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Background In 2019, the Hand Therapy Certification Commission (HTCC), in consultation with Scantron Corporation, performed a practice analysis study of hand therapy, the sixth in a series of similar studies performed byHTCC over a 35-year period. Purpose The primary goal of this study was to update and validate the definition and delineation of hand therapy and to ensure that the test content outline for the Hand Therapy Certification Examination (HTCE) reflects the critical tasks, knowledge, and skills required in the practice of hand therapy. Additionally, HTCC explored specific trends in hand therapy practice, compared findings with previous studies, and gathered data about the frequency, criticality, and performance expectations for the use and fabrication of orthoses by hand therapists. Study Design Quantitative Descriptive. Methods More than 40 subject matter experts from the United States and Canada, representing a broad range of experiences and perspectives, developed an updated delineation of the domains, tasks, knowledge, and techniques and tools used in hand therapy practice. A large-scale online survey of all certified hand therapists from the United States, Canada, and other countries was completed to test the profile within the practice of hand therapy. Results This large-scale online survey overwhelmingly validated the profile of hand therapy. The results affirmed the test specifications for the Hand Therapy Certification Examination; affirmed the definition of hand therapy; and refined the scope of hand therapy practice. New data was gathered regarding the use of orthotics in hand therapy. Conclusions This study establishes content validity for the HTCE. It highlights that the specialty of hand therapy is a mature and stable specialty field of occupational therapy and physical therapy. Certified Hand Therapists frequently issue pre-fabricated and fabricate custom orthoses in the course of rehabilitation for clients with hand and arm injuries, and overall consider this a highly critical task in hand therapy practice. Level of Evidence N/A

Outreach to people with serious mental illness who are disengaged from treatment can facilitate return to care. However, little is known regarding what outreach strategies are effective. This mixed-methods evaluation assessed best practices for conducting outreach to Veterans with serious mental illness via the national Veterans Health Administration Re-Engaging Veterans with Serious Mental Illness program by comparing the strategies used by high-performing sites and low-performing sites. Quantitative data included the types and number of contact attempts used to reach Veterans. Qualitative data included interviews with clinicians from high- and low-performing sites. Results indicated making at least four contact attempts using methods of phone, certified letter, and next of kin differentiated high from low-performing facilities. Clinicians from high-performing sites also differed from low-performing sites in their expressed philosophy about outreach, demonstrated a broader array of strategies in attempting to contact Veterans, and described greater connections with others at their site, with clinicians around the country, and with national program resources. Implications of evaluation findings for outreach programs and research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background and objective Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. Materials and methods Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. Results Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. Discussion and conclusions SpACE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.

Background: Although mobile apps are readily available for speech sound disorders (SSD), their validity has not been systematically evaluated. This evidence-based appraisal will critically review and synthesize current evidence on available therapy apps for use by children with SSD. Objective: The main aims are to (1) identify the types of apps currently available for Android and iOS mobile phones and tablets, and (2) to critique their design features and content using a structured quality appraisal tool. Methods: This protocol paper presents and justifies the methods used for a systematic review of mobile apps that provide intervention for use by children with SSD. The primary outcomes of interest are (1) engagement, (2) functionality, (3) aesthetics, (4) information quality, (5) subjective quality, and (6) perceived impact. Quality will be assessed by 2 certified practicing speech-language pathologists using a structured quality appraisal tool. Two app stores will be searched from the 2 largest operating platforms, Android and iOS. Systematic methods of knowledge synthesis shall include searching the app stores using a defined procedure, data extraction, and quality analysis. Results: This search strategy shall enable us to determine how many SSD apps are available for Android and for iOS compatible mobile phones and tablets. It shall also identify the regions of the world responsible for the apps’ development, the content and the quality of offerings. Recommendations will be made for speech-language pathologists seeking to use mobile apps in their clinical practice. Conclusions: This protocol provides a structured process for locating apps and appraising the quality, as the basis for evaluating their use in speech pathology for children in English-speaking nations. [JMIR Res Protoc 2016;5(4):e233]

Purpose To evaluate the impact of the current structure and schedule of the American Board of Radiology (ABR) radiation oncology initial certification (RO-IC) examinations, with a primary focus on implications for family planning and early professional barriers among female radiation oncologists. Methods and Materials The Society of Women in Radiation Oncology (SWRO) conducted a survey of crowdsourced ABR candidates and diplomates for radiation oncology between June and July of 2020. The primary study cohort was early career female radiation oncologists of the 2016 through 2021 graduating classes. Results The survey response rate of early career female radiation oncologists was 37% (126 of an estimated 337). Among this cohort, 58% (73 of 126) reported they delayed or are currently delaying / timing pregnancy or adoption to accommodate the annual schedule of the four qualifying and certifying examinations required to achieve board certification in radiation oncology. One in every five respondents who had attempted to become pregnant reported experiencing infertility (25 of 79, 20%). Women who reported intentionally delaying pregnancy to accommodate the ABR RO-IC examination schedule were significantly more likely to experience infertility (46% versus 18%, p=0.008). Seven women (6%) reported at least a one-year delay in sitting for a RO-IC examination due to an unavoidable scheduling conflict related to childbirth and/or the peripartum period. A majority reported that full board certification had a significant impact on achieving academic promotion or professional partnership (52%), annual compensation (54%), and non-clinical professional commitments (58%)—these rates mirror those of surveyed early career male counterparts (n=101). Conclusions The current structure and scheduling of the ABR RO-IC examinations imposes noteworthy hurdles for many female radiation oncologists when entering the workforce. The recent transition to virtual examination platforms creates an important opportunity to increase flexibility in the structure and scheduling of the board examination process to improve equitable board certification practices.

OBJECTIVES: Reducing inappropriate nursing home (NH) antibiotic usage by implementing stewardship programs is a national priority. Our aim is to evaluate the influence of antibiotic stewardship programs on antibiotic use rates in NHs over time. DESIGN: Retrospective, repeated cross-sectional analysis. SETTING AND PARTICIPANTS: Long-term residents not receiving hospice care in freestanding NHs that participated in one or both surveys in 2013 and 2017. METHODS: Survey data were merged with the Minimum Data Set and the Certification and Survey Provider Enhanced Reporting data. Our outcome was a binary indicator for antibiotic use. The main predictor was the NH antibiotic stewardship policy intensity. Using multivariate linear regression models adjusting for resident and facility characteristics that differed between the two years, we calculated antibiotic use rates in 2013 and 2017 for all residents, those with Alzheimer’s disease, and those with any infection including urinary tract infections (UTIs). RESULTS: Our sample included 317,003 resident assessments from 2013 and 267,537 assessments from 2017, residing in 953 and 872 NHs, respectively. NH antibiotic stewardship policy intensity increased from 2013 to 2017 (p < 0.01) and among all NH residents, including those with Alzheimer’s disease, antibiotic use rate decreased (p < 0.05), with 45% of the decline attributable to strengthening stewardship programs. For most residents, policy intensity was associated with decreased usage in residents with UTI. However, among Alzheimer’s disease residents with a UTI, this association did not persist. CONCLUSIONS AND IMPLICATIONS: While there was a decrease in antibiotic use in 2017, more time is needed to see the full impact of antibiotic stewardship policy into practice. Adjustments to programs that directly address barriers to implementation and appropriate UTI antibiotic use for residents with Alzheimer’s disease are necessary to continue strengthening NH antibiotic stewardship and improve care.

