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This article proposes a blockchain-based system to address the inefficiencies of the current healthcare credentialing process that contribute to workforce shortages. Leveraging blockchains unique features, the proposed system aims to reduce time, cost, and labor, offering significant time savings, increased trustworthiness, and enhanced staffing resilience. Real-world blockchain examples demonstrate the feasibility of this approach. The study concludes that a blockchain-based credentialing system could streamline healthcare credentialing, enhance preparedness for future challenges, and improve healthcare delivery and patient outcomes.

The article stresses the importance of expanding the quality of critical care pharmacy education to ensure the provision of critical care to patients. Topics mentioned include state of the pharmacy practice, several reasons for providing inconsistent care to patients and the key steps to optimize critical care pharmacy models.

In the process of professionalization, the American Society for Bioethics and Humanities (ASBH) has emphasized process and knowledge as core competencies for clinical ethics consultants; however, the credentialing program launched in 2018 fails to address both pillars. The inadequacy of this program recalls earlier critiques of the professionalization effort made by Giles R. Scofield and H. Tristram Engelhardt, Jr.. Both argue that ethics consultation is not a profession and the effort to professionalize is motivated by self-interest. One argument they offer against professionalization is that ethics consultants lack normative expertise. Although the question of expertise cannot be resolved completely, the accusation of self-interest can be addressed. Underlying these critiques is a concern for hubris, which can be addressed in certification and the vetting of candidates. Drawing on the virtue ethics literature of Alasdair MacIntyre and Edmund D. Pellegrino, I argue that medicine is a moral community in which ethics consultants are moral agents with a duty to foster the virtue of humility (or what Pellegrino and Thomasma call self-effacement). The implications of this argument include a requirement for self-reflection in one's role as a moral agent and reflection on one's progress toward developing or deepening virtuous engagement with the moral community of medicine. I recommend that professionalization of clinical ethics consultants include a self-reflective narrative component in the initial certification and ongoing renewal of certification where clinical ethics consultants address the emotional dimensions of their work as well as their own moral development. Adopting a teleological view of ethics consultation and incorporating narratives that work toward that purpose will mitigate the self-interest and hubris of the professionalization project. [ABSTRACT FROM AUTHOR]

FLASH radiation therapy (FLASH-RT), delivered with ultrahigh dose rate (UHDR), may allow patients to be treated with less normal tissue toxicity for a given tumor dose compared with currently used conventional dose rate. Clinical trials are being carried out and are needed to test whether this improved therapeutic ratio can be achieved clinically. During the clinical trials, quality assurance and credentialing of equipment and participating sites, particularly pertaining to UHDR-specific aspects, will be crucial for the validity of the outcomes of such trials. This report represents an initial framework proposed by the NRG Oncology Center for Innovation in Radiation Oncology FLASH working group on quality assurance of potential UHDR clinical trials and reviews current technology gaps to overcome. An important but separate consideration is the appropriate design of trials to most effectively answer clinical and scientific questions about FLASH. This paper begins with an overview of UHDR RT delivery methods. UHDR beam delivery parameters are then covered, with a focus on electron and proton modalities. The definition and control of safe UHDR beam delivery and current and needed dosimetry technologies are reviewed and discussed. System and site credentialing for large, multi-institution trials are reviewed. Quality assurance is then discussed, and new requirements are presented for treatment system standard analysis, patient positioning, and treatment planning. The tables and figures in this paper are meant to serve as reference points as we move toward FLASH-RT clinical trial performance. Some major questions regarding FLASH-RT are discussed, and next steps in this field are proposed. FLASH-RT has potential but is associated with significant risks and complexities. We need to redefine optimization to focus not only on the dose but also on the dose rate in a manner that is robust and understandable and that can be prescribed, validated, and confirmed in real time. Robust patient safety systems and access to treatment data will be critical as FLASH-RT moves into the clinical trials.

Professional credentialing schemes based on experience and examination are used to clarify the scope and required competencies associated with the practice of a profession. National occupational hygiene (OH) credentials developed in 17 nations have been recognized by the International Occupational Hygiene Association (IOHA) to meet or exceed the requirements of a model certification program. To date, there is no credentialing or certification scheme for occupational hygienists in Spanish-speaking regions. To fill this void, a new credentialing body has been created named the Iberoamerican Board of Occupational Hygiene (JIHO). As a first step to the development of a certification exam for a profession, it is necessary to determine the interest in an occupational hygiene certification exam in Spanish and to clarify the most common work practices for those practicing the profession. To determine the proper exam weightings for occupational hygiene competencies needed to practice in Spanish-speaking regions JIHO conducted a comprehensive survey of professional practice of occupational hygiene in nations where Spanish is spoken as the primary language. Surveys were sent to 456 practicing occupational hygienists in nine different countries on a variety of topics. Results indicated that 79% of respondents felt the need for an OH certification exam in Spanish was very or extremely important. The most frequent and important technical competencies utilized in practice were (1) awareness about the health effects of hazardous agents to make decisions about workplace activities and exposures, (2) application of the hierarchy of controls, control banding, hazard communication, training of employees and other methods to reduce worker exposure and workplace risks, and (3) application of principles to recognize and control biohazards in the workplace. The study results have been used to guide the weighting and importance of various technical topics and rubrics on the JIHO exam. Data from this study can be used in the development of certification examinations, to improve international coherence in the profession, and the development of educational programs in OH. [ABSTRACT FROM AUTHOR]

