible veterans and their companions in the longitudinal study responded to questions about the veteran's function at baseline and 90 days later. Visual function was measured with the 48-item Low Vision Visual Function Questionnaire (LV-VFQ-48) and items from the Activity Inventory. RESULTS: Of 291 veterans assessed (mean ± standard deviation age, 78.2 ± 12 years), 136 (46.7%) were cognitively intact (Modified Telephone Interview for Cognitive Status scores, ≥33), whereas 58 (19.9%) had borderline scores of 30 to 32, 82 (28.2%) had scores suggesting mild/moderate cognitive impairment (scores of 20 to 29), and 15 (5.2%) had scores suggesting severe cognitive impairment (score of <20). After 90 days, mean LV-VFQ-48 reading scores tended to improve in veterans with (n = 21) and without (n = 28) cognitive impairment. The magnitude of self-reported improvement in LV-VFQ-48 scores was greater among cognitively intact, compared with cognitively impaired, veterans (effect size, 0.56 for reading; 0.71 for visual motor). Veterans and companions reported similar 90-day reduction in difficulty with the veterans' top 3 Activity Inventory goals, regardless of cognitive status. CONCLUSIONS: Approximately one in three veterans referred to outpatient vision rehabilitation has detectable cognitive impairment, yet many still experience functional improvements. Future research should determine best practices to accommodate challenges associated with cognitive impairment in vision rehabilitation and to track clinically meaningful outcomes.

Exploring the influence of the nursing and medical professions on policy and politics.

BACKGROUND: The Nursing Now global campaign is aimed at raising the profile of nursing and its influence on policy and politics. Calls for the profession to have an increased role in policymaking are not new, but recent developments offer significant opportunities to advance this message. AIM: To compare and contrast the published scholarly evidence, indexed in Web of Science (WoS), relating to how medicine and nursing influence policy and politics. METHOD: A bibliometric analysis of scholarship was undertaken to determine how medicine and nursing influence policy and politics. Indexed articles in Web of Science were compared to examine the evolution of scholarly contributions by both professions. RESULTS: Since 1990, nursing and medicine have been consistent contributors to scholarship on policy and politics. At the same time, there has been an exponential growth in scholarly output, but nursing is now starting to fall behind. Nursing has focused on the necessary knowledge and skills, whereas medicine has focused on acting on specific issues. CONCLUSION: There are multiple opportunities for nursing scholars to accelerate their indexed output to inform evidence-based advocacy, and influence policy and politics. These endeavours will increase their potential to inform future healthcare.

A retrospective study of more than 400 feline nasal biopsy samples in the UK (2006-2013).

OBJECTIVES: The main objective of this study was to utilise a large database from a UK-based, commercial veterinary diagnostic laboratory to ascertain the prevalence of different forms of nasal disease within the feline population. Further objectives included using this database to detect any breed, sex or age predilections, or associations between the degree of brachycephalism, and the different conditions diagnosed. METHODS: Records from the laboratory were searched for feline submissions received between 31 May 2006 and 31 October 2013. For all samples taken from the nasal cavity, the diagnosis was recorded together with the breed, age, sex and neuter status of the cat, whether the clinical presentation was uni- or bilateral and whether a nasal discharge was present. Pedigree breeds were further subclassified according to skull conformation into brachycephalic, mesocephalic and dolichocephalic. Logistic regression models were constructed to assess the adjusted magnitude of association of significant risk factors with each disease, and each disease was also used as a potential independent risk factor for each other disease. RESULTS: The most prevalent nasal disease was rhinitis, followed by neoplasia and polyps. The most commonly diagnosed neoplasm was lymphoma, followed by adenocarcinoma and undifferentiated carcinoma, with benign tumours being very uncommon. No significant association was found between skull conformation and nasal diseases. The only statistically significant association was polyps being more likely to arise in younger male cats, with a mesocephalic skull conformation and no nasal discharge. CONCLUSIONS AND RELEVANCE: No significant association was found between skull conformation and nasal diseases, contrary to what might be expected. The only significant association found between any of the potential risk factors and various forms of nasal disease was polyps being more likely to arise in younger cats; other identified associations are only likely to be weak.

Imperative for Health Systems Research, How Robust Evidence Collection Advances Global Health.

For the advancement of universal health coverage and the Sustainable Development Goals (SDG), especially SDG 3, strong health systems research is needed and to understand how systems are performing and how can these be strengthen and organized as to support the advancement towards universal health coverage with a perspective to social determinants of health.

Beyond a Single Country's Borders: Trade in Services Uncovered Through Bibliometrics.

