Latest news with #clinicalpractice
The Guardian
07-08-2025
- Health
- The Guardian
Len Doyal obituary
My friend Len Doyal, who has died aged 80, was for many years a senior lecturer in medical ethics at St Bartholomew's and the Royal London Hospital Medical School, where his academic programme, Ethics and Law Applied to Medicine and Dentistry, was much praised for the way it integrated law and ethics with clinical practice. He was appointed professor of medical ethics and law there in 1996 and became the first non-medical honorary consultant in a British hospital. Much in demand as a bridge between ethics and hands-on medicine, he became a longstanding member of the BMA ethics committee, before retiring in 2000. Len was born in the US, in Atlanta, Georgia, to Thomas, who was director of transportation for the state of Georgia, and Muriel (nee Pendley), a homemaker. After completing a degree in philosophy at Georgia State University he won a Fulbright scholarship to further study the subject under Karl Popper at the London School of Economics. It was a momentous journey from the Jim Crow South to the court of a legendary figure in the philosophy of science, but sadly he found many of Popper's ideas almost as problematic as those that he had left behind. Not wishing to return to the US, in 1968 Len found refuge in teaching philosophy at Middlesex Polytechnic (now University) and there met Lesley Coates, a fellow academic whom he married in 1973. Over the years, as Lesley rose to be a professor of health studies, they also cooperated academically, writing joint articles and books, including Living With HIV and Dying With Aids (2013). Their house in Finsbury Park, north London, was a convivial meeting point for feminist and leftwing groups and it was there that I first met Len at the founding of the journal Critical Social Policy. Our book, A Theory of Human Need (1991), was awarded both the Isaac Deutscher and Gunnar Myrdal prizes. Working through those ideas together in the 1980s was a joy and a useful antidote to the prevailing Thatcherite tide. Among his other books were Clinical Ethics: Theory and Practice (2011) and Informed Consent in Medical Research (2000), the latter of which he co-edited. After 22 years at Middlesex Polytechnic, Len moved to teach medical ethics at Barts and the Royal London Hospital Medical School, where he was consistently popular with students, who elected him staff president of the student union for five consecutive years. He was always willing to engage positively and sensitively with those who disagreed with him, yet his determination to explore the most basic of ethical dilemmas did sometimes cause upset. The most notable of his controversial positions was his argument that non-voluntary euthanasia should be legal under certain limited circumstances. In his spare time Len played the guitar and loved the American canon of popular music from the 60s onwards. He is survived by Lesley, their children, Daniel and Hannah, and four grandchildren.
Yahoo
18-07-2025
- Business
- Yahoo
Wedgewood Expands Advisory Committee with the Launch of Two New Veterinary Councils
SWEDESBORO, N.J., July 18, 2025--(BUSINESS WIRE)--Wedgewood is excited to announce the expansion and evolution of its Veterinary Advisory Committee to reflect the company's continued growth and leadership in the veterinary community. As part of this transformation, the company welcomes new members to both the Strategic Veterinary Council and the Specialists Customer Council. These additions are intended to bring fresh perspectives and ensure Wedgewood remains deeply connected to both emerging trends and frontline clinical practice. This new structure will strengthen Wedgewood's ability to collaborate with a broader range of veterinary professionals and ensure its offerings are shaped by those delivering care every day. The councils are designed to provide meaningful guidance across clinical, operational, and strategic areas, helping the company stay responsive to the needs of the profession and grounded in real-world insight. The Strategic Veterinary Council includes leaders in education, operations, regulatory, and medical excellence who will advise Wedgewood on big-picture strategy and forward-looking industry trends. This group will play a critical role in helping us ensure our offerings are aligned with the evolving realities of veterinary practice. The council includes: Dr. Dawn Boothe – Professor Emerita and board-certified pharmacologist known for her decades-long impact in clinical pharmacology and education. Dr. Kelly Cairns – VP of Medical Excellence and Education at Thrive Pet Healthcare, with deep expertise in internal medicine and veterinary education. Brian Carlson – Director of Operations at Old Derby Animal Hospital and veterinary business consultant specializing in growth strategy. Dr. Matthew Edson – Founding Dean of the Shreiber School Veterinary Medicine of Rowan University and advocate for veterinary education that prepares confident, practice-ready graduates. Dr. Andrea Johnson – Co-founder of PetVet365, focused on reinventing practice ownership