Background: Point-of-Care Ultrasound (POCUS) consists of a range of increasingly important imaging modalities across a variety of specialties. Despite a variety of accreditation pathways available in the UK, lung POCUS training remains difficult to deliver and accreditation rates remain suboptimal. We describe a multidisciplinary, multi-centre, and multi-pronged approach to lung POCUS education within a region. Methods: A survey was conducted in a region. From these results, bottlenecks were identified for improvement. We utilised key stages in an established accreditation pathway, and the Action Learning process. Analysing participant feedback, consensus amongst the team, regional educational needs, and leveraging the expertise within the faculty, we implemented several solutions which were multidisciplinary, multi-centre, and multi-pronged. We also set up a database across several accreditation pathways to facilitate supervision and assessment of rotational trainees. Results: Utilising the Action Learning process, we implemented several improvements at elements of the lung ultrasound accreditation pathways. An initial regional survey identified key barriers to accreditation: lack of courses (52%), lack of mentors (93%), and difficulty arranging directly supervised scans (73%). A multidisciplinary team of trainers was assembled. Regular courses were organised and altered based on feedback and anecdotal educational needs within the region. Courses were set up to also facilitate continuing professional development and exchange of knowledge and ideas amongst trainers. The barrier of supervision was removed through the organisation of regular supervision sessions, facilitating up to fifty scans per half day per trainer. We collected feedback from courses and optimised them. Remote mentoring platforms were utilised to encourage asynchronous supervision. A database of trainers was collated to facilitate triggered assessments. These approaches promoted a conducive environment and a commitment to learning. Repeat survey results support this. Conclusion: Lung ultrasound accreditation remains a complex educational training pathway. Utilising an education framework, recruiting a multidisciplinary team, ensuring a multi-pronged approach, and fostering a commitment to learning can improve accreditation success. [ABSTRACT FROM AUTHOR]

Background: There is increasing global evidence on the impact of advanced nursing and midwifery practitioners, and Kenya's healthcare system has an excellent opportunity to develop scopes of practice and other regulatory frameworks for the integration of these roles. Objective: The primary purpose of this gap analysis was to explore the existing evidence on opportunities and threats toward the integration of the advanced practice nursing (APN) and advanced practice midwifery (APM) roles in Kenya's healthcare system. Methods: The study team conducted a structured electronic database search of PubMed, CINAHL, Scopus, EBSCOhost Academic Search Complete, and PsycINFO to retrieve articles and credible websites for reports highlighting the opportunities and threats toward the integration of the APN and APM roles in Kenya's healthcare systems. The retrieved articles were screened for relevance and synthesized for reporting using the traditional literature review approach. Results: The Kenya Health Policy Framework 2014–2030, growing population needs, and implementation of universal health coverage provide an opportunity to harness and leverage advanced practice roles in nursing and midwifery. There is also momentum to develop advanced practice because of strategic alliances and global evidence showing the contributions and quality of services offered by advanced practice nurses and advanced practice midwives. However, lack of financial support, structural challenges, and lack of national policies, regulations, and legislation continue to obstruct progress. Conclusion and implications for nursing policy: Developing scopes of practice for APN and APM in Kenya will benefit the professions, the country's healthcare delivery system, and the population. Achieving universal health coverage depends on a health workforce trained and practicing at optimal levels in tandem with education and training to deliver quality care. [ABSTRACT FROM AUTHOR]

Library and information science schools and their accreditations play a crucial role in preparing individuals to become effective and competent library and information professionals. A number of efforts have been undertaken to analyze the accreditation standards and procedures for library and information science professionals in a specific context (e.g. country). However, there is limited research from a global perspective. This article provides an overview of the qualifications of library and information science professionals and accreditation and certification in library and information science schools around the world. A non-probability sampling strategy was employed to collect all this information. A total of 586 programs (e.g. undergraduate) from 198 library and information science schools in 69 countries was represented. The results show that an accredited national degree was the most required credential to work as a professional librarian in the field. Master's degree programs appeared to be the most commonly offered degree programs at these schools, and English was the most popular language of instruction in all degree programs. [ABSTRACT FROM AUTHOR]

Aim Background Introduction Methods Findings Discussion Implication for nursing Implication for health policy To determine teachers’ understanding of and attitudes towards nursing education reform at four medical colleges in Kyrgyzstan.The quality of nursing education at undergraduate and postgraduate levels has a major impact on patient outcomes and the development of nursing as a profession and a science.Lower middle‐income countries have sought to advance their nursing education by adopting the experiences of high‐income countries.A mixed‐method cross‐sectional study design was used. The STROBE combined checklist was followed. A cohort of all faculty members at four colleges were included (N = 150). The questionnaire consisted of 10 groups of questions and statements. Both quantitative and qualitative data were collected.A total of 56.4% of respondents were familiar with the European approach to nurse education; 73.3% of respondents with a nursing education reported being familiar with the European approach, compared to 40.7% of respondents with a medical education. Qualitative written comments yielded 57 superscripts of codes, 14 subcategories, 5 categories and 2 themes as drivers and barriers of reform.The survey revealed weak support for the nursing education reform. Respondents do not envisage nurse education being offered at all three levels of higher education (bachelor's, master's, and PhD), and even fewer recognise nurses as leaders of healthcare institutions.Teachers in nursing programmes should mostly be nurses with academic careers.Nursing is still not recognised as an extremely important health profession that needs to be developed. This misunderstanding and negative attitude towards the role of nurses in the health care system are evident in both the quantitative and qualitative parts of the study. [ABSTRACT FROM AUTHOR]

Objective:: To review and summarize the peer-reviewed literature for Surgical Training and Research in Mesh Complications. Methods:: An international author team reviewed available published literature. Results:: This paper reviews the current training situation and recognizes there are no fellowships globally which specifically train in mesh removal/ complications. The UK has recently launched a mesh complications training pathway pilot. New Zealand has recently implemented a credentialing framework for pelvic floor procedures including mesh removal and undertaken national credentialing of surgeons. A proposed training pathway is outlined including training sequence, the training setting, and a modular pathway of training.The authors acknowledge that there is very limited research and evidence for management of mesh complications. Several important research questions are suggested for future research. Future projects for collaborative research are proposed including registries, and development of improved patient education materials for pelvic floor conditions to improve shared decision making.