Work-related diseases of the musculoskeletal and the peripheral nervous system are classified as overload cumulative microtrauma diseases, resulting from chronic overload and/or damage of specific neuromusculoskeletal structures. Occupational activities which predispose to them are characterised by monotypy (repetition of movements during a significant part of the working shift). Authors described 4 cases of women with musculoskeletal and peripheral nervous system disorders qualified as occupational background just in the 2nd instance of medical certification. Detailed analysis of occupational exposure and medical interview with individual diagnostic approach allowed to determine the occupational etiology of diseases, regardless of non-occupational risk factors in some cases, even if the workstation was not common. Difficulties in estimating the probability of disease process induction on the background of occupational exposure are caused by frequent coexistence of non-occupational risk factors. The 2-tier system of certification provides an independent evaluation of medical history and occupational exposure. Med Pr. 2022;73(1).

As the acuity, complexity, and illness severity of patients admitted to cardiac intensive care units have increased, the need to recognize critical care cardiology (CCC) as a dedicated subspecialty in cardiovascular disease has received increasing support. Differing viewpoints exist regarding the optimal pathway for CCC training. Currently, all proposed CCC training pathways involve permutations of individual training years culminating in subspecialty certification across multiple disciplines; however, there are significant disadvantages to these training paradigms. We propose an innovative, pragmatic approach to CCC training through tailored subspecialty training in advanced heart failure and transplant cardiology (AHFTC), using elective time to enrich AHFTC training with skills and experiences necessary to become a highly skilled critical care cardiologist. The completion of this pathway would lead to completion of AHFTC training with a novel designation: distinction in critical care cardiology.

The use of intraoperative transesophageal echocardiography (TEE) has become the standard of care for most cardiac surgical procedures. There are guidelines established for training, practice, and quality improvement in perioperative TEE by the joint efforts of the American Society of Echocardiography and Society of Cardiovascular Anesthesiologists. Cardiac point-of-care ultrasound (POCUS) increasingly is being incorporated into anesthesiologists’ training and practice. While a special “certification in Critical Care Echocardiography” was created by the National Board of Echocardiography in 2019, there currently exist no guidelines for training, certification, and practice of perioperative TTE by anesthesiologists. In this review, the authors describe the categories, indications and applications of perioperative TTE and provide a recommended sequence for performing an examination tailored to the evaluation of perioperative patients. Although the authors describe a protocol utilized at their institution, there are no standards described in the literature for PTTE. Cardiac anesthesiologists and cardiac anesthesia societies (Society of Cardiovascular Anesthesiologists, European Association of Cardiothoracic Anesthesiologists) must come forward to establish standards working in collaboration with echocardiography societies (American Society of Echocardiography, European Society of Cardiology).

Background COVID-19 is a global health crisis. Close contact with the mucous membranes and respiratory secretions of patients and aerosol-generating procedures renders dentists and other oral health professionals at high risk of exposure to SARS-CoV-2. We examined dentists’ knowledge, preparedness, and experiences of managing COVID-19 in Australia. Methods A cross-sectional online survey of dentists with a current membership with The Australian Dental Association (ADA) was conducted between March and April 2021. Results Of the 368 survey responses, most dentists (72.3%) reported having a good level of knowledge about COVID-19, with most visiting the ADA Federal COVID-19 (74.7%) and state/territory department of health websites (62.8%), respectively to source up-to-date information. Most dentists (87.6%) felt prepared to manage COVID-19 into the future, although 66% reported not receiving training or certification in the use of PPE. Over half (58.7%) reported not being concerned about contracting SARS-CoV-2 at work, with some (28.9%, n=98/339) feeling more stressed than usual and having heavier workloads. Conclusions COVID-19 had significant impact in oral healthcare in Australia. Dentistry has adapted to the varied challenges raised by the pandemic. Comprehensive training and detailed guidelines were fundamental for successful patient management during the COVID-19 outbreak.

OBJECTIVE To survey occupational health-related activities conducted at hospitals certified by the Japan Council for Quality Health Care in the Kanto region of Japan. METHODS The survey tool was sent to 470 hospitals and comprised the following items: hospital size, occupational health system, infection control practices, mental health services, promotion of work system reforms, and priorities in achieving occupational health. RESULTS A total of 140 hospitals completed the survey. A monthly workplace inspection was conducted in approximately 60% of the hospitals. Testing of new employees for hepatitis and four other viruses was conducted in approximately 65% of the hospitals, and influenza vaccination was administered to the employees in all the hospitals. Most hospitals provided mental health services to their workers, which included consultation with an occupational physician. Work system reforms for changing conference time and task shifting or sharing were adopted in approximately 50% of the hospitals. Prevention of blood-borne pathogens, respiratory infections, and healthcare coverage for healthcare workers was identified as areas of improvement in several hospitals. CONCLUSIONS Legally required infection control and occupational health-related practices were conducted in most hospitals. Additionally, several hospitals undertook work system reforms, including the management of changes in conference time and task shifting or sharing.

Objective The use of basic transesophageal echocardiography (TEE) in critically ill and older surgical patients can change patient management and improve outcomes after noncardiac surgery. The authors hypothesized that educating the future generation on basic TEE skills by an intense two-month rotation will help them achieve basic TEE certification by the National Board of Echocardiography (NBE) and facilitate good use of their skills for patient care during their practice. Design This is a descriptive report of graduating anesthesiology residents who completed two months basic TEE rotation at the authors’ residency program between 2013 and 2019. The authors report the clinical training goals, NBE testamur and certification status, and a survey report on the use of basic TEE skills in their practice Settings University medical center. Participants Residents who completed two months basic TEE rotation during their Clinical Anesthesia (CA)-3 year. Interventions None. Measurements and Main Results Of a total of 115 residents, 67 (58%) elected basic TEE rotation. The NBE basic TEE certification and testamur status were achieved by 12 (21%) and 14 (24%) eligible residents, respectively. Residents (n = 43) personally performed 73 ± 21 (mean ± standard deviation) and reviewed 72 ± 28 (mean ± standard deviation basic TEE studies before graduation. The survey indicated that 63.4% of residents trained in basic TEE did not use their skills in their practice. Conclusions Two months’ basic TEE rotation was able to fulfill its educational goals (testamur status and clinical training) but fell short on achieving NBE certification rate and its ultimate impact on practice and patient care.

Basic life support (BLS) seminars’ knowledge declines over time. The Hellenic Cardiological Society (WG CPR), a principal BLS (European Resuscitation Council) organizer in Greece, interviewed 5.545 certified BLS providers of the previous 3 years’ HCS seminars through an online survey tool questionnaire. We evaluated knowledge scoring and examined any possible association with other factors. Certified BLS providers were predominantly female (68.7%) with a university-level education (50.2%), and registered nurses (40.1%). A better score was associated with female gender, younger age, medical profession and university education. Among healthcare professionals medical doctors reached higher scores. Time elapsed since the last attended BLS course did not affect the remaining knowledge in any subgroup.

The inaugural certifying examination for special competence in pediatric surgery in North America was given by the American Board of Surgery (ABS) in April 1975, the day before the sixth meeting of the American Pediatric Surgical Association at a resort near San Juan, PR. The event came after failed applications before the ABS and the Advisory Board for Medical Specialties in 1957, 1961, and 1967. The specialty had matured with a scholarly publication devoted to the field (Journal of Pediatric Surgery, 1965), the establishment of standards for training and training programs (1966), and a society independent of pediatrics and devoted solely to pediatric surgery (American Pediatric Surgical Association, first meeting 1970). Harvey Beardmore had guided the successful campaign for a certificate for pediatric surgery under the aegis of the ABS that was approved in June 1972. Pediatric surgery had thus gained full recognition as a specialty of surgery. A group photograph of its participants became one of the iconic images in our specialty. Thanks to Jim and Nancy Hopkins of Windsor Heights, IA, and to their many friends and colleagues, nearly half (71 of 151) of the pediatric surgeons in the photo were identified, marking their places in the history of pediatric surgery.

