Assisted infant toilet training: A pathway to planetary health?

The occupational therapy profession in the United States is in crisis. This is not a new phenomenon in occupational therapy's history; we have previously experienced two crises, in the 1940s and 1970s. Crises arise when the current professional paradigm insufficiently addresses occupational therapy practice challenges. Similar to the past, there are issues in society, health care, and the profession prompting this identity crisis. Occupational therapy practitioners no longer have a consensus about the field's theoretical base, view of humans, and scope of practice. By calling attention to this crisis, we hope to awaken occupational therapy practitioners to actively decide the future of our profession.

The physician associate (PA) profession was introduced in Switzerland through an informal hospital-based training program in 2014. In 2016, a formal education process was instituted at Zurich University of Applied Sciences (ZHAW) Institute of Public Health. ZHAW remains the only university with a PA curriculum in Switzerland. Presently, PAs are trained through a multi-tiered certification program with an option to complete a master's degree. Approximately 300 PAs practice in Switzerland as of 2025. As the number of PAs steadily increases, professional organizations, academic institutions, medical leaders, and Swiss authorities are working to develop policies for governance of the PA profession and to establish consistent expectations for PA education, training, and scope of practice.

The debate about whether health visiting, a specialist community public health nursing role, is at the level of advanced practice nurse has gone on for more than a decade. There is little empirical evidence that the role matches the traditional role of an advanced practice nurse, although many of the attributes of advanced practice nursing such as prescribing rights, managing complex cases, caseloads with undifferentiated need and advanced assessment and decision-making are certainly present. The current study aimed to develop, refine and test the Health Visiting Advanced Practice Scale to assess the scope of advanced practice of UK health visitors. A cross-sectional and methodological scale validation design, following classical test theory. The design consisted of three phases; the first involved scale development including item generation, phase two assessed the content validity index, and the third phase involved a cross-sectional survey to establish construct validity, content validity, and internal consistency reliability, and conduct exploratory and confirmatory factor analysis. The initial 44-item scale underwent iterative exploratory and confirmatory factor analyses, leading to a refined 5-factor structure with 29 items covering domains such as family-centred care, leadership, prescribing, diagnostic reasoning, and professional practice. This final version demonstrated strong reliability and construct validity in the EFA but mixed fit indices in the CFA, supporting both internal consistency and validity of the scale. The final scale offers a rigorously validated tool for assessing advanced practice among UK health visitors, capturing core domains such as family-centred care, leadership, prescribing, and diagnostic reasoning. By bridging theoretical frameworks with real-world practice, it fills a critical gap in evaluating and supporting the professional scope of this public health nursing specialty. These findings provide valid and reliable insights for measuring and improving health visitors' advanced practice and developing future professional policies. No patient or public contribution. STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies.

Occupational and environmental health (OEH) encompasses occupational and environmental medicine and OEH nursing. Nurse practitioners specializing in OEH (OEHNPs) assess and mitigate occupational hazards, thereby promoting health and safety among workers, drawing on advanced knowledge and skills. This review had a two-fold aim: (1) to determine whether core competencies for OEHNPs practicing in the United States exist; and (2) to identify relevant occupational and environmental medicine and OEH nursing core competencies for the future development of OEHNP core competencies. An integrative review was conducted in accordance with Whittemore and Knafl's five-step process and the PRISMA guidelines. Peer-reviewed literature published in the United States within the last 50 years was searched across five databases. Of the 31 articles included, 22 were OEH nursing-focused, seven were occupational and environmental medicine-focused, and two were nurse practitioner-focused. The OEH nursing articles addressed topics essential to OEH nursing practice, as well as standards of practice and core competencies. The occupational and environmental medicine literature addressed practice guidance, with core competencies periodically updated to reflect evolving practice. Lastly, the nurse practitioner articles focused on entry-level, general nurse practitioner core competencies. No articles explicitly identified core competencies for OEHNPs. Evidence establishes the need to develop specific core competencies that reflect the advanced scope of practice, clinical decision-making, and autonomy of OEHNPs. Employing a consensus-driven approach to agree upon a preliminary set of core competencies for OEHNPs would support role delineation, inform OEHNP education and certification, and ensure quality OEH care.