Radiology and pathology, though distinct fields within medical education, share a common foundation in their essential roles for accurate diagnosis and understanding of diseases. While pathology, particularly histopathology, has long been integrated into preclinical medical education in the United States, radiology education has traditionally been less emphasized. This paper examines the historical development of histopathology training in medical education and its central role, contrasting it with the comparatively peripheral position of radiology education. We explore the historical context of medical education in the United States, tracing the integration of histopathology following the Flexner Report of 1910. In contrast, radiology, emerging later as a specialized field, has faced challenges in achieving comparable integration into medical curricula. Despite the increasing importance of medical imaging in diagnosis and treatment, radiology education remains variable and often lacking in standardization across medical schools. We highlight the need for greater emphasis on radiology education to better prepare medical students for modern clinical practice, where medical imaging plays an increasingly pivotal role. A call for a comprehensive assessment of radiology education and advocacy for its integration into preclinical curricula is made, emphasizing the importance of collaboration between the radiology profession and accrediting bodies to ensure competence in imaging across medical specialties. As medical imaging continues to advance and become more integral to healthcare, it is imperative that medical education reflects this evolution by establishing radiology as a fundamental component of preclinical training. [ABSTRACT FROM AUTHOR]

Background: Nursing home (NH) residents' vulnerability to COVID‐19 underscores the importance of infection preventionists (IPs) within NHs. Our study aimed to determine whether training and credentialing of NH IPs were associated with resident COVID‐19 deaths. Methods: This retrospective observational study utilized data from the Centers for Disease Control and Prevention's National Healthcare Safety Network NH COVID‐19 Module and USAFacts, from May 2020 to February 2021, linked to a 2018 national NH survey. We categorized IP personnel training and credentialing into four groups: (1) LPN without training; (2) RN/advanced clinician without training; (3) LPN with training; and (4) RN/advanced clinician with training. Multivariable linear regression models of facility‐level weekly deaths per 1000 residents as a function of facility characteristics, and county‐level COVID‐19 burden (i.e., weekly cases or deaths per 10,000 population) were estimated. Results: Our study included 857 NHs (weighted n = 14,840) across 489 counties and 50 states. Most NHs had over 100 beds, were for profit, part of chain organizations, and located in urban areas. Approximately 53% of NH IPs had infection control training and 82% were RNs/advanced clinicians. Compared with NHs employing IPs who were LPNs without training, NHs employing IPs who were RNs/advanced clinicians without training had lower weekly COVID‐19 death rates (−1.04 deaths per 1000 residents; 95% CI −1.90, −0.18), and NHs employing IPs who were LPNs with training had lower COVID‐19 death rates (−1.09 deaths per 1000 residents; 95% CI −2.07, −0.11) in adjusted models. Conclusions: NHs with LPN IPs without training in infection control had higher death rates than NHs with LPN IPs with training in infection control, or NHs with RN/advanced clinicians in the IP role, regardless of IP training. IP training of RN/advanced clinician IPs was not associated with death rates. These findings suggest that efforts to standardize and improve IP training may be warranted. [ABSTRACT FROM AUTHOR]

Driven by the Industry 4.0 paradigm and the resulting demand for connectivity in industrial networking, there is a convergence of formerly isolated operational technology and information technology networks. This convergence leads to attack surfaces on industrial networks. Therefore, a holistic approach of countermeasures is needed to protect against cyber attacks. One element of these countermeasures is the use of certificate-based authentication for industrial components communicating on the field level. This in turn requires the management of certificates, private keys, and trust anchors in the communication endpoints. The work at hand surveys the topic of certificate management in industrial networking environments throughout their life cycle, from manufacturing until their disposal. To the best of the authors' knowledge, there is no work yet that surveys the topic of certificate management in industrial networking environments. The work at hand considers contributions from research papers, industrial communication standards, and contributions that originate from the IT domain. In total, 2042 results from IEEE Xplore, Science Direct, Scopus, and Springer Link were taken into account. After applying inclusion and exclusion criteria and title, abstract, and full-text analysis, 20 contributions from research papers were selected. In addition to the presentation of their key contributions, the work at hand provides a synopsis that compares the overarching aspects. This comprises different proposed entity architectures, certificate management functions, involvement of different stakeholders, and consideration of life cycle stages. Finally, research gaps that are to be filled by further work are identified. While the topic of certificate management has already been addressed by the IT domain, its incorporation into industrial communication standards began significantly later and is still the subject of research work. [ABSTRACT FROM AUTHOR]

Background "Prejuvenation," a practice gaining enormous popularity among younger adults, can largely attribute its explosive growth to TikTok, the platform on which many first encounter this trend. Despite the rising usage of prejuvenation, however, there is a lack of clarity regarding its clinical practice and efficacy. Objectives To investigate the understandability, reliability, and actionability of prejuvenation-related TikTok content. Methods TikTok was queried using 13 hashtags consisting of popular colloquial terms associated with prejuvenation treatments, and the top 25 videos meeting inclusion criteria for each hashtag were analyzed. For each video, poster credentials and video type were determined. Videos considered "educational" were analyzed using the validated modified DISCERN score and the Patient Education Materials Assessment Tool scales. Creator's prejuvenation recommendations were recorded. Univariate and linear regression models were utilized for analysis. Results A total of 303 videos amassed over 61,000,000 million views, 3,957,091 likes, 24,455 comments, and 71,697 shares. Nonphysicians posted the most videos (n = 257, 84.8%) and had significantly higher median views, likes, comments, and engagement than physician videos. Analysis of "educational" videos showed that most videos (50, 67%) supported the use of prejuvenation treatments, 18 (24%) were neutral, and 6 (8%) were opposed. Conclusions Prejuvenation content on TikTok varies widely in terms of quality and recommendations, calling for more standardization regarding the practice. Physician-generated prejuvenation content was more reliable, but distinguishing it from nonphysician content was challenging, underscoring the need for platform-specific verification tools. [ABSTRACT FROM AUTHOR]