and advancing pet care delivery. Dr. Natalie Marks – CEO of VANE and nationally recognized speaker, columnist, and veterinary media contributor. Dr. Joshua Stern – Associate Dean and Professor of Cardiology at NCSU, leading groundbreaking research in companion animal genetics and cardiology. Dr. Dean Vicksman – Chair of the Board of Directors at EveryCat Health Foundation and long-time champion of feline health. Dr. Sathya Chinnadurai – Senior VP of Animal Health at Brookfield Zoo, a highly respected zoological veterinarian and researcher, best known for his leadership in animal health, welfare, and conservation medicine. The Specialists Customer Council is composed of practicing veterinarians who will keep Wedgewood closely connected to the day-to-day challenges of specialty care. These members offer deep clinical expertise and will provide actionable feedback on how we can better serve the needs of high-demand specialty practices. Members of this council include: Dr. Gary Block – President of the Evidence Based Veterinary Medicine Association and co-founder of OSVS and BSVESS referral hospitals. Dr. Jane Brunt – Executive Director of the CATalyst Council and founder of Maryland first feline-exclusive hospital. Dr. Rustin Sturgeon – National Medical Director of Ophthalmology at Pathway Vet Alliance with expertise in medical excellence coaching. Dr. Rob Swinger – Board-certified ophthalmologist and Medical Director at Elite Veterinary Specialists. Dr. Noël Lucas – Founder of Blue Oasis Pet Hospital and advocate for transparency in veterinary care and mental health. Dr. Stephanie Correa – Founder and President of Animal Cancer Care Clinic, the largest dedicated veterinary oncology network in the U.S. "It's an exciting time at Wedgewood as we continue to grow and deepen our partnerships across the veterinary community," said Dr. Rae Hutchins, Chief Veterinary Officer at Wedgewood. "Expanding our Advisory Committee allows us to stay at the forefront of clinical innovation, grounded in scientific rigor, and ensures we're responding directly to the evolving needs of veterinarians and the animals they care for." This momentum reflects Wedgewood's long-standing commitment to serving the veterinary community with insight, integrity, and partnership. By continuing to work closely with leaders across the profession, the company is dedicated to building smarter, more agile solutions that elevate clinical care and support continued progress for all. About Wedgewood: Wedgewood is the nation's largest and most trusted provider of compounded veterinary medications. Its next-generation home delivery platform, Blue Rabbit, streamlines patient care and marks a significant evolution in online pharmacy services. Together, Blue Rabbit and Wedgewood serve more than 70,000 veterinary professionals and more than one million animals annually. For more information visit View source version on Contacts Jennifer Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Medscape
23-05-2025
- Health
- Medscape
Intranasal Schirmer Test Shows Promise in Allergy Diagnosis
The intranasal Schirmer test (INSCH) may help detect allergic rhinitis during a nasal provocation test. Among patients with allergic rhinitis, the INSCH revealed significantly increased nasal secretions upon exposure to relevant allergens such as mites or birch. METHODOLOGY: The INSCH was performed by attaching Schirmer filter paper — widely used in ophthalmology to measure tears — to each nostril. To investigate whether INSCH could objectively assess rhinorrhea during evaluations for allergy, the researchers recruited 50 participants from March 2023 to March 2024. Half the participants underwent nasal provocation testing after they had a negative or borderline result for a tested allergen on a skin prick test or specific serum immunoglobulin E test. The other half were in a control group with no history of allergy. TAKEAWAY: Among patients with allergic rhinitis, INSCH wetting distance in significantly increased in the nostril that was provoked with an allergen (mean difference, 13.95 mm; P = .01). = .01). Individuals with nonallergic rhinitis showed no change in nasal secretions upon provocation with a potential allergen. A difference in wetting distance of at least 2.75 mm after provocation had a sensitivity of 81.8% and a specificity of 71.4% in detecting allergic rhinitis. IN PRACTICE: 'The INSCH could serve as a simple tool in everyday clinical practice to quickly objectify nasal secretion,' the authors wrote. SOURCE: Paula von der Lage, MD, with the University of Zurich, Zurich, Switzerland, was the corresponding author of the study, which was published online on May 17 in Annals of Allergy, Asthma and Immunology . LIMITATIONS: The study included patients who smoke, despite evidence that smoking can lead to drier nasal mucosa. DISCLOSURES: The study received support from the Theodor und Ida Herzog-Egli-Stiftung, Switzerland. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. Medscape Medical News © 2025 WebMD, LLC Cite this: Intranasal Schirmer Test Shows Promise in Allergy Diagnosis - Medscape - May 23, 2025.