Background On December 7, 2020, the Acting Commissioner of the Connecticut Department of Public Health (DPH) issued an order authorizing eligible health professionals to administer coronavirus disease (COVID-19) vaccines provided they complete a vaccination training program. The University of Connecticut (UConn) School of Pharmacy was approached to collaborate with DPH to create a certification program to meet the needs of this order. Objectives To use a unique, pharmacist-led practice model to increase the number of competent vaccinators to administer the COVID-19 vaccine and to reduce vaccine hesitancy with timely vaccine information. Practice description A didactic and in-person training program was developed, with an evaluation completed by a vaccination-certified pharmacist. In addition, faculty members, staff, and students developed short videos answering questions about COVID-19 vaccines. Practice innovation We are aware of no other such programs using pharmacists and student pharmacists as primary creators of training and certification of health professionals to administer the COVID-19 vaccine. Evaluation methods Success was gauged by the rapid increase in the number of eligible health professionals who completed the developed training program and became certified as COVID-19 vaccinators. When addressing vaccine hesitancy, success was defined by the number of videos created and the number of views and likes the videos received. Results As of April 30, 2021, 1834 health professionals registered to administer the COVID-19 vaccine. A total of 1195 (65%) participants completed the online training developed by pharmacists, and 872 participants (48%) attended pharmacist-led, in-person competencies. As of July 29, 2021, efforts resulted in 14,972 views and 257 “Likes” for 79 videos promoted through social media platforms. Conclusion A partnership between the Connecticut DPH and the UConn School of Pharmacy allowed the rapid increase in capacity to administer the COVID-19 vaccine to citizens of Connecticut. Patients are receptive to accessing health information that pharmacists create on social media.

Background and purpose The use of smartphone applications is ubiquitous within healthcare. Over recent years there have been multiple applications developed within the field of plastic surgery. In the UK, applications with a medical purpose should be registered with the Medicines and Healthcare products Regulatory Authority (MHRA) as a medical device. The aim of this study was to evaluate plastic surgery specific smartphone applications designed for healthcare professional usage, and determine what proportion meet the criteria of a medical device and are suitably certified. Methods A systematic review of the Apple and Google Play App stores was carried out using search terms relevant to plastic surgery. Data was extracted from the app store listing, developer website and the contents of each application. Each application was evaluated against the criteria given by the MHRA to determine whether it constituted a medical device. Results 215 applications for plastic surgery healthcare professionals were identified, of which 22 met the definition of a medical device. Only 14% (n = 3) of these applications were appropriately certified, 14% (n = 3) were validated in peer-reviewed literature and 45% (n = 10) had documented medical professional involvement. Conclusion Most applications with a medical purpose were not certified as a medical device, had not been validated in any peer-reviewed research, and did not have any documented involvement of medical professionals. The potential consequences of such applications operating incorrectly are stark and represent a risk to patient safety. Usage of multiple applications in a single patient encounter may compound error and safety of clinical care.

BACKGROUND More patients are turning to the internet for their health information than ever before. This is a growing problem as it is well recognized that medical information on the internet is highly variable. We assessed the quality of information on the internet regarding the anti-reflux procedure, Nissen Fundoplication. Three commonly used measures of website quality are the Health On the Net code, the Journal of the American Medical Association Benchmark criteria, and the DISCERN tool. The HON code is a seal of approval awarded by an independent organization where the JAMA Benchmark and DISCERN Tool are a set of standards that can be utilized by an internet user or webpage creator. METHODS We performed a Google search using the term "Nissen Fundoplication", where we analyzed the top 75 websites. We included English language websites and excluded advertisements, websites for medical professionals, duplicates, and requiring a login. Each website included was evaluated for presence of the HON seal and scored with the JAMA Benchmark and DISCERN criteria to determine quality. RESULTS Only 16.28% of websites were found to be HON code certified. The average JAMA benchmark score was 1.23, with 9.3% websites scoring the maximum 4 points and 39.53% receiving a score of 0. The average DISCERN score was 34.65 out of a total possible score of 75, where the mean score for the overall quality of the website (question 16) was 2.19 out of a maximal score of 5. CONCLUSION This study, using 3 commonly used validated measures, has found that the quality of online information pertaining to Nissen Fundoplication is sorely lacking. The implications of these results are twofold as an important reference for institutions to update their source material and a guide when providing patients with adequate resources.

In the United States, attaining the orthopedic certified specialist (OCS) credential or the orthopedic subspecialty credential of Fellow of the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT), may lead to a higher level of orthopedic practice. It is unknown whether attaining these credentials influences physical therapist confidence in and frequency of engagement in prescription opioid medication misuse (POMM) management practices. A national cross-sectional web-based survey of PTs identified whether respondents had an OCS or FAAOMPT credential. Self-report confidence in POMM-related management practices and the frequency of engaging in these practices were assessed. Logistic regression evaluated association between credential status and confidence in, and frequency of, engagement in POMM-related management practices. The analysis included 402 respondents with a mean age of 41.0 (SD = 11.2) and 203 (50.4%) females. There were 91 (22.6%) PTs with a FAAOMPT credential, 143 (35.6%) with an OCS but with no FAAOMPT credential and 168 (41.8%) had neither credential. Compared to those with an OCS credential, FAAOMPTs reported greater confidence in, and greater frequency of engagement in, POMM-related management practices (p

BACKGROUND AND OBJECTIVES: In 2016, the American Board of Medical Specialties (ABMS) approved pediatric hospital medicine (PHM) as the newest pediatric subspecialty. To characterize development of the field, this article aims to: (1) describe the responsibilities and practice settings of US pediatricians self-identifying as hospitalists; and (2) determine how exclusive PHM practice, compared with PHM practice in combination with general or subspecialty care, was associated with professional development interests. METHODS: Pediatricians enrolling in the 2017-2018 American Board of Pediatrics (ABP) Maintenance of Certification program were offered a voluntary survey about their responsibilities, interests, and practice settings. Logistic regression was employed to characterize associations between exclusive PHM practice and: (1) interest in quality improvement (QI) leadership; (2) intention to take the PHM certifying exam; (3) satisfaction with allocation of professional time; and (4) intention to maintain more than one ABP certification. RESULTS: The survey response rate was 70.0%; 1662 (13.1%) self-reported PHM practice. Four-hundred ninety-one (29.5%) practiced PHM exclusively, 518 (31.1%) practiced PHM and general pediatrics, and 653 (39.3%) practiced PHM and one or more subspecialties. Respondents reporting exclusive PHM practice were significantly more likely to report interest in QI leadership or consultation (adjusted odds ratio [OR], 1.39; 95% CI, 1.09-1.79), PHM exam certification (adjusted OR, 7.10; 95% CI, 5.45-9.25), and maintenance of more than one ABP certification (adjusted OR, 2.64; 95% CI, 1.89-3.68). CONCLUSIONS: Hospitalists reported diverse clinical and nonclinical responsibilities. Those practicing PHM exclusively expressed high levels of interest in board certification and QI leadership. Ongoing monitoring of PHM responsibilities and practice settings will be important to support the professional development of the PHM workforce.