Background: The use of extracorporeal membrane oxygenation (ECMO) has grown rapidly over the past decades because of evolving indications, advances in circuit technology, and encouraging results from modern trials. Because ECMO is a complex and highly invasive therapy that requires a multidisciplinary team, optimal education, training, and credentialing remain a challenge. Objective: The primary objectives of this study were to investigate the prevalence and application of ECMO education and ECMO practitioner credentialing at ECMO centers globally. In addition, we explored differences among education and credentialing practices in relation to various ECMO center characteristics. Methods: We conducted an observational study of ECMO centers worldwide using a survey querying participants in two major domains: ECMO education and ECMO practitioner credentialing. Of note, the questionnaire included ECMO program characteristics, such as type and size of hospital and ECMO experience and volume, to explore the association with the two domains. Results: A total of 241 (32%) of the 732 identified ECMO centers responded to the survey, representing 41 countries across the globe. ECMO education was offered at 221 (92%) of the 241 centers. ECMO education was offered at 105 (98.0%) high–ECMO volume centers compared with 136 (87.5%) low–ECMO volume centers (P = 0.005). Credentialing was established at 101 (42%) of the 241 centers. Credentialing processes existed at 52 (49.5%) high–ECMO volume centers compared with 51 (37.5%) low–ECMO volume centers (P = 0.08) and 101 (49.3%) Extracorporeal Life Support Organization centers compared with 1 (2.7%) non–Extracorporeal Life Support Organization center (P < 0.001). Conclusion: We found significant variability in whether ECMO educational curricula are offered at ECMO centers. We also found fewer than half of the ECMO centers surveyed had established credentialing programs for ECMO practitioners. Future studies that assess variability in outcomes among centers with and without standardized educational and credentialing practices are needed. [ABSTRACT FROM AUTHOR]

Background The 'WHO-ASPHER Roadmap to Professionalizing the Public Health Workforce in the European Region' provides recommendations for strategic and systematic workforce planning around professionalization levers including: (i) competencies, (ii) training and education, (iii) formal organization, (iv) professional credentialing and (v) code of ethics and professional conduct as well as taxonomy and enumeration. It was based on a literature review till 2016. This scoping review aims to explore how the professionalization was documented in the literature between 2016 and 2022. Methods Following the Joanna Briggs Institute guidelines, we searched Medline via PubMed, Web of Science, ERIC via EBSCO and Google Scholar and included studies on professionalization levers. Four critical appraisal tools were used to assess qualitative, quantitative, mixed methods studies and grey literature. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) was used for reporting. Results Eleven articles included in this review spanned 61 countries, targeting undergraduate, master's, doctoral degrees and continuing professional development. Most of these documents were reviews. About half provided a definition of the public health workforce; more than half covered the taxonomy and included information about competences, but the use of frameworks was sporadic and inconsistent. Formal organization and the necessity of a code of conduct for the public health workforce were acknowledged in only two studies. Conclusions In spite of some efforts to professionalize the public health workforce, this process is fragmented and not fully recognized and supported. There is an urgent need to engage policymakers and stakeholders to prioritize investments in strengthening the public health workforce worldwide. [ABSTRACT FROM AUTHOR]

Purpose: The O-(2-[18F]-fluoroethyl)-l-tyrosine (FET) PET in Glioblastoma (FIG) trial is an Australian prospective, multi-centre study evaluating FET PET for glioblastoma patient management. FET PET imaging timepoints are pre-chemoradiotherapy (FET1), 1-month post-chemoradiotherapy (FET2), and at suspected progression (FET3). Before participant recruitment, site nuclear medicine physicians (NMPs) underwent credentialing of FET PET delineation and image interpretation. Methods: Sites were required to complete contouring and dynamic analysis by ≥ 2 NMPs on benchmarking cases (n = 6) assessing biological tumour volume (BTV) delineation (3 × FET1) and image interpretation (3 × FET3). Data was reviewed by experts and violations noted. BTV definition includes tumour-to-background ratio (TBR) threshold of 1.6 with crescent-shaped background contour in the contralateral normal brain. Recurrence/pseudoprogression interpretation (FET3) required assessment of maximum TBR (TBRmax), dynamic analysis (time activity curve [TAC] type, time to peak), and qualitative assessment. Intraclass correlation coefficient (ICC) assessed volume agreement, coefficient of variation (CoV) compared maximum/mean TBR (TBRmax/TBRmean) across cases, and pairwise analysis assessed spatial (Dice similarity coefficient [DSC]) and boundary agreement (Hausdorff distance [HD], mean absolute surface distance [MASD]). Results: Data was accrued from 21 NMPs (10 centres, n ≥ 2 each) and 20 underwent review. The initial pass rate was 93/119 (78.2%) and 27/30 requested resubmissions were completed. Violations were found in 25/72 (34.7%; 13/12 minor/major) of FET1 and 22/74 (29.7%; 14/8 minor/major) of FET3 reports. The primary reasons for resubmission were as follows: BTV over-contour (15/30, 50.0%), background placement (8/30, 26.7%), TAC classification (9/30, 30.0%), and image interpretation (7/30, 23.3%). CoV median and range for BTV, TBRmax, and TBRmean were 21.53% (12.00–30.10%), 5.89% (5.01–6.68%), and 5.01% (3.37–6.34%), respectively. BTV agreement was moderate to excellent (ICC = 0.82; 95% CI, 0.63–0.97) with good spatial (DSC = 0.84 ± 0.09) and boundary (HD = 15.78 ± 8.30 mm; MASD = 1.47 ± 1.36 mm) agreement. Conclusion: The FIG study credentialing program has increased expertise across study sites. TBRmax and TBRmean were robust, with considerable variability in BTV delineation and image interpretation observed. [ABSTRACT FROM AUTHOR]

Background and purpose: The [18]F-fluoroethyl-l-tyrosine (FET) PET in Glioblastoma (FIG) study is an Australian prospective, multi-centre trial evaluating FET PET for newly diagnosed glioblastoma management. The Radiation Oncology credentialing program aimed to assess the feasibility in Radiation Oncologist (RO) derivation of standard-of-care target volumes (TVMR) and hybrid target volumes (TVMR+FET) incorporating pre-defined FET PET biological tumour volumes (BTVs). Materials and methods: Central review and analysis of TVMR and TVMR+FET was undertaken across three benchmarking cases. BTVs were pre-defined by a sole nuclear medicine expert. Intraclass correlation coefficient (ICC) confidence intervals (CIs) evaluated volume agreement. RO contour spatial and boundary agreement were evaluated (Dice similarity coefficient [DSC], Jaccard index [JAC], overlap volume [OV], Hausdorff distance [HD] and mean absolute surface distance [MASD]). Dose plan generation (one case per site) was assessed. Results: Data from 19 ROs across 10 trial sites (54 initial submissions, 8 resubmissions requested, 4 conditional passes) was assessed with an initial pass rate of 77.8 %; all resubmissions passed. TVMR+FET were significantly larger than TVMR (p

