Latest news with #clinicalpractice
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.
Associated Press
07-05-2025
- Health
- Associated Press
Nanophotonic sensing and label-free imaging of extracellular vesicles
GA, UNITED STATES, May 7, 2025 / / -- This review examines imaging-based nanophotonic biosensing and interferometric label-free imaging, with a particular focus on vesicle detection. It specifically compares dielectric and plasmonic metasurfaces for label-free protein and extracellular vesicle detection, highlighting their respective advantages and limitations. Proteins play a vital role in human health and detecting them is crucial in medical research and clinical practice. Protein assays are typically used to diagnose diseases, track disease progression, and assess treatment effectiveness. A growing area of interest is the detection of extracellular vesicles (EVs), nanoscale particles secreted by cells into bodily fluids. These vesicles present proteins that reflect their cell of origin and overall physiological state, making them valuable disease indicators. Because EVs can be collected from fluids rather than requiring invasive procedures like biopsies, they offer a promising way to monitor conditions like cancer in a minimally invasive manner. Traditionally, protein detection has relied on enzyme-linked immunosorbent assays (ELISA), which use antibodies to bind to specific proteins. However, ELISA has limitations, such as requiring precise antibody pairs, which are not always available. Additionally, labeling proteins with chemical markers can alter their natural structure and function, potentially affecting results and increasing costs. To overcome these challenges, the research community is exploring label-free detection methods. Advanced techniques such as surface plasmon resonance (SPR), photonic crystal resonance, interferometry, and nanoparticle tracking analysis enable the study of proteins and EVs in their natural state, reducing the risk of experimental interference. Label-free approaches also allow for real-time analysis, offering faster and more detailed insights compared to traditional methods. A particularly promising area of label-free detection is imaging-based nanophotonic sensing, which uses specially engineered surfaces to detect molecular interactions with high sensitivity. Within this field, dielectric and plasmonic metasurfaces are emerging as key technologies. Plasmonic systems are highly effective at detecting small molecules because they enhance electromagnetic fields at the nanoscale. Meanwhile, dielectric metasurfaces offer higher stability and precision and are ideal for analyzing EVs and larger biomolecules. Despite these advancements, challenges remain. The scientific community is working to improve surface chemistry approaches for more specific biomarker detection, develop cost-effective manufacturing methods, and integrate artificial intelligence to enhance data analysis. Further innovations in high-Q resonant structures—designed to optimize light-matter interactions—could lead to ultrasensitive, label-free biosensing and single-particle imaging. As these technologies improve, they have the potential to transform disease detection and monitoring, advancing both research and clinical applications. References DOI 10.1038/s41377-025-01866-2 Original Source URL Funding information This work was supported in part by National Institute of Health (NIH) 1U01CA279858, U01CA284982, R01CA239078, R01HL163513, R21CA267222, and R01CA264363. Lucy Wang BioDesign Research email us here Legal Disclaimer: EIN Presswire provides this news content 'as is' without warranty of any kind. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author above.