People with rheumatic and musculoskeletal diseases (RMDs) can acquire disabilities that affect their participation in work and school. Generative artificial intelligence (genAI) may reduce documentation time, providing a tool for providers to efficiently write letters for accommodation and maximally advocate for people with disabilities. Therefore, fellows-in-training (FITs) must develop skills in disability advocacy and genAI for clinical care. We created an online module and simulation activity in which FITs wrote letters for accommodation using genAI. We aimed to improve FITs' confidence implementing these skills and to identify areas needing further instruction. FITs completed an online module and simulation activity engineering genAI prompts for letters for accommodation. Educators scored FITs' skills against a rubric. FITs measured their confidence conducting these skills in retrospective pre-post Likert scales that we compared with Wilcoxon signed rank tests. Twenty-three FITs participated; 18 FITs (78.6%) completed the Likert scales. On average, FITs scored 83.83% against the rubric. The strongest skill was engineering genAI prompts (95.45%), and the lowest was differentiating the scope of practice between rheumatology providers and disabilities professionals coordinating accommodations (74.55%). FITs' confidence significantly improved across all objectives, most notably in engineering genAI prompts and finalizing letters drafted with genAI (P < 0.0001). Our educational materials teach FITs to incorporate genAI into writing letters for accommodation and addressing disparities from medical disabilities. Such skill development prepares FITs to enter the rheumatology workforce confident in their abilities to integrate genAI into clinical activities and deliver care to people with disabilities from RMDs.

Quantum mechanical methods for modeling hydrogen atom transfer by halogen reactions were systematically tested against experimental activation energies and regioselectivity data from modern synthetic organic reactions reported in the literature. For the practical and reliable predictions aimed at elucidating mechanisms or determining selectivity, an accurate description of saddle point energetics is critical, outweighing the benefits of explicit dynamical treatments or higher-level geometry optimizations. Among the methods evaluated, DLPNO-CCSD(T) single-point energies computed on M06-2X geometries achieve a practical predictive accuracy, with a mean absolute error of 0.6 kcal/mol in ΔΔG‡. This is sufficient for predicting regioselectivity and assessing whether photoredox reactions proceed via HAT by free halogen atoms. The protocol delivers performance comparable to higher-level ab initio approaches using MP2 geometries, as well as to variational transition state theory treatments incorporating dynamical corrections, while maintaining computational efficiency. Single point energy calculations with CCSD(T) deliver excellent predictions, but high computational cost and applicability only to small systems limit the practical scope.

Civilian-led crisis response teams provide emergency mental healthcare for individuals in acute distress in community settings, often without the involvement of police as first responders. These models represent one of several emerging alternatives to police-led crisis response and have gained attention for their potential to improve safety, trust, and care outcomes. Reports included in this scoping review discussed: the development, need, potential, implementation, and outcomes of civilian-led crisis response models. Covidence software was utilized by two independent reviewers to search 11 databases, with a third reviewer resolving conflicts. A dataset of 46 reports were then analyzed with thematic content analysis by a multidisciplinary team using critical theories to offer an exploration of how civilian-led crisis teams have begun to address the harms of policing responses to mental health. In exploring the key processes for civilian-led crisis response teams, three themes emerged. The first theme, Decentering Police, explores the growing collective awareness of the harms associated with police-involved crisis intervention and the corresponding need for alternative approaches, alongside efforts to establish a team composition that is intentionally distinct. The second theme, Team Scope of Practice, explores the subthemes of dispatch logistics and defining criteria for response. Team Sustainability is the third theme and explores how social and political will shape the uptake and long-term operation of civilian-led crisis programs.

An extended scope of practice for audiology: the case for Ireland.

Advanced practitioners: Limit their scope of practice and hold a safety review, doctors say.

While Baby-Friendly Hospital initiatives play a critical role in the initiation of breastfeeding and the prevention of prelacteal feeding, growing evidence highlights the need for context-specific, equitable, and community-based breastfeeding support strategies that extend beyond the early postnatal period. In Türkiye, the scope of baby-friendly practices has progressively expanded from hospital settings to encompass the broader health system and community level. This expansion includes the introduction of the Baby-Friendly Family Medicine Initiative, the Baby-Friendly Neonatal Intensive Care Unit (NICU) Program, and the Baby-Friendly Province Program, further strengthened by the Golden Baby-Friendly Province Program. Breastfeeding support is delivered as a continuous, system-integrated service across all levels of care, from pregnancy through infancy. Within this framework, World Breastfeeding Week (1-7 August) and National Breastfeeding Week (1-7 October) serve as intensified, multisectoral campaign periods that enhance visibility, community engagement, and public awareness of ongoing efforts. Within this framework, Baby-Friendly Provinces in Türkiye have moved beyond facility-based education toward innovative, community-oriented, and multisectoral approaches to breastfeeding promotion. These initiatives aim to reach diverse population groups, address social inequities, and foster community ownership of breastfeeding as a shared public health responsibility. The reported activities are organized into six thematic areas, including individualized support for vulnerable populations, community engagement and social inclusion, youth and intergenerational participation, sports-based outreach, environmental sustainability, and visual public messaging. The experience of Baby-Friendly Province initiatives in Türkiye demonstrates how community-based breastfeeding promotion can be operationalized at scale within an institutional framework. This model may offer transferable insights for strengthening breastfeeding support in other country contexts. Not applicable.