Abstract Introduction The increasing popularity of robotic assisted surgery (RAS) as it is implemented in to sub specialities poses many challenges to ensuring standards in quality and safety. The area of Reconstructive and Functional Urology (RFU) has a wide range and largely complex heterogeneous procedures. In recent years RFU has started to incorporate RAS as the primary method to undertake these procedures due to improved vision, dexterity, and access to deep cavities. To ensure patient safety majority of institutions maintain minimal requirements to operate using RAS however across specialities and institutions these greatly vary. Methods A narrative review of all the relevant papers known to the author was conducted. Results Specific challenges facing RFU is the inability to rely on case numbers as a surrogate means to measure competency as well the ongoing consideration of how to differentiate between surgeons with robotic training and those with the clinical experience specific to RFU. Conclusion This review explores current models of training and credentialling and assess how it can be adapted to suggest a standardised guideline for RFU to ensure the highest standards of patient care.

Dental academia in Pakistan has recently achieved an important milestone. The name of Operative Dentistry speciality has been changed to Operative Dentistry & Endodontics (ODE). It was a much-needed change that was first felt about two decades ago. However, with the correction of name, there are certain challenges that this speciality has to manage now. These include improving the curriculum, setting up standards, and lastly, setting up its boundaries and scope of practice as some of its scope overlaps with a sister speciality called Prosthodontics. This overlapping of the boundaries of dental disciplines is a problem that is unique to Pakistan, India, and some East Asian countries where Operative Dentistry or Conservative Dentistry is combined with Endodontics. This paper aims to discuss the objective delineation of dental procedures and suggest a model of peaceful co-existence of sister dental specialities. Keywords: Scope-of-practice regulation, Appointment, Credentialing, Group practice.

Background: In April 2020, pharmacists were added as medical providers under Idaho Medicaid in response to recent scope expansion for pharmacists and to increase beneficiaries' access to coronavirus disease 2019 (COVID-19) testing and services. The COVID-19 pandemic prompted expedited Medicaid enrollment for pharmacists but did not address coverage of medical services provided to privately insured individuals for pharmacy-based testing services. Objective: This study aimed to describe processes used by independently owned, community-based pharmacies in Idaho to credential with private insurers and report outcomes. Methods: Relevant information and forms required to credential with the four major payers in the state of Idaho were collected. Packets were obtained via medical insurers' websites and by direct contact. Questions that arose from community pharmacists during the submission process were collected and answered on a shared spreadsheet, and insurance representatives were contacted directly to resolve questions. Results: Eight out of 13 participating pharmacies submitted an average of three credentialing packets for their facilities. Thirty-five pharmacists also submitted an average of four credentialing packets for themselves. As of mid-May 2021, nearly 20 weeks after submission, only 67 out of 129 pharmacists had received word regarding the status of their applications. Less than half of all pharmacist applications were approved (after their first attempt). Conclusion: Efforts to support the education of both pharmacists and medical insurers may streamline the credentialing processes in the future. [ABSTRACT FROM AUTHOR]

Aim: To explore contextual literature on nursing and midwifery education, regulation and workforce in Kenya to develop an understanding of the current state and inform opportunities to strengthen the nursing and midwifery professions. Introduction: Kenya has yet to achieve the minimum nursing and midwifery workforce threshold, despite the exponential increase in population and epidemiologic disease transitions. Background: There are glaring health gaps and inequities in sub‐Saharan African countries. Health systems are evolving into complex and costly utilities, increasing the demand for nurses and midwives. It is, therefore, necessary to re‐examine systems that educate, deploy and retain the nursing workforce, especially given the ongoing COVID‐19 pandemic and increase in non‐communicable diseases. Methods: This scoping review was guided and reported following the PRISMA‐ScR guidelines. Four electronic databases (PubMed, Scopus, CINAHL and Web of Science) were probed for relevant studies conducted in Kenya between 1963 and 2020. The search was supplemented using Google Scholar. Findings from selected studies were extracted and analysed thematically. Results: Of the 238 retrieved studies, 37 were included in this review: 10 articles on nursing and midwifery education, 11 on regulation and 16 on the workforce. Discussion: There have been changes in regulation and an increase in nursing and midwifery enrolment and graduates. However, maldistribution and shortage of nurses and midwives persist. Conclusions: Kenya's nursing and midwifery professions have undergone significant changes to meet the demand for a skilled workforce. However, the shortage of qualified and specialised nurses and midwives persists. Moreover, this shortage is exacerbated by underinvestment, outmigration and a need for more reforms to expand the nursing and midwifery workforce. Implication for nursing and midwifery policy: Investment in nurse and midwifery education, mentorship and legislation is needed to build the capacity of the profession to provide quality health services. Several nursing and midwifery policy changes utilising a multipronged approach involving stakeholders' collaboration are suggested to address the bottlenecks from education to deployment. [ABSTRACT FROM AUTHOR]

The American Board of Toxicology (ABT), in consultation with ACT Credentialing & Career Services (ACT), performed a practice analysis study of general toxicology in 2020-21. This work follows up on an initial practice analysis commissioned by the ABT and conducted in 2014-2015, results of which were published in 2016. The purpose of the current, second-generation study was to update and validate the existing process-based delineation of practice of general toxicologists, including major domains of responsibility and tasks performed in practice. In addition, the study included the review, update, and validation of the knowledge areas required by toxicologists developed by subject-matter experts (SMEs) that have been used for ABT examination development initiatives. Consistent with best practices in the field of credentialing, ABT also contracted with ACT to conduct 2 follow-on activities: a study to evaluate the reliability of a reduced-length ABT examination and a standard setting study to establish a valid passing score for the updated examination. In addition to informing ongoing ABT certification examination and question writing activities, it is anticipated that the results of this practice analysis will be of value to those responsible for developing graduate and undergraduate toxicology curricula, creating continuing education content, and authoring textbooks covering the contemporary practice of toxicology. [ABSTRACT FROM AUTHOR]