Background Family physicians provide a sizable portion of emergency care in the United States. However, there is limited work characterizing this population. Methods We completed a cross-sectional analysis of the 2020 American Medical Association Physician Masterfile that was inclusive of all clinically active physicians who designated emergency medicine as their primary or secondary specialty and had family medicine residency training and/or family medicine board certification. We used Accreditation Council for Graduate Medical Education information to determine family medicine residency training and data from the American Board of Medical Specialties to determine family medicine board certification status. We calculated physician density using US Census Bureau estimates; urban-rural assignments were based on Urban Influence Codes. Results We identified 4354 clinically active emergency physicians (9% of the overall emergency physician workforce). Of these, a majority were male (88%) and completed their training at least 20 years ago (84%), and a majority (59%) reported emergency medicine as their primary specialty. There is notable variation in physician density per 100,000 US population, and these densities declined compared with prior estimates from 2008. Conclusions We find that family physicians represent a sizable portion of the overall emergency physician workforce despite decreases in physician densities across the United States.

The Board Certified Psychiatric Pharmacist (BCPP) specialty certification was launched by the Board of Pharmacy Specialties in 1994. Candidates for the BCPP can qualify for the examination through 3 possible pathways: practice experience (4 years) in the specialty, completion of a PGY-1 residency plus an additional 2 years of practice experience, or completion of a PGY-2 specialty residency in psychiatric pharmacy. Recent fluctuations in the passing rate raised questions as to explanatory factors. This article represents the first published comprehensive study of candidate performance on the BCPP Examination. It describes a retrospective, observational study presenting (a) statistical trends of examination passing rates for biannual cohorts over the past 5 years, as well as (b) score distributions on the 3 performance domains of the certification. Pass-rate trend analyses suggest that variation in the proportion of eligibility pathway cohorts in the respective testing samples explains some of the fluctuation in passing rates. An analysis of variance of domain-level scores, using groups defined by eligibility pathway, yielded significant differences for nearly all group comparisons. Evaluation of the effect sizes suggest that the most disparate performance was observed on the core clinical domain, Patient-Centered Care. The results of this study are consistent with previously published research and will inform the upcoming role delineation study for the Psychiatric Pharmacy Certification.

Background The pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match. Methods This retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied. Results Lower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates. Conclusions Changes in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.

This study aimed to examine the challenges and needs of certified nursing assistants (CNAs) working in nursing homes during the COVID-19 pandemic in the greater New York City area. Between September and November of 2020, a telephone survey was administered to and completed by 208 CNAs in the study area about various aspects of their working experience during COVID-19. CNAs reported significant exposure to COVID-19 and experienced additional emotional and financial strain due to the pandemic. CNAs also expressed the influence of COVID-19 on their work schedules and intent to continue working as CNAs, and strong interest in financial support and further training. This study offers empirical insights into the experiences of CNAs working in nursing homes during the pandemic, which are of unique value to inform future efforts to support CNAs and other long-term care providers in general and during public health emergencies in New York and beyond.

International audience; Aim: To assess nurses’ ability to observe newborn behaviour after in situ training provided by caregivers with advanced practice certification in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).Design: Prospective observational study.Methods: Twelve nurses viewed 20-min films showing the behaviour of 10 premature newborns before, during and after the usual caregiving. The behaviour was rated on an observation sheet with 88 items distributed into six systems. The responses were compared to the reference ratings established by two professionals certified for this programme.Results: Despite less accurate observations during care and for some components, the nurses generally showed a satisfactory ability to observe newborn behaviour after training by NIDCAP expert professionals. The dissemination of observation skills among caregivers may result in an improved quality of patient care and better communication among professionals in a department of neonatology.

The endoscopic retrograde cholangiopancreatography (ERCP) procedure requires concentration while wearing a heavy radiation protective suit and taking the risk of radiation exposure and complications. In order to successfully perform an ERCP procedure, it is necessary to understand the target disease, as well as appropriate education and training, and a certain amount of experience in the procedure. The Korean Pancreatobiliary Association organized a promotion committee to implement the “ERCP Certification” system to maintain education and quality control of ERCP procedures. A blueprint was prepared.

The Certificate of Competence and Advanced Studies Program is an academically recognized postgraduate program that is organized by the European School of Oncology in collaboration with the University of Ulm and the University of Zurich. It is a part-time educational activity that aims to provide physicians and scientists with advanced knowledge in the management of patients with breast cancer, lymphoma, and lung cancer. The program encloses three attendance seminars and four to five e-learning modules that extend over 12 to 14 months. To be certified, participants have to pass an online test after each module followed by a final certification exam at the end of the program. This article reports on the 8-year experience of the 166 graduated fellows who have attended the program. Supplementary Information The online version contains supplementary material available at 10.1007/s13187-021-02105-z.

Specialized centers for weaning in neurological and neurosurgical early rehabilitation can be certified by the German Society for Neurorehabilitation (DGNR) since 1 October 2021. The certification criteria are indicators for structure and process quality and for treatment results for weaning of neurological patients from mechanical ventilation. In Germany these patients are treated in departments for neurological and neurosurgical early rehabilitation in acute care hospitals as well as in specialized rehabilitation hospitals. Acknowledging this diversity of care, certification is possible for both kinds of institutions. Certification is granted by the DGNR in cooperation with TUV Rheinland as the certification authority, analogous to the certification of stroke units. Institutions apply for certification by sending all necessary documents to the TUV Rheinland. Afterwards auditors of the TUV Rheinland (lead auditor) and the DGNR (medical speciality auditor) visit the institution on site. The results of this visit are reported to the certification committee of the DGNR, which in turn recommends or declines certification. The certification of centers for weaning in neurological and neurosurgical early rehabilitation is an important step towards defining neurorespiratory care and the role of the neurologist for intensive care and weaning in Germany. Thereby, the interdisciplinary dialogue between pneumologists, anesthesiologists, and neurologists is fostered. Also, the dialogue on treatment capacities and strategies with healthcare politicians, health insurances, and patient associations is facilitated.

Современный уровень развития медицины требует от врача-анестезиолога овладения большим объемом теоретических знаний и практических навыков, способности использовать их в сложных и критических условиях. Исходя из этого оптимизация учебного процесса нуждается в реструктуризации систем оценки и контроля приобретенных знаний и практических навыков. На кафедре анестезиологии, интенсивной терапии и медицины неотложных состояний факультета последипломного образования три года назад для промежуточного контроля теоретических знаний и практических умений врачей-интернов первого года обучения был введен объективный структурированный клинический экзамен (Objective Structured Clinical Exam — ОSСЕ). Цель данной работы — анализ результатов проведения объективного структурированного клинического экзамена и оценка промежуточных знаний и практических навыков у врачей-интернов первого года обучения по специальности «анестезиология и интенсивная терапия» в соответствии с методологией OSСЕ. Для проведения экзамена было подготовлено 7 станций: клинические станции, включавшие взаимодействие врачей-интернов с реальным или стандартизированным пациентом; практические станции (выполнение технических процедур и манипуляций) и статические (теоретические) станции. Инструментами оценки были оценочные листы и адаптированная к профессиональным требованиям глобальная рейтинговая шкала. Из 32 интернов, которые сдавали экзамен, только 10 набрали более половины от возможного количества баллов, остальные — меньше. Средний балл составил 10,3 (из 14 возможных). Большинство интернов, которые, как мы считали, успешно сдадут данный экзамен, едва превысили показатель в 60 %. Самые высокие оценки врачи-интерны получили за предоперационную подготовку больных, гемотрансфузиологию, а также за демонстрацию реанимационных навыков на манекене. Низкие оценки интерны получили за ответы по внутривенной анестезии и за практический навык по установке ларингеальной маски. В дальнейшем мы планируем разработать дополнительные станции, согласно требованиям типовой учебной программы по интернатуре Министерства образования Украины, усовершенствовать методическое обеспечение для каждой новой станции, адаптировать критерии оценки практических навыков и внедрить их для итоговой аттестации на звание врача-специалиста.