Across dental hygiene and therapy education, increasing standardization has led to greater consistency in how professional roles are defined and taught. However, the roles that graduates enter remain variable across healthcare systems and continue to evolve in response to regulatory, workforce, and service pressures. This paper suggests that this variation is not simply a problem of alignment but reflects the interaction of multiple systems shaping how roles are enacted in practice. Drawing on examples from the United Kingdom and the United States, it is proposed that professional roles may be stable in definition within education, but dynamic in function within practice. The implications for dental education are considered, with particular attention to curriculum design, competencies, and assessment. The paper argues that preparing graduates for variability may be as important as preparing them for defined scopes of practice.

Pharmacists' role in primary care has rapidly evolved in recent years, driven by pressures on primary care and supported by increased government funding, further enabling full scope of practice while reducing patient costs. To optimize healthcare delivery, the patient outcomes of pharmacist-led primary care in community settings must be evaluated. This scoping review aimed to identify and explore the breadth of patient health outcomes used to assess the quality, effectiveness, and safety of pharmacist-led primary care. A comprehensive search was conducted in four databases and Google for articles published from 1997 to July 2023, updated in February 2025. Database records were screened independently by two reviewers at two stages in Covidence. Google search results were screened by one reviewer, with selections verified by a second reviewer. Studies were included if they involved pharmacist-led primary care and reported patient health outcomes related to quality, effectiveness, and/or safety. Extracted data on study design, disease state, clinical services, and patient outcomes were categorized by two reviewers. Data are reported descriptively (frequencies, percentages) and are displayed using heat maps. Results were reported using PRISMA-ScR guidelines. A total of 299 studies (297 peer-reviewed, 2 grey literature) were included from 10,498 database records and 300 grey literature search results. Experimental study designs were the most common (61%) and increased in prevalence over the study period. Patient populations primarily comprised those with chronic diseases, primarily endocrine (27%) and cardiovascular (26%), with the volume of studies focused on these groups also increasing over time. Studies often evaluated multiple types of clinical service, with more focusing on education or counselling (29%) and chronic disease management (23%). A wide variety of outcomes were measured, with more than 70% being positive. The number of studies reporting outcomes increased markedly after 2002, particularly those examining clinical measures (29%), resource use (19%), and laboratory measures (14%). This scoping review identified patient health outcomes used to evaluate pharmacist-led primary care. Although studies on pharmacist-led clinical services have increased, the most assessed services may not reflect current practice. These findings should inform health system metrics grounded in outcomes that matter to patients to ensure safe, effective pharmacist-led care.

Community Midwifery Postpartum Care: National Data From Community Practice.

Neonatal nurses and APRNs may not recognize when AI drives an alert, recommendation, or summary unless training and policy make it explicit. Nurses protect infants and practice when they treat AI output as clinical decision support, not clinical truth. Limited transparency about "black box" performance requires nurses to verify information, increases professional risk, and blurs practice boundaries when AI-driven recommendations conflict with clinical judgment. Provide practical guidance to identify where AI appears in workflow, apply a "nurse as verifier" stance, and use clear documentation and escalation pathways when AI affects care. We describe common AI encounters in the NICU summarization tools, EHR-based clinical decision support, and embedded AI in monitors and sensors. We outline actions to verify outputs, reduce automation bias, preserve an audit trail when AI influences escalation or de-escalation, and report AI-related errors. AI can strengthen situational awareness, but it does not replace nursing judgment or accountability. In a high-acuity environment with rapid physiologic change, undisclosed or poorly understood AI increases risk, especially when nurses cannot confirm data sources or limitations underlying clinical decision support outputs. Nurses carry responsibility to determine when AI use supports safety and when it introduces risk within their scope of practice and standards of care. These responsibilities increasingly align with evolving legal and regulatory expectations related to AI-informed actions and documentation. Research is needed to determine how nurses use AI in current workflow and identify risk to nursing practice and infant safety.