To identify the challenges and common issues that the rehabilitation health workforce experienced in delivering services in different practice settings across the world. These experiences could suggest approaches to improving rehabilitation care to people in need. A semi-structured interview protocol centering on 3 broad research questions was conducted to collect data. The data were analyzed to identify common themes across the cohort interviewed. Interviews were conducted using Zoom. Interviewees not able to access Zoom provided written responses to the questions. Participants included 30 key rehabilitation opinion leaders from different disciplines from 24 countries, across world regions and income levels (N=30). NA. Although rehabilitation care deficiencies differ in severity, participants reported that the demand for services consistently outstrips available care, regardless of world region or income level. Access and social barriers, particularly in rural areas and remote regions, are common challenges for those delivering and receiving rehabilitation care. Individual voices from the field reported both challenges and hopeful changes in making rehabilitation services available and accessible. The descriptive approach undertaken has allowed individual voices, rarely included in studies, to be highlighted as meaningful data. Although the research findings are not generalizable beyond the convenience cohort included without further analysis and validation in specific local practice contexts, the authentic voices that spoke out on these issues demonstrated common themes of frustration with the current state of rehabilitation services delivery but also hopefulness that more solutions are on the horizon. [ABSTRACT FROM AUTHOR]

An updated position paper on critical care pharmacy services recommends the development of new clinical programs. However, proposed pragmatic strategies for critical care pharmacy practice advancement are lacking. The purpose of this position paper is to develop consensus recommendations aimed at direct patient care activities for the advancement of critical care pharmacy practice. A 24‐member task force of critical care pharmacists, physicians, and nurses participated in a Recommendation Development Phase and Consensus‐building Phase (using a Delphi method) to produce the final critical care practice advancement recommendations. Proposed recommendations of pragmatic medication management opportunities with an advanced scope of practice involving pharmacist prescriptive authority for initiating, modifying, or discontinuing drug therapy and medication monitoring were developed. Task force participants anonymously voted on each proposed recommendation using a five‐point Likert scale (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). Recommendations failing to achieve consensus (≥70% agreement on "strongly agree"/"agree" votes) were revised for subsequent voting. Task force response rates during the first and second voting rounds were 71% (n = 17) and 79% (n = 19), respectively. A total of 57 (93.4%) of the 61 proposed practice advancement recommendations achieved consensus of which 88.5% (n = 54) met consensus after the first round. Consensus recommendations involved the critical care pharmacist initiating (n = 15), modifying (n = 22), or discontinuing (n = 9) drug therapy, and ordering relevant laboratory values or tests to optimize drug therapy (n = 11). One recommendation failing consensus was not revised for additional voting given the impracticality of achieving agreement. Fifty‐seven of the proposed 61 recommendation statements (93%) achieved the consensus threshold after two rounds of voting by an interprofessional expert panel. These recommendations provide a conceptual framework for promoting novel critical care pharmacist prescriptive authority over specific aspects of direct patient care. Implementation challenges and barriers, further described in this paper, must be explored at the institutional level for acceptance. [ABSTRACT FROM AUTHOR]

Background: Since 2015, the College of Family Physicians of Canada has certified enhanced skills in palliative care (PC) with a certificate of added competence. Aim: This study aimed to describe the ways family physicians with enhanced skills in PC contribute within their communities, the factors that influence ways of practicing, and the perceived impacts. Design: Secondary analysis of data from a multiple case study on the role and impacts of family physicians with enhanced skills (i.e., PC physicians) was undertaken. Setting/Participants: Interviews were conducted in 2018 to 2019 with PC and generalist family physicians and residents associated with six family medicine practice cases across Canada. An unconstrained qualitative content analysis was performed. Results: Twenty-one participants (nine PC physicians, five generalist family physicians, two residents, and five physicians with enhanced skills in other domains) contributed data. PC physicians worked by enhancing their own family practice or as focused PC physicians. Roles included collaborating with other physicians through consultations, comanaging patients (shared care), or assuming care of the patient as the main provider (takeover). PC physicians increased capacity among their colleagues, with some patient care and education activities not being remunerated. Funding models and other structures were perceived as incentivizing the takeover model. Conclusion: Family physicians with enhanced skills in PC contribute to comprehensive care through the end of life. Remuneration should support system capacity and relationships that enable family physicians to provide primary PC especially outside the takeover model.

Driven by the Industry 4.0 paradigm and the resulting demand for connectivity in industrial networking, there is a convergence of formerly isolated operational technology and information technology networks. This convergence leads to attack surfaces on industrial networks. Therefore, a holistic approach of countermeasures is needed to protect against cyber attacks. One element of these countermeasures is the use of certificate-based authentication for industrial components communicating on the field level. This in turn requires the management of certificates, private keys, and trust anchors in the communication endpoints. The work at hand surveys the topic of certificate management in industrial networking environments throughout their life cycle, from manufacturing until their disposal. To the best of the authors’ knowledge, there is no work yet that surveys the topic of certificate management in industrial networking environments. The work at hand considers contributions from research papers, industrial communication standards, and contributions that originate from the IT domain. In total, 2042 results from IEEE Xplore, Science Direct, Scopus, and Springer Link were taken into account. After applying inclusion and exclusion criteria and title, abstract, and full-text analysis, 20 contributions from research papers were selected. In addition to the presentation of their key contributions, the work at hand provides a synopsis that compares the overarching aspects. This comprises different proposed entity architectures, certificate management functions, involvement of different stakeholders, and consideration of life cycle stages. Finally, research gaps that are to be filled by further work are identified. While the topic of certificate management has already been addressed by the IT domain, its incorporation into industrial communication standards began significantly later and is still the subject of research work.