Purpose To evaluate reviewers’ timeliness and review quality for the International Journal of Radiation Oncology, Biology, Physics (IJROBP) by sex and seniority. Methods and Materials The IJROBP editorial office provided data on 3962 individuals invited to review manuscripts from 2011 through 2014. We identified 1657 reviewers who had been invited to provide a review on at least 3 occasions during the study period and compared review timeliness and scoring between male and female reviewers. We confirmed the reviewers’ sex after having unblinded their names based on our personal acquaintance with them and via an Internet search on their department websites. We then did a subset analysis of 124 US-based reviewers who had returned a “major revision” decision. We used the Review Quality Instrument (RQI) to rate their reviews. We used odds ratios and t tests to look for differences in mean RQI scores and factors that might be associated with quality—in particular, Hirsch indices (h indices) and year of first certification. Results Of the 1657 reviewers of interest, 1245 (75.1%) were men and 412 (24.9%) were women. We found no statistically significant differences between men and women in the time to respond to invitations. There were no statistically significant differences in timeliness or review reminders based on sex. Our subset analysis showed no difference in quality (RQI scores) based on the reviewers’ sex, h index, or year of first certification. Conclusions Women and men render reviews of equal quality regardless of seniority and h index, yet women have been invited less frequently to review. This is likely because of the underrepresentation of women in radiation oncology. A more balanced academic population is needed to address this continuing disparity of women's representation in academic publishing.

Background The United States has experienced substantial consequences associated with the opioid epidemic. One such consequence has been an increased need for patients who misuse opioids to interface with health care professionals. As such, it is important to understand physician attitudes toward and experiences with this patient population. The goal of this paper is to assess the extent to which physicians hold negative attitudes toward patients who misuse opioids and whether this patient population receives differential treatment. Methods Using a mixed methods design, we surveyed board-certified physicians in Ohio regarding their attitudes toward patients who misuse opioids as well as their observations of bias toward these patients in health care settings. Results Our findings suggest that negative attitudes toward patients who misuse opioids are common among physicians as were personal experiences of bias toward this patient population. We also found that physicians rationalized treating these patients differently and perceived barriers to achieving more equitable treatment. Finally, some physicians expressed a desire for additional training and resources to reduce bias. Conclusions Negative attitudes toward patients who misuse opioids may serve as a critical barrier to patients accessing care in areas heavily affected by the U.S. opioid epidemic.

Obesity is a widespread disease which adversely impacts all organ systems and disproportionately affects African Americans and other minority groups. Physicians across medical specialties must possess current knowledge of obesity as an important, distinct disease with biological and social causes. Coverage of obesity on board certification examinations, which influence standards in medical knowledge and practice in each specialty, has not previously been examined. The member boards of the American Board of Medical Specialties offer a content outline or “blueprint” detailing material tested. We parsed the 24 available general certification exam blueprints for mentions of obesity and related keywords. We categorized blueprints into three tiers: mention of obesity (Tier 1), mention of related terminology but not obesity (Tier 2), and no mention of obesity or related terminology (Tier 3). We analyzed mentions of obesity and related terms by blueprint word count and procedural versus non-procedural specialties. Six (25.0%) of 24 board exam blueprints mentioned obesity (Tier 1), fifteen (62.5%) mentioned related terminology only (Tier 2), and three (12.5%) mentioned neither obesity nor related terminology (Tier 3). There was no significant difference in obesity-related mentions between procedural and non-procedural specialties (X2, p = .50). None of the blueprints included racial/ethnic disparities related to obesity. Word count was not significantly correlated with mentions of obesity in linear regression (p = .42). The absence of any mention of obesity on most content outlines and of racial/ethnic disparities on all content outlines indicates need for increased coverage of the diagnosis, prevention, and treatment of obesity across all board examinations.

Objectives In the vast majority of Children's Hospitals, the critically ill patient can be found in one of three locations: the PICU, the neonatal ICU, and the cardiac ICU. Training, certification, and maintenance of certification for neonatology and critical care medicine are over seen by the Accreditation Council for Graduate Medical Education and American Board of Pediatrics. There is no standardization of training or oversight of certification and maintenance of certification for pediatric cardiac critical care. Data sources The curricula from the twenty 4th year pediatric cardiac critical care training programs were collated, along with the learning objectives from the Pediatric Cardiac Intensive Care Society published "Curriculum for Pediatric Cardiac Critical Care Medicine." Study selection This initiative is endorsed by the Pediatric Cardiac Intensive Care Society as a first step toward Accreditation Council for Graduate Medical Education oversight of training and American Board of Pediatrics oversight of maintenance of certification. Data extraction A taskforce was established of cardiac intensivists, including the directors of all 4th year pediatric cardiac critical care training programs. Data synthesis Using modified Delphi methodology, learning objectives, rotational requirements, and institutional requirements for providing training were developed. Conclusions In the current era of increasing specialized care in pediatric cardiac critical care, standardized training for pediatric cardiac critical care is paramount to optimizing outcomes.

Congenital heart disease (CHD) is an indication which spans multiple specialties across various genetic counseling practices. This practice resource aims to provide guidance on key considerations when approaching counseling for this particular indication while recognizing the rapidly changing landscape of knowledge within this domain. This resource was developed with consensus from a diverse group of certified genetic counselors utilizing literature relevant for CHD genetic counseling practice and is aimed at supporting genetic counselors who encounter this indication in their practice both pre- and postnatally.

Background Limited COVID‐19 vaccination acceptance among healthcare assistants (HCAs) may adversely impact older adults, who are at increased risk for severe COVID‐19 infections. Our study objective was to evaluate the perceptions of COVID‐19 vaccine safety and efficacy in a sample of frontline HCAs, overall and by race and ethnicity. Methods An online survey was conducted from December 2020 to January 2021 through national e‐mail listserv and private Facebook page for the National Association of Health Care Assistants. Responses from 155 HCAs, including certified nursing assistants, home health aides, certified medical assistants, and certified medication technicians, were included. A 27‐item survey asked questions about experiences and perceptions of COVID‐19 vaccines, including how confident they were that COVID‐19 vaccines are safe, effective, and adequately tested in people of color. Multivariable regression was used to identify associations with confidence in COVID‐19 vaccines. Results We analyzed data from 155 completed responses. Among respondents, 23.9% were black and 8.4% Latino/a. Most respondents worked in the nursing home setting (53.5%), followed by hospitals (12.9%), assisted living (11.6%), and home care (10.3%). Respondents expressed low levels of confidence in COVID‐19 vaccines, with fewer than 40% expressing at least moderate confidence in safety (38.1%), effectiveness (31.0%), or adequate testing in people of color (27.1%). Non‐white respondents reported lower levels of confidence in adequate testing of vaccines compared to white respondents. In bivariate and adjusted models, respondents who gave more favorable scores of organizational leadership at their workplace expressed greater confidence in COVID‐19 vaccines. Conclusion Frontline HCAs reported low confidence in COVID‐19 vaccines. Stronger organizational leadership in the workplace appears to be an important factor in influencing HCA's willingness to be vaccinated. Action is needed to enhance COVID‐19 vaccine uptake in this important population with employers playing an important role to build vaccine confidence and trust among employees.