We live and work in an increasingly connected global environment where actions in one part of the world can have consequences for all of us. This article examines, through the use of bibliometric analysis, the extent to which nursing scholars are engaged in the policy debate surrounding trade in services. Results demonstrate that, in comparison to medical colleagues, the nursing profession is more regionally orientated, focused on more operational-based themes and orientated to Mode 4: Mobility of the Profession. However, with the impetus of initiatives such as Nursing Now, opportunities exist to increase nurses' contribution to policy in today's ever more connected supranational environment. To be effective, and if quantum rather than incremental progress is to be made, more scholarship on policy-oriented topics is needed. An increased output of PhD-prepared nurses is essential. Collaborative working in multidisciplinary policy teams must become the norm, so nurses can demonstrate their unique and essential contribution to addressing the many and complex challenges that health systems now face. This is what is required if nurses are to be equipped to make robust evidence-based arguments at national and supranational levels.

What interests young autistic children? An exploratory study of object exploration and repetitive behavior.

Behaviors characterized as restricted and repetitive (RRBs) in autism manifest in diverse ways, from motor mannerisms to intense interests, and are diagnostically defined as interfering with functioning. A variety of early autism interventions target RRBs as preoccupying young autistic children to the detriment of exploration and learning opportunities. In an exploratory study, we developed a novel stimulating play situation including objects of potential interest to autistic children, then investigated repetitive behaviors and object explorations in 49 autistic and 43 age-matched typical young children (20-69 months). Autistic children displayed significantly increased overall frequency and duration of repetitive behaviors, as well as increased specific repetitive behaviors. However, groups did not significantly differ in frequency and duration of overall object explorations, in number of different objects explored, or in explorations of specific objects. Exploratory analyses found similar or greater exploration of literacy-related objects in autistic compared to typical children. Correlations between repetitive behaviors and object explorations (their frequency and duration) revealed positive, not negative, associations in both groups. Our findings, from a novel situation incorporating potential autistic interests, suggest that RRBs do not necessarily displace exploration and its possibilities for learning in autism.

Opportunities for change: the United Nations Working for Health and Growth report.

The United Nations High-Level Commission on Health Employment and Economic Growth recently published a report that makes ten recommendations and four calls for immediate action. Analysis of the report, Working for Health and Growth: Investing in the Health Workforce, highlights several opportunities for nursing to contribute to a wide-based agenda while positioning the profession to gain wider influence. The report, when analysed through the lens of regulation, professional practice and socio-economic welfare, offers opportunities for nurses in different sectors to work collaboratively to further the recommendations. Importantly, the report seeks to reframe how money spent on healthcare provision is viewed. In particular, it suggests that such funding should be regarded as an investment rather than a cost, and one that delivers up to ninefold returns. The report is supported by several technical evidence-based documents, and features contributions from a range of intergovernmental agencies, such as the World Health Organization, the Organisation for Economic Cooperation and Development and the International Labour Organization. This article argues that nurses can, and should, make a significant contribution to this agenda and, in so doing, position the profession for the future.

Windows to the Future: Can the United Nations Sustainable Development Goals Provide Opportunities for Nursing?

Windows of opportunity are wide open for the nursing profession to actively participate and engage in the policy implementation, evaluation, and achievement of the United Nations Sustainable Development Goals. Nurses bring valuable perspectives as members of diverse governance structures and offer a range of solutions that can help governments pursue and achieve the Sustainable Development Goals and targets by 2030.

How anxiety about communication affects the role of nurse leaders in international social networks.

Social network analysis examines the way individuals are connected within groups or networks, and the role they play in these groups. In terms of its application to issues related to nurse leaders, much of the research focuses on the structure of their networks, the roles they play, and whether the networks can be changed to improve communication flows. This article reports results of a study that aimed to deepen understanding of how a particular trait - communication apprehension - can affect the roles that nurse leaders play within network structures. It also shows how the research expands understanding of the factors that influence connections between senior nurse leaders internationally, and describes the communication apprehension instrument used, which provides a practical tool to assist aspirant nurse leaders to identify areas for personal development.

The ICN Leadership For Change™ Programme--20 years of growing influence.