Malay Mail
19-05-2025
- Health
- Malay Mail
Creating value through the power of sustainability — Nor Malina Manan
MAY 19 — What does it mean to be a sustainable educator in today's world? For me, it goes beyond simply delivering lessons or meeting curriculum outcomes. It's about cultivating values that endure both in the classroom and in our clinical practice and aligning what we teach with the realities our students will face in a changing world. My journey toward sustainability in education began with a mix of personal experience and institutional exposure. As a principal investigator (PI) under the Universiti Malaya Sustainability and Development Centre (UMSDC) grant, I was fortunate to participate in workshops focused on the United Nations Sustainable Development Goals (SDGs). These sessions opened my eyes to how deeply sustainability intersects with healthcare, education, and daily professional routines. One realisation struck me clearly: the sheer amount of waste generated in our clinical teaching environment, both in materials and mindset was something we could no longer ignore. This insight marked the beginning of my commitment to embed sustainability into my teaching and clinical supervision. It wasn't long before that commitment took shape in the form of action. Together with my students, we won first place in a university-level SULAM (Service Learning Malaysia–University for Society) project in 2024, where judges highlighted our innovation, sustainability-driven teaching methods. Since then, sustainability has become an integral part of how I teach, think, and practice. Sustainability in the classroom and the clinic As a tertiary educator involved in oral healthcare, I view sustainability through the lens of both SDG 4 (Quality Education) and SDG 3 (Good Health and Well-being). This dual perspective helps me design learning experiences that are not only effective but also socially and environmentally conscious. In my classes, sustainability shows up in both content and delivery. I encourage the use of digital tools to reduce paper waste, foster critical discussions around the environmental impact of clinical materials, and integrate principles of low-waste dentistry into treatment planning exercises. For example, my students reflect on the balance between infection control and environmental responsibility in their clinical exercise. They explore the use of reusable vs. disposable items, challenging them to think beyond cost and convenience. One of our more engaging initiatives involved using toy food models and simple items you'd find in a local supermarket or toy shop to teach children about healthy and unhealthy eating habits. The activity mimicked real-life dental scenarios in a fun, hands-on way. But more than that, it opened a conversation about responsible consumption, aligning with SDG 12 (Responsible Consumption and Production). It was a reminder that impactful teaching doesn't always require expensive tools. Sometimes, everyday items can make the message more relatable. Aligning with institutional goals At the university level, sustainability is no longer just a buzzword, it's a strategic priority. Universiti Malaya has outlined its commitment to sustainable development through its Sustainability Policy 2021–2030, and I see this not as a top-down directive, but as an invitation to act meaningfully within our own teaching domains. As a PI in UM's sustainability efforts, I've helped to develop content that aligns with relevant SDGs, particularly SDG 3, SDG 4, and SDG 12. I've also supervised student-led projects that translate these goals into real-world clinical and community engagement strategies. Our students aren't just learning sustainability. They're living it through projects, outreach, and reflective practice. The role of the educator One of the most important things I've learned is that being a sustainability-minded educator doesn't require sweeping reform. It starts with small, intentional shifts by choosing reusable materials, integrating environmental themes into class discussions, or simply asking students to consider how their actions impact others. In a profession where it's easy to be overwhelmed by content delivery and KPIs, we sometimes forget the influence we have in shaping how our students think not just about knowledge, but about responsibility. I believe that every clinical simulation, every audit discussion, and every class activity is an opportunity to model a sustainable mindset. Ultimately, my message to fellow educators is this: we each hold the power to shape a more responsible generation of professionals. While institutional support is valuable, individual effort matters just as much. The way we teach today will shape how our students practice tomorrow. A Teachers' Day reflection As we celebrate Teachers' and Educators' Day on May 16th here in Malaysia, I take this moment to express my gratitude to all educators who continue to give their best, especially those who go the extra mile to incorporate sustainability into their work. We may not always see the immediate impact of our choices, but over time, those small shifts create lasting change. In our hands lies the future and not just of our students, but of the communities they will serve. Let us continue to lead with care, teach with purpose, and inspire with action. All the best to my fellow educators on this meaningful journey. * Dr Nor Malina Manan is a dental lecturer at the Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, and may be reached at [email protected] ** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
Medscape
09-05-2025
- Health
- Medscape
Is Decision Fatigue Sabotaging Your Clinical Choices?