Objectives There is wide variation between Countries in the structures of residency programmes, need for subspecialisation, and health care system organisation. This survey was aimed at gathering information regarding current musculoskeletal (MSK) educational programmes offered both in European and non-European Countries. Methods We administered an online survey to European Society of Radiology (ESR) residents and radiologists aged up to 35 years. The questionnaire was further disseminated by delegates of the ESR Radiology Trainees Forum. Survey consisted of 20 questions about the structure and organisation of MSK training programmes. Results Overall, 972 participants from 86 Countries completed the survey, with a wide heterogeneity of answers. Of them, 636 were residents (65.9%), 329 were certified radiologists (34.1%), with a mean age of 30.8 ± 3 years. Almost half of the participants had a dedicated MSK rotation/block during residency, with a duration of 3–6 months in 62.5% of cases. A dedicated period in MSK Ultrasound was present in only one-third of residency programmes; 38% of participants were expected to learn interventional MSK procedures, but only 28.2% have been actively involved in interventions during their residency. Overall, 62.7% of participants rated the quality of their MSK training as poor to average. Almost all (93.1%) thought that MSK training could be improved in their residency, especially ultrasound practice (80.7%) and MRI reporting (71.1%). Conclusions There are significant inconsistencies in the structure of MSK training offered by different Countries. Radiology trainees are showing substantial interest in MSK training, which necessitates strategic investments to standardise and enhance its quality.

OBJECTIVE Neurosurgery continues to be one of the medical specialties with the lowest representation of females in both the resident and faculty workforce. Currently, there are limited available data on the gender distribution of faculty and residents in Accreditation Council for Graduate Medical Education (ACGME)–accredited neurosurgery training programs. This information is critical to accurately measure the results of any effort to improve both the recruitment and retention of women in neurosurgery. The objective of the current study was to define the current gender distribution of faculty and residents in ACGME-accredited neurosurgery training programs. METHODS Data publicly available through institutional and supplemental websites for neurosurgical faculty and residents at ACGME-accredited programs were analyzed for the 2017–2018 academic year. Data collected for faculty included gender, age, year of residency graduation, academic rank, h-index, American Board of Neurological Surgery certification status, and leadership positions. Resident data included gender and postgraduate year of training. RESULTS Among the 109 ACGME-accredited neurosurgical residency programs included in this study, there were 1350 residents in training, of whom 18.2% were female and 81.8% were male. There are 1320 faculty, of whom 8.7% were female and 91.3% were male. Fifty-eight programs (53.2%) had both female faculty and residents, 35 programs (32.1%) had female residents and no female faculty, 4 programs (3.7%) had female faculty and no female residents, and 6 programs (5.5%) lacked both female residents and faculty. Six programs (5.5%) had incomplete data. Female faculty were younger, had lower h-indices, and were less likely to be board certified and attain positions of higher academic rank and leadership. CONCLUSIONS This study serves to provide a current snapshot of gender diversity in ACGME-accredited neurosurgery training programs. While there are still fewer female neurosurgeons achieving positions of higher academic rank and serving in leadership positions than male neurosurgeons, the authors’ findings suggest that this is likely due to the small number of women in the neurosurgical field who are the farthest away from residency graduation and serves to highlight the significant progress that has been made toward achieving greater gender diversity in the neurosurgical workforce.

Introduction Core needle biopsies (CNBs) have proven to be an excellent source of tissue for diagnosis and ancillary testing in the era of personalized medicine, commonly yielding sufficient material for testing via a relatively minimally invasive technique. Thus, there has been an increase in touch preparations (TPs) evaluated with rapid onsite evaluation (ROSE) of these small biopsies either in isolation or with concurrent fine needle aspiration (FNA). This in turn has forced cytopathology practices to make decisions with regard to processing and workflow of CNBs, which affects cytopathology fellowship education substantially. Study design The present review is based on a review of recent literature and an evaluation of the authors' personal experiences. Results and conclusions Deciding whether CNBs with associated TPs should be assigned to the cytology service, the subspecialty or general surgical pathology service, or a split between cytopathology and surgical pathology, is complicated. The workflow is variable at different institutions depending on multiple factors. Each of these routes has benefits and disadvantages that can affect patient care and laboratory workflow, in addition to having downstream effects on the quality and type of education our pathology trainees receive. Herein, the advantages and disadvantages of the different approaches for CNB triage are discussed, with an emphasis on the impact upon cytopathology fellowship education.

Introduction Cytopathology is one of the most sought-after fellowships within pathology, with a lower fellowship vacancy rate compared with most other subspecialties. The Accreditation Council for Graduate Medical Education (ACGME) actively tracks annual program data for cytopathology fellowship programs, and evaluating this longitudinal data looking at trends in programs and positions over the past 10 years could provide insights into the future of cytopathology and its training programs. Methods Data obtained from the ACGME was examined in detail for all ACGME-accredited cytopathology fellowship programs over the past decade (2011-2021). Additional responses from program directors (PDs) from a 2021 American Society of Cytopathology (ASC) survey are also included. Results The total number of ACGME-approved cytopathology training programs and cytopathology fellowship positions remained relatively constant over the past 10 years, but the vacancy rate and number of programs with 1-2 unfilled spots has gradually but steadily risen over the past 6 years. In a 2021 ASC PD survey with 66% response rate, 53% of PDs reported having recruitment problems at least occasionally and 46% reported an increase in unexpected fellowship openings. Conclusions Although the number of cytopathology positions has been relatively constant over the past decade, there has been a recent increase in cytopathology fellowship vacancies that may indicate changes in career choices or the job market, with fellows choosing jobs over additional fellowships, and potentially signal a growing shortage of fellowship-trained, Board-certified cytopathologists in the coming years.

Introduction Cytopathology fellowships need measures to assess performance of fellows. We sought to compare several internal quantitative assessment metrics in our fellowship with external metrics, such as performance on the American Society of Cytopathology (ASC) Progressive Evaluation of Competency (PEC) examination and United States Medical Licensing Examination (USMLE). Methods Quantitative parameters generated from our laboratory information system (LIS) on cytopathology fellows were evaluated over 6 years, including case volume and diagnostic discrepancies, in addition to ASC PEC and USMLE scores. For discrepancy reports, interpretations made by the fellow were compared with that of the cytopathologist, and classified as none (concordant), minor ( Results We evaluated internal and external metrics on 13 fellows over 6 years. The program average diagnostic concordance rate was 89.9%, with an average major discrepancy rate of 1.5%, and an average monthly case volume of 260 cases. More fellows with above-average ASC PEC performance showed above-average concordant diagnoses and lower case volume, while below-average PEC scores were seen more often with higher major discrepancy rates. More fellows with above-average USMLE scores had higher case volumes, while low USMLE scores showed a trend towards higher major discrepancy rates. Conclusion Our fellowship program has used a variety of internal and external measures of performance for cytopathology fellows. Although the findings show no statistically significant finding correlating performance, these quantitative parameters generated from our LIS were helpful to identify areas of improvement, facilitate comparison to peers, and provide case volume documentation.

Background In 2017, there were 288.7 million global cases of neck pain. A growing treatment option for neck pain is complementary and alternative medicine (CAM), with approximately 50% of Americans seeking these therapies. Despite the popularity of CAM, patients hesitate to disclose their use of these therapies to their healthcare provider, likely contributing to greater reliance on the Internet for information. The present study evaluates the quality of online CAM consumer health information for neck pain. Methods We used Google to search six unique terms across four English-speaking countries. Eligible websites discussed CAM use for neck pain. Websites were scored in duplicate using the DISCERN instrument, which assesses publication reliability (questions 1–8), quality of treatment information (questions 9–15), and overall publication quality (question 16). Scores were summed (questions 1–15), and means and standard deviations were calculated. Results Overall, 473 webpages were identified, of which 104 were unique; thirty-seven eligible websites were assessed with the DISCERN instrument. The mean summed DISCERN score across all websites was 46.04/75.00 (SD=9.79), and the mean overall quality rating was 3.05/5.00 (SD=0.76). Websites discussed treatment benefits, treatment options, and shared decision-making, but inadequately described treatment risks, the effect of no treatment, and treatment impact on quality of life. Conclusion Variable website quality suggests that healthcare providers should inquire about any online health information accessed by their patients. Commercial websites in particular should be cautiously navigated given their low DISCERN scores and lack of HONcode certification.