We examine how signals of a candidate's capability affect perceptions of that person's commitment to an employer. In four experimental studies that use hiring managers as subjects, we test and show that managers perceive highly capable candidates to have lower commitment to the organization than less capable but adequate candidates and, as a result, penalize high-capability candidates in the hiring process. Our results show that managers have concerns about a high-capability candidate's future commitment to the organization because they view highly capable candidates as having lower levels of organizational interest—meaning they care less about the mission and values of the organization and exert a lower level of effort toward those ends—and because they assume highly capable candidates have more outside job options, increasing their flight risk. Our findings highlight that capability signals do not necessarily afford candidates an advantage in selection, suggesting an upper limit on credentials and other signals of capability in helping candidates get jobs. Our study contributes to research on labor markets, human capital, and credentialing by offering a theory for why and when capability signals can negatively influence job candidate selection decisions. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the current scope of practice of sonographers in the United States and ascertain if sonographers' daily responsibilities align with the Society of Diagnostic Medical Sonography's (SDMS) Sonographer's Scope of Practice and Clinical Standards. Materials and Methods: A survey was disseminated to SDMS members and clinical sonographers with at least 5 years experience. The survey addressed demographics, education, certification, specialties practiced, job title, work environment, and scope of practice. Results: Of the 613 sonographers who responded, 90% were female and 10% male; the most common age group was 55–64 (36.7%). Most sonographers had a Bachelor's or Associate's degree. Eighty-three percent of respondents were White, 5.4% Hispanic, Latino, or Spanish origin, 3% Black or African American, and 3% Asian. While 63% of sonographers have read the SDMS Scope of Practice, 52% reported they perform tasks not included or addressed, in their job description. Many teach sonography in the workplace and provide oral and/or written preliminary impressions and diagnoses. Conclusion: There are regional differences in scope of practice and gender differences in place of employment and job title. Sonographers reported to practice within the SDMS parameters. The guidelines can be expanded to include educating health professionals in sonography and having an increased role in providing diagnoses. [ABSTRACT FROM AUTHOR]

Purpose This article highlights one academic medical center's effort to implement a complete credentialing and privileging (C&P) process for both inpatient and ambulatory clinical pharmacists. Summary The C&P process offers a recognized method to advance pharmacy practice. Credentialing is defined as a process whereby an individual is deemed qualified in a specific subject matter area. Privileging is the process whereby an institution grants authority to an individual to perform services based on credentials. Federal guidelines permit pharmacists to obtain the same level of privileges as professional medical staff, such as physicians, if relevant state laws allow for the corresponding pharmacist scope of practice. States establish laws and regulations that specify the scope of practice for various types of licensed healthcare professionals, including pharmacists. Many health systems have attempted pharmacist C&P practices in both the inpatient and ambulatory care setting with varying degrees of success and reach. Privileged pharmacists provide established benefits and value to other members of the healthcare team. Oregon Health & Science University (OHSU) pursued C&P for both inpatient and ambulatory clinical pharmacists. Initiation and implementation processes were complex and accompanied by a variety of challenges. Conclusion OHSU operates with advanced pharmacy practice integrated into the interdisciplinary patient care team. Pharmacist C&P allows pharmacists to demonstrate significant clinical benefits and quality improvement in patient care delivery in both inpatient and ambulatory settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Migrating to Australia to work as a midwife can be challenging, particularly for those from non-English speaking backgrounds, since they must achieve strict qualification standards, English language skills, and professional competence to be eligible for registration. AIM: The purpose of this study was to explore the registration experiences of Middle Eastern-qualified midwives in Australia. METHODS: Multiple case narrative study, underpinned by structuration theory, involving 19 Middle Eastern-qualified midwives from different states of Australia. Individual semi-structured interviews were conducted between November 2020 and September 2021 and digitally recorded and then transcribed. Transcriptions were analyzed in three stages, with categories generated in the second stage and core categories developed in the third. RESULTS: This study found that Middle Eastern-qualified midwives' registration experiences were significantly impacted by evolutions in policies in Australia. The accounts of participants who applied for registration at varying stages suggested the process became more complicated over time. Overall, four categories emerged with varying prominence from the accounts of participants who applied for registration at different times including: language barrier, variation in the process, inadequate orientation, and misdirection. Systemic issues were identified as significant barriers to the registration of Middle Eastern-qualified midwives in Australia. CONCLUSION: With Australia's reliance on internationally qualified midwives, strategies should be developed to identify the language support, appropriate orientation, and regulatory adjustment necessary to reduce the underutilization of Middle Eastern-qualified midwives. [ABSTRACT FROM AUTHOR]

The Federal Bureau of Prisons clinical skills training development (CSTD) team accomplished the planning, creation, and execution of a first-ever national clinical skills assessment program (CSAP) for nurses and advanced practice providers (APPs). Clinical skills assessment is a part of nurse and APP credentialing and privileging and must be completed for new hires along with continued biennial recredentialing accreditation standards. A training resource manual, discipline-specific skills checklist, pre-/postprogram written examination, and standard operating procedures were created. The CSTD team used commercially available manikins, food items, and easily obtainable office supplies for simulated experiential skills assessments. The CSAP provided a consistent, reproducible, and scalable approach for the orientation, assessment, and, if indicated, remediation for correctional nurses and APPs. [ABSTRACT FROM AUTHOR]

Lack of access to birth facilities and maternity care providers has contributed to rising US maternal mortality and morbidity rates, especially among women in rural areas. Evidence supports the increased use of midwives as a potential solution for access-to-care issues. This observational survey was conducted to identify the practice environment for Certified Nurse-Midwives® in Colorado for the purpose of informing future workforce expansion. Study results indicate that midwives provide services aligned with the midwifery model of care and have mostly autonomous practice in hospitals where midwifery practices are already established. However, there is limited use of midwives, as fewer than half of Colorado's 69 birthing hospitals have midwifery practices, and financial constraint created by low Medicaid reimbursement could be a limiting factor in establishing new midwifery practices. Policy recommendations based on survey results include (a) support for midwifery education and workforce development, (b) removal of hospital-level restrictions for privileges of midwives, and (c) consideration for public payment models that promote expansion of midwifery practices. [ABSTRACT FROM AUTHOR]