The decision-making process is a fundamental activity in the medical field. It translates into diagnosis, treatment selection, examination choices, provision of relevant information, follow-up scheduling, or the decision not to intervene. In recent years, decision-making processes in medicine have faced increasing pressure to comply with regulatory standards such as evidence-based medicine, patient-centered care, and patient safety. This context has made medical decision-making cognitively more intense, with internists making an average of 15.7 decisionsduring each patient visit. Consequently, for physicians operating in high-complexity clinical settings with heavy workloads and significant cognitive demands, the quality of their decisions may be compromised owing to fatigue resulting from repeated decision-making processes. Decision fatigue (DF) refers to the concept that making decisions is mentally taxing and impairs the quality of subsequent decisions. It is hypothesized that humans have a finite cognitive reserve for decision-making, and as this reserve depletes, executive function and self-control diminish, ultimately affecting the decisions that follow. Clinical Implications DF is of particular concern in medicine because of the critical nature of the decisions made by physicians and the potential consequences of suboptimal decision-making. In clinical practice, decision fatigue has been linked to various outcomes related to sequential decision-making processes, often concerning the timing or order of appointments. Notable examples include increased rates of antibiotic prescriptions later in the day, more conservative surgical recommendations with increased case prescriptions just before lunch, and a higher likelihood of physicians prescribing painkillers, such as opioids, later in the workday. However, most studies available to date have utilized retrospective observational designs, lacking preregistration or external validation. Additionally, the definitions of DF are often vague or inconsistent, resulting in weak cumulative evidence despite numerous reports on its effects. Research Insights A systematic review and meta-synthesis summarized the existing literature on DF in medicine, focusing on its definitions, determinants, and implications for clinical practice while attempting to address some unresolved questions. DF has been broadly defined as a reduced capacity to make decisions and regulate behavior following repetitive decision-making tasks. Although qualitative studies have not directly investigated DF, many have indirectly explored its impact on physician performance or patient outcomes. DF has been described as a consequence of cognitive overload, time pressure, acts of omission, and interprofessional disagreements. No qualitative study has analyzed DF by asking participants to define it or by observing its cognitive, emotional, or behavioral components. Nonempirical articles have examined the concept of DF more directly than empirical studies, describing its possible determinants and associated outcomes. These studies have shown that DF includes ego depletion, physical fatigue, burnout, and repeated or difficult decision-making. Other contributing factors include workload, dysfunctional work environment; implementation of new procedures; and pressure from colleagues, patients, and their families. Risk and Protective Factors At the individual level, risk factors include ego depletion or willpower exhaustion, where repeated DF depletes mental resources; self-perceived medical errors, which can increase stress and anxiety; uncertainty and inherent risks in medical practice; ethical challenges requiring careful reflection; and emotional challenges such as dealing with patient suffering or death. Female sex and residency status were notable sociodemographic risk factors. At the contextual level, the healthcare environment plays a crucial role, with high patient volumes, time pressure, inadequate support, and organizational culture exacerbating the pressure on healthcare professionals, making them more prone to DF. Protective factors against DF include various individual, sociodemographic, and contextual elements. At the individual level, effective communication skills, effective coping strategies, empathy and compassion, trust in one's instincts, motivation, a strong professional identity, the ability to seek advice, self-control and awareness in DF, high self-esteem, and tolerance for ambiguity contribute to greater resilience. At the sociodemographic level, being male, maintaining good mental health, a good quality of life, and good sleep quality were protective factors. At the system level, communication and ethics training, collaborative work environments, decision-making support tools, autonomy, professional experience, and a safe work culture provided resilience against DF. Key Considerations Clinical DF is a complex and multifaceted phenomenon with significant implications for clinical practice and patient outcomes. No current study has comprehensively defined clinical DF within a theoretical framework supporting hypotheses or research questions or provided a definition that could be used systematically. The analysis of risk and protective factors for clinical DF has identified contextual and individual factors with interrelated psychological dimensions. Given the results of this review, it is plausible to assert that clinical DF is a multifaceted cognitive and motivational process that influences a physician's decision-making capacity, driven by contextual and individual factors. These, in turn, are closely linked to psychological distress and an increased risk for errors in healthcare.