Objectives Determine the feasibility of implementing an evidence-based training program compared to a control during a basic infantry training course, and compare their effectiveness on measures of injuries and associated burdens. Design Prospective, cohort, feasibility study. Methods Infantry candidates awaiting course between 01-April-2019 and 31-March-2020 were invited to participate while those releasing from the military, awaiting occupational transfer or having >5 medical employment limitation days were excluded. Consenting participants were allocated to an infantry course prospectively scheduled to host either the evidence-based program or a control. The evidence-based program adapted modified physical training strategies from previous studies reporting reduced injuries in recruits and was supervised by certified fitness professionals, while the control was at the discretion of infantry instructors. Results With the exception of intervention duration which was limited due to operational factors, all feasibility outcomes were met including a recruitment rate of 171/203 = 84.2% and an intervention adherence of 126/144 = 87.5%. Stakeholders reported that the evidence-based program implementation was feasible, posing a manageable demand on resources without compromising operations. Evidence-based program participants reported 68% fewer overuse musculoskeletal injuries, 296 fewer medical employment limitation days and 11 fewer attritions than control participants. Conclusions An evidence-based training program is feasible to implement on a basic infantry training course, and results in fewer musculoskeletal injuries, medical employment limitation days and attrition. Given these results, this program should be generalizable for a full experimental trial, and may be scaled for intermediate/advanced infantry and/or other combat occupation courses to promote an evolution towards evidence-based training.

Introduction Papanicolaou test quality metrics include the ASC rate, ASC:SIL ratio, and ASC HPV+ rate. What a laboratory should do when metrics show a worrisome trend is not well defined. In 2015, our laboratory noted a worrisome trend in our quality metrics and decided to implement a systemic education program in 2016; we monitored the effectiveness of our program. Methods An educational intervention was designed for March/April 2016. Cytotechnologist education consisted of: group meeting on March 10 to discuss metrics, lecture, and written materials on ASC-US criteria, a quiz on challenging ASC-US cases, encouragement to seek consultation, and each cytotechnologist received quarterly individual metrics. The cytopathologist education consisted of: group meeting on April 16 to discuss metrics, encouragement to bring borderline cases to consensus conference, and each faculty received quarterly individual metrics. The ASC rate, ASC:SIL ratio, and ASC HPV+ rate was collected for the institution and each individual faculty in 2016 for January to March (pre-interventions, Q1), April to June (post-interventions, Q2), and July to September (post-interventions, Q3). ASC-H was included in the calculation of ASC %, ASC:SIL, and ASC HPV+ rates. Results There was a substantial decline in the lab ASC rate and ASC:SIL ratio, and the ASC HPV+ rate increased. Individual faculty changes in ASC:SIL ratio and ASC HPV+ rate also improved. Conclusions In our institution, an educational program has been very effective in improving Papanicolaou test metrics. It is helpful to perform re-education at all levels within the department.

Introduction Doctoral-level clinical chemists work in various settings including academia, healthcare systems, reference laboratories, and industry. Information regarding compensation and benefits for PhD board-certified clinical chemists is limited. The American Association for Clinical Chemistry’s (AACC) Society for Young Clinical Laboratorians (SYCL) Core Committee completed a compensation survey in February 2021 and compared that to previous survey results. Methods The 2021 salary survey was made available to all doctoral-level AACC members working in the United States and Canada. Respondents provided information on type of degree and board certification, years of experience, employment sector, geographic location, and gender. The survey collected confidential self-reported data from 208 respondents, with 187 (90%) respondents residing in the United States. Results The 25th percentile, median and 75th percentile total compensation range for 113 PhDrespondents who are certified by the American Board of Clinical Chemistry (ABCC) and residing in the United States was $150 000 to $159 000, $180 000 to $189 000, and $230 000 to $239 000, respectively. Most of the respondents worked in either an academic, hospital, or healthcare system setting, with 47% of respondents working at academic medical centers. Conclusions In this 2021 compensation survey, we continue to see an upward trend in compensation ranges for board certified PhD clinical chemists. This report is important in allowing individuals to actively advocate with prospective and current employers for equal and fair compensation as well as other benefits that impact career development and growth.

Aim To explore the cardio-pulmonary function of children returning to play sports after mild or asymptomatic SARS-CoV-2 infection. Methods This is a consecutive case series conducted at the Institute for Maternal and Child Health, Trieste, Italy. Paediatric patients who accessed the Institute for cardiologic and pneumological evaluation before the return-to-play competitive sports were recruited, according to the Italian Sports Medical Federation recommendations. Echocardiogram, electrocardiogram, treadmill ECG test and pulmonary function tests were performed. Results One hundred and thirty-two patients (aged 8-17 years old, mean age 12.8 ± 2.5) were recruited. Among these, 127 children were considered for the final analysis (49.6% females). Out of 127, 84 (66.1%) had a mild symptomatic form of SARS-CoV-2 infection, while 43 (33.9%) were asymptomatic. The main referred symptoms were fever (n = 37, 44%), asthenia (n = 14, 16.7%), rhinitis (n = 16, 19%), ageusia (n = 19, 22.6%), anosmia (n = 24, 28.6%), sore throat (n = 3, 3.6%), cough (n = 9, 10.7%), arthralgia-myalgia (n = 11, 13.1%), headache (n = 23, 27.4%) and gastrointestinal symptoms (n = 7, 8.3%). No child presented evidence of cardio-pulmonary function impairment after an average time of 77.3 days (SD 35) from SARS-CoV-2 swab positivity and a median of 68 days (IQ1 52, IQ3 92.5). Conclusion This preliminary study suggests that, in the absence of specific symptoms, the diagnostic yield of cardio-pulmonary tests before returning to play sports may be very low.