AIM: The aim of this article was to present experiences from the field in the context of the International Council of Nurses' Leadership for Change™ programme, which celebrates 20 years of excellence in 2016 for developing the leadership and management capacity of nurses worldwide. BACKGROUND: The programme was launched in 1996 in order to boost nurse participation in the healthcare policy-making process, globally, and to foster within the nursing profession the requisite skills for nurses to lobby for and assume a greater responsibility in the leadership and management of health care services. INTRODUCTION: Over the course of two decades, the programme has been implemented in cooperation between ICN, national nurses associations, the World Health Organization, Ministries of Health and a variety of donor organizations such as the W.K. Kellogg Foundation and development agencies such as USAID and AUSAID. The programme has been implemented in more than 60 nations throughout Africa, Asia, Europe, the Middle East, Latin America and the Pacific Islands, to name a few regions. METHODS: This article offers an overview of the impact that certified ICN LFC nurse trainers and their colleagues have had in the United Arab Emirates, Vietnam and the United States of America and is affiliated islands and the North Pacific Islands. RESULTS: Twenty years of growth and empowerment are now the ongoing legacy of the ICN LFC Program, which has graduated and deployed nurse trainers around the world and achieved significant advances in the professional development of nurse leaders on an international scale. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse leaders can improve the health and well-being of their nations in collaboration with consumers and other key stakeholders. Nurse leaders are critical in improving health systems, their work places and broader societal challenges through sound nursing practice, education, research and evidence-based health and social policy change.

The World Health Organization Launches the 2016-2020 Global Strategic Directions for Strengthening Nursing and Midwifery.

The World Health Organization (WHO) Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 provide a framework to ensure nursing and midwifery interventions are developed, implemented, and evaluated at global, regional, and country levels and in partnership with key stakeholders. The Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 supports the WHO's Global Strategy on Human Resources for Health: Workforce 2030. The WHO Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 presents a vision, guiding principles, and four themes to maximize nursing and midwifery workforce contributions to improve global health. Implementation of the strategy is articulated in the context of country and regional needs, areas for expedited action, partnerships and alliances, and accountability for ongoing monitoring and evaluation. As a framework, the 2016-2020 Global Strategic Directions for Nursing and Midwifery can help countries achieve the United Nations' Sustainable Development Goals and universal health coverage.

Want to Create Jobs and Drive Economic Growth? Invest In Nursing and Global Health Workforce.

The High-Level Commission on Health Employment and Economic Growth was created by the United Nations to tackle the projected global shortfall of health care workers. The Commission developed recommendations addressing job creation, gender and women's rights, education, training and skills, health service delivery and organization, technology, and crises and humanitarian settings. The Commission report is an opportunity for nurse leaders, key stakeholders, and advocates in our nation to continue to champion heath workforce issues. The timing is right as we anticipate a new presidential administration and state, federal, and local leadership in 2017.

The World Health Organization's Sixty-Eighth World Health Assembly: Updates and Opportunities.

The World Health Assembly (WHA) is the decision-making body of the World Health Organization. Delegates attending the Sixty-Eighth WHA, May 2015, covered a wide range of global challenges and agreed on several key resolutions of importance to nurse leaders. Some of the resolutions adopted relevant for nurse leaders and nursing care such as air pollution, strategies to strengthen epilepsy care, antimicrobial drug resistance, and strategies to strengthen surgical care, are highlighted. Nurse leaders should consider attending the World Health Assembly, as the topics discussed are critical for the future directions of strengthening human resources for health worldwide and, in particular, nursing and midwifery services.

The World Health Organization: Is It Still Relevant?

The World Health Organization (WHO) is the United Nation's lead agency for directing and coordinating health. As leaders, nurse executives must advocate for a stronger nursing and midwifery health policy agenda at the global level and a seat at the table on WHO's technical advisory bodies and expert committees. There are no more borders as nurse executives; we are global citizens, leading global change. Nurse leaders hold the master key to shape the world's policies for sustainable global development.

Transformational Nurse Leaders Key to Strengthening Health Systems Worldwide.

This column, presented by the director of the International Council of Nurses (ICN), discusses the work of the ICN over the past 20 years and into the future in developing nursing leaders across the globe. Dr Ferguson relates this activity to the constructs of the Magnet Recognition Program. The ICN is at the forefront of making sure nurses and nurse executives have the knowledge, skills, and ability to lead effectively worldwide and meet the global health challenges.

How nurse leaders are connected internationally.

AIM: To determine whether communication networks exist in a diverse and competitively selected cohort of nurse leaders, and to identify variables that explain any patterns of connection. METHOD: Twenty seven nurse leaders completed a form to ascertain the presence and strength of communication between participants. Data were analysed using social network analysis, generating a visualisation of the network and associated quantitative measures. RESULTS: Participants were poorly connected. Those connections that did exist centred on geographic proximity and participation in regional and global bodies. CONCLUSION: These results help improve understanding of how nurse leaders are connected internationally, and prompt inquiry in to how connections might be strengthened.