Despite evidence of cerebral vulnerability in the early postnatal period, neonates diagnosed with mild hypoxic-ischemic encephalopathy (HIE) may not routinely receive continuous neuromonitoring, limiting opportunities for timely neuroprotective interventions. Near-infrared spectroscopy (NIRS) offers continuous, noninvasive monitoring of cerebral oxygenation; however, standardized, nurse-driven, clinical practice guidelines (CPG) for NIRS use in this population are lacking. Guided by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework, a systematic review was conducted to identify evidence related to NIRS use in term neonates with mild HIE. Searches of CINAHL, Embase, and MEDLINE were performed from 2019 to 2025. Additional literature sources included clinical guidelines, institutional protocols, and device manuals. Recommendations were synthesized based on cerebral vulnerability in mild HIE, benefits of NIRS monitoring, alignment with nursing scope of practice, and feasibility within neonatal nursing workflows. Final recommendations were endorsed by multidisciplinary stakeholder consensus, resulting in a bedside implementation guide. The CPG recommends 1) NIRS initiation within the first 6 hours of life, 2) standardize sensor site care to ensure data integrity and skin protection, and 3) continuous cerebral monitoring for the first 24 hours in term neonates (≥36 weeks' gestation) with mild HIE. Thresholds for immediate nursing assessment and care escalation are recommended for rScO2 <55% and >85%-90%. Implementation of nurse-driven NIRS CPGs may enhance early detection of cerebral oxygenation abnormalities, improve consistency of neuromonitoring, and support timely neuroprotective care for neonates with mild HIE.

A bibliometric analysis describing the global scope of pharmacist roles (2000-2024).

The sustained well-being of the nurse practitioner (NP) workforce is threatened by pervasive role ambiguity. This ambiguity is frequently cited as a barrier to successful professional integration and practice. Although existing literature acknowledges this issue, it lacks a formal definition within the context of NP practice. This omission prevents targeted evaluation of its true impacts and the development of effective interventions. The purpose of this article is to present a concept analysis of role ambiguity within the NP context. Rodgers' evolutionary concept analysis was used. A targeted integrative literature review was conducted across PubMed, CINAHL, and Scopus. This process resulted in 29 articles selected for thematic analysis. The analysis revealed NP role ambiguity manifests as both an internal professional identity conflict and an externally imposed issue driven by systemic barriers. The derived working definition is a state of confusion or lack of clarity regarding the practice authority, scope of practice, abilities, and educational preparation of NPs experienced not only by NPs themselves but also by health care consumers, other health care staff, administrators, and the public ultimately leading to decreased job satisfaction, difficulties in professional identity formation, and the marginalization of NPs. Key attributes include conflict over scope of practice and the discrepancy between the anticipated and actual NP role. Antecedents span legal, organizational, and financial barriers, with consequences such as underutilization and burnout. These findings require recognizing NP role ambiguity as an externally imposed systemic challenge that generates internal conflict. Nurse practitioners should leverage this clarified definition to advocate for broader professional recognition and guide the implementation of external strategies, such as targeted education campaigns and policy advocacy, to support professional sustainability.

The aim of our study was to understand how routine pharmacy practice was impacted during the COVID-19 pandemic and the consequences for patient access. Community pharmacists are among the most accessible primary care providers, playing a vital role in primary care access for patients. During the COVID-19 pandemic, community pharmacists took on numerous additional roles to support safe primary care access. As health systems are in the latter stages of recovery from the pandemic, understanding how the pandemic impacted routine community pharmacy practice and the repercussions for post-pandemic practice is important. Between September 2020 and January 2021, we interviewed 11 pharmacists working in community pharmacies in Nova Scotia, Canada. We thematically analyzed qualitative data pertaining to pharmacists' perceptions of pandemic impacts on providers, patients, and pharmacy practice. The COVID-19 pandemic greatly impacted community pharmacy practice, patients, and community pharmacists. Participants recommended maintaining some of the community pharmacy practice changes and suggested that continuing to expand the scope of practice for pharmacists is essential to meeting population health needs moving forward. Pharmacists recognize and are willing to maintain the essential roles they have assumed in facilitating patient access to primary care. Decision-makers should consider providing the necessary supports (e.g., communication software) and funding support to enable the full scope of community pharmacist practice.

Peer coaching is a promising strategy for continuing professional development for enhancing physicians' skills and mitigating burnout. Coaching may be particularly important for helping rural physicians maintain or extend their traditionally broader scope of practice, yet little is known about what motivates rural physicians to engage in coaching. To address this gap, the purpose of this study was to investigate rural physicians' motivation to participate in a peer coaching program. This study analyzed semi-structured interviews with 22 rural physicians who participated in the Coaching and Mentoring Program offered by University of British Columbia's continuing professional development. Interviews, which were originally collected for program evaluation, were analyzed using template analysis within a constructivist framework. Deductive codes were informed by expectancy-value theory and self-determination theory, while inducive codes captured novel insights. Four key themes emerged: (1) Participants valued closing perceived gaps between their current skills and their evolving scope of practice; (2) credible and invested coaches fostered expectancies of success; (3) experiences during the coaching journey facilitated ongoing motivation; and (4) competing demands threatened ongoing motivation. This study suggests that coaching programs for rural physicians should be responsive to the varied demands that drive rural physicians to seek coaching and support meaningful coach-coachee interactions to foster sustained engagement. Future research should seek the perspective of non-participants and compare peer versus professional coaching models.