The current credentialing and privileging (C&P) climate has evolved due to a risk reduction/management awareness of increased institutional legal liability. This recognition affects dental colleges and has caused the implementation of C&P processes. Contemporary best practices for methods, processes, and structure are reported here. Data reported from the process show how and what clinicians' red flags were discovered during the process. Conclusions include the following: C&P is a significant process to introduce in terms of institutional resources and commitment. This process includes increased clinician and administrative burden that needs to have a governor. Attention to experiences of other institutions can reduce but not eliminate challenges from the clinician and some administrators. A primary data‐based verification process administered by a credentialing specialist can make the process valid and workable. [ABSTRACT FROM AUTHOR]

Healthcare credentialing plays a vital role in ensuring the competence and integrity of healthcare professionals. However, the current credentials verification process suffers from time-consuming procedures due to the large number of intermediaries, limited information access, data fragmentation and the persistent risk of fraudulent credentials, leading to delayed hiring, increased administrative burden, and loss of trust and reputation in the healthcare system. In this paper, we utilize blockchain technology to enhance the credentialing process by streamlining the verification steps, improving data security, and providing stakeholders with confidence through secure storage of credentials. In addition, we utilize advanced security techniques, such as proxy re-encryption and cryptographic algorithms, to ensure the protection of sensitive data, facilitate secure communication, and prevent unauthorized access. We develop smart contracts which eliminate the need for intermediaries, automate the verification process, and enhance transparency and data integrity. We present system architecture, sequence diagrams, entity relationship diagrams, and the underlying algorithms of our blockchain-based solution. We discuss how our proposed solution attains the objectives outlined in the paper. We conduct cost evaluation and security analysis to validate the effectiveness of our solution. Additionally, we compare our proposed system with existing blockchain-based solutions, highlighting its novelty. The code of our smart contracts is made publicly available on GitHub.

Introduction: The African Federation of Emergency Medicine (AFEM) recommends the use of emergency point-of-care ultrasound (ePOCUS) as a core skill for health care practitioners in Africa. The study explored the use of ePOCUS by health care practitioners among AFEM members who work across Africa. Methods: An anonymous online survey was distributed to individual members of AFEM and affiliated organisations. The questionnaire was tested by the AFEM Scientific Committee for potential content modifications prior to distribution. Summary statistics are presented. Results: Of the 220 participants that were analysed, 148 (67.3%) were using ePOCUS. The mean age was 36 years; 146 (66%) were male; and 198 (90%) obtained their primary medical qualification in Africa. In total, 168 (76%) were doctors, and most participants (n = 204, 93%) have worked in Africa during the last 5 years. Reasons for not using ePOCUS mainly related to lack of training and problems with ultrasound machines or consumables. Most ePOCUS users (116/148, 78%) attended courses with hands-on training, but only 65 (44%) participants were credentialed (by 18 different organizations). The median score for self-perceived level of ePOCUS skills was 75 in credentialed users versus 50 in those that were not credentialed. Ultrasound in trauma was the most frequently used module (n = 141, 99%), followed by focused cardiac assessment (n = 128, 90%) and thoracic (including lung) assessment (n = 128, 90.1%). The FASH-module (Focused Assessment with Sonography for HIV/TB) was the least used (n = 69, 49%). Conclusion: Access barriers to ePOCUS training, mentorship, equipment and consumables are still relevant in Africa. The low credentialing rate and the potential discordance between local burden of disease and ePOCUS training requires further investigation.

The Institute of Medicine defines health care quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. However, defining which are the desired outcomes and current professional knowledge can be controversial. In this review article the effectiveness of quality assurance is reviewed along with pointing out some of the dangers to physicians. Since deficient quality assurance can affect credentialing, solutions for the problem are offered including an independent medical staff and election rather than appointment of the chief of staff. Solutions to expedite and ensure accuracy in credentialing are offered including use of the Interstate Medical Licensure Compact (IMLC). These solutions should lead to improved and fairer quality assurance, reduced administrative expenses, decreased fraud, and modernization of physician licensing and credentialing.

To describe differences in perioperative RN job satisfaction by specialty certification status. A retrospective, exploratory, cross-sectional design. We conducted a secondary analysis of annual data from the National Database of Nursing Quality Indicators (NDNQI) RN Survey with 12 Job Satisfaction Scales. The sample consisted of 776 perioperative units in 206 hospitals with 13,061 study participants. We used multilevel mixed modeling to examine differences in job satisfaction for nurses holding CAPA (Certified Ambulatory Perianesthesia Nurse), CPAN (Certified Post Anesthesia Nurse), CNOR (certification for perioperative registered nurses), CRNFA (Certified RN First Assistant), other specialty certification, and not specialty certified. Twelve percent of RN participants held a perioperative nursing certification (CAPA, CPAN, CNOR, CRNFA), 15% held other nursing specialty certifications, and 73% were not certified. Regardless of certification status, nurses were the most satisfied with nurse-nurse interactions and task. They were the least satisfied with nursing administration, decision-making, and pay. CNOR certified nurses reported the lowest levels of job satisfaction in the study. CAPA and CPAN certified nurses reported higher job satisfaction than their noncertified colleagues on multiple job satisfaction scales (ie, CAPA 10 of 12; CPAN 5 of 12). CNOR certified nurses did not report meaningful differences in job satisfaction from non-certified nurses. As job satisfaction impacts retention, productivity, and patient care quality, our findings have important implications for hospital leaders, nurses, and health care consumers. Based on our findings, we identified nursing professional development as a potential gap in job satisfaction that leaders can target for improvement. Our findings suggest that higher specialty nursing certification rates in perianesthesia nurses may potentially improve job satisfaction and retention of nurses. [ABSTRACT FROM AUTHOR]