In the light of the increasing importance of cardiovascular cross-sectional imaging in current guidelines, the goal of this study is to provide a comprehensive overview of cardiovascular imaging (CVI) offered by radiological institutions across Germany.Data were extracted from the national certification program database of the German Roentgen Society (DRG) from 2015-2021. A nationwide online survey among radiology institutes (university hospitals, non-university hospitals, and private practices) was conducted for 2019, and data was extracted from the European Society of Cardiovascular Radiology (ESCR) registry. The data collection's key points included the number of centers and individuals certified for CVI, the number of cardiac CT and MRI examinations performed, the reporting habits, and the participation in the ESCR registry.71 centers and 1278 persons, both with a substantial increase since 2015, were registered and certified by the DRG to perform CVI. According to the survey, a total of 69,286 CT and 64,281 MRI examinations were performed annually. Data from the survey and the ESCR registry indicated that reporting was mostly done solely by radiologists or, to a lesser degree, in joint consensus meetings with non-radiologists. The overall participation rate in the ESCR registry was 48 % among the survey's participants.This comprehensive analysis demonstrates that high-quality CVI by radiologists is available nationwide. The current challenges are to provide the best medical and technical quality of CVI by radiology for patient care and to ensure economic sustainability in the German health care system to accommodate the predicted substantial need for CVI in the future.· High-quality advanced CVI service by radiologists is available nationwide.. · Highly qualified specialist knowledge is widely represented from university to private practices.. · Certification programs successfully contribute to the disseminationdeepening of CVI expertise.. · The ESCR registry is an established international tool for the documentation of CVI..· Sieren M, Maintz D, Gutberlet M et al. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists. Fortschr Röntgenstr 2022; 194: 181 - 191.ZIEL: Vor dem Hintergrund der stark zunehmenden Bedeutung der kardiovaskulären Schnittbildgebung (KVB) in den aktuellen Leitlinien soll diese Arbeit einen umfassenden Überblick über die von radiologischen Einrichtungen in Deutschland angebotene KVB geben.Die Daten wurden aus der Datenbank des nationalen Zertifizierungsprogramms der Deutschen Röntgengesellschaft (DRG) von 2015–2021 extrahiert. Für den Zeitraum 2019 wurden eine bundesweite Online-Befragung unter radiologischen Einrichtungen (Universitätskliniken, nichtuniversitäre Krankenhäuser und niedergelassene Ärzte) durchgeführt sowie Daten aus dem Register der European Society of Cardiovascular Radiology (ESCR) extrahiert. Zu den Kernpunkten der Datenerhebung gehörten die Anzahl der für KVB zertifizierten Zentren und Personen, die durchgeführten kardialen CT- und MRT-Untersuchungen, die Befundungsgewohnheiten und die Teilnahme am ESCR-Register.71 Zentren und 1278 Personen, jeweils mit einem deutlichen Anstieg seit 2015, waren für KVB von der DRG zertifiziert. Laut der Umfrage wurden in den teilnehmenden Einrichtungen insgesamt 69 286 CT- und 64 281 MRT-Untersuchungen jährlich durchgeführt. Die Daten aus der Umfrage und dem ESCR-Register zeigten, dass die Befundung der Untersuchungen meist durch Radiologen, in geringerem Maße in gemeinsamen Konsensus-Meetings mit nichtradiologischen Fachdisziplinen erfolgte. Die Teilnahmequote am ESCR-Register lag bei 48 %.Diese umfassende Analyse zeigt, dass eine qualitativ hochwertige KVB durch Radiologen flächendeckend verfügbar ist. Die aktuellen Herausforderungen bestehen darin, die beste medizinische und technische Qualität in der KVB für die Patientenversorgung durch Radiologen sicherzustellen und die wirtschaftliche Nachhaltigkeit im deutschen Gesundheitssystem zu gewährleisten, um den prognostizierten, erheblichen Bedarf an kardiovaskulärer Bildgebung in der Zukunft zu decken.· Hochqualifizierte KVB durch Radiologen ist bundesweit flächendeckend verfügbar.. · Hochqualifizierte Expertise ist in Universitätskliniken, Krankenhäusern und niedergelassenen Praxen breit vertreten.. · Zertifizierungsprogramme tragen erfolgreich zur Verbreitung und Vertiefung der KVB-Expertise bei.. · Das ESCR-Register ist ein etabliertes internationales Instrument zur Dokumentation der KVB..

Aim As the number of frail and disabled older people increases in Japan, systems are needed to detect efficiently the populations at high risk in need of care and to allow early intervention. We investigated cut-off values for those physical functioning assessments adopted by AWGS 2019 associated with new or worsening long-term care insurance (LTCI) certification. Methods We recruited 497 outpatients from our locomotive syndrome-frailty clinic. After excluding patients who had undergone orthopedic surgery right after assessment or ≤65 years old, 233 patients (mean age, 78 ± 6 years) were included. Logistic regression analysis was performed using new certification for LTCI services need or deterioration of care status in 1 year as the dependent variable and physical function and other assessments as independent variables. Next, we constructed receiver operating characteristic curves and calculated areas under the curve and optimal cut-off values. Results During 1-year follow-up, 37 patients (16%) obtained new certification for LTCI services need or deterioration of status. After adjusting, usual walking speed and Short Physical Performance Battery score were significantly associated with outcomes. With receiver operating characteristic curves, usual walking speed as the test variable showed an area under the curve of 0.740 with a cut-off of 0.92 m/s, whereas the Short Physical Performance Battery score showed an area under the curve of 0.737 with a cut-off score of 9. Conclusions Slower walking speed and lower Short Physical Performance Battery score may predict new or worsening LTCI for older people. Geriatr Gerontol Int 2021; 21: 919-925.

Introduction: As part of the development of the evidence-based (S3) clinical practice guidelines for kidney and bladder cancer by the German Guideline Program in Oncology, quality indicators (QIs) were defined to measure the quality of care. Based on these guidelines and QIs, the German Cancer Society (DKG) developed two new certification systems. The aim of this article is to show the process of development and implementation of QIs in certified cancer centres. Methods: Based on strong recommendations of each guideline and an additional systematic literature review for national and international QIs, two sets of QIs were derived in a multistep standardized approach. These QIs were implemented in the centres in certification data sheets to measure their outcomes. First results of treatment years 2018 and 2019 are available. Results: The final sets include 9 QIs for kidney cancer and 12 QIs for bladder cancer. Two-thirds of the QIs were transferred to the data sheets. In 2018 and 2019, the results of all but one QI are within the plausibility limits. From 2020 on, they are replaced by stricter target values that will challenge centres to improve their outcomes. Conclusions: Guideline-derived QIs make relevant aspects of patient care measurable and consequently improvable. The first QI results are encouraging. However, the DKG certification system and the methods of measuring quality are under ongoing development. Systematic QI implementation and evaluation may help to generate broader databases and thus expand knowledge.

Objective To assess the problem of unlicensed practitioners and quacks in Sindh, Pakistan. METHODS A cross-sectional study was conducted in 29 districts of Sindh province in Pakistan from December 2019 to January 2020. Initial data available with Sindh Health Department about locations where quacks were practicing was used to identify unlicensed practitioners. A structured questionnaire was developed which contained information about certification of practitioners and an observational checklist was developed to assess infection prevention and control practices (IPC) and injection safety. RESULTS A total of 4315 private practitioners were inspected out of which 3022 (70%) were unlicensed health practitioners belonging to different categories. Within the six surveyed divisions of Sindh, the highest proportion of unlicensed practitioners were documented in Shaheed Benazirabad division (n=739; 24.5%) followed by Hyderabad (n=599; 19.8%). In Mirpur Khas, there were 510 (16.9%), in Karachi 310 (10.3%), in Sukkur 484 (16%) and in Larkana there were 380 (12.6%) unlicensed practitioners. Poor IPC was observed in 89.4% (3861/4315) of all health providers. Reuse of syringes and intravenous drip sets was observed among 78.7% (1916/2432) of the untrained providers across the province. It was also found that 155 MBBS doctors had given their names on rent to be used as a signboard outside the clinics of some of the unlicensed practitioners. Conclusion The problem of quackery is widespread in the Sindh province. It can be proactively addressed by shutting down all unlicensed practitioners and educating the community to avoid visiting them in order to reduce the probability of exposure to unsafe healthcare practices.

The design of medical board certification examinations continues to evolve with advances in testing innovations and psychometric analysis. The potential for subjectivity is inherent in the design of oral board examinations, making improvements in reliability and validity especially important. The purpose of this quality improvement study was to analyze the impact of using two examiners on the overall reliability of the oral certification examination in physical medicine and rehabilitation.This was a retrospective quality improvement study of 422 candidates for the American Board of Physical Medicine and Rehabilitation Part II Examination in 2020. Candidates were examined by examiner pairs, each of whom submitted independent scores. Training for all 116 examiners included examination case review, scoring guidelines, and bias mitigation. Examiner performance was analyzed for both internal consistency (intrarater reliability) and agreement with their paired examiner (interrater reliability).The reliability of the Part II Examination was high, ranging from 0.93 to 0.94 over three administrations. The analysis also demonstrated high interrater agreement and examiner internal consistency.A high degree of interrater agreement was found using a new, two-examiner format. Comprehensive examiner training is likely the most significant factor for this finding. The two-examiner format improved the overall reliability and validity of the Part II Examination.