Search results for Practice

In the second part of our series looking at the impact of ageing, Léa Suruge asks how to support older patients whose quality of life has been affected by age-related eye disease, and reviews the treatments available.

As advances in optical coherence tomography imaging shed new light on the choroid, Carina Bailey asks how measuring choroidal thickness could help determine ocular health.

The latest picture of vision impairment across the world.

A framework for delivering eye care to children in special schools aims to help those who often seek treatment the least, writes Anna Scott.

Clinical Editor Kieran Loft MCOptom and Consultant Neuro-ophthalmologist James Benzimra FRCOphth discuss a case of toxic nutritional optic neuropathy.

Michelle Hanratty, Senior Optometrist at Optegra Birmingham Eye Hospital, on finding macular lesions in a patient at a postoperative assessment, and the ensuing treatment.

Kim Thomas looks at new developments in optical coherence tomography hardware, including faster refresh rates and increased accuracy, and wonders what the future holds for the technology.

New research has found links between the severity of visual impairment and the risk of dementia. Kathy Oxtoby asks: how can optometrists play a greater role in supporting patients with these conditions?

We break down the 2021 England and Wales figures, highlighting age and deprivation demographics that will impact healthcare.

Artificial intelligence could be used to predict heart disease risk using a retinal photograph. But, Kim Thomas asks, is it an opportunity for optometrists to extend their skill-set – or an unwelcome addition to their workload?

The pandemic has restarted the discussion about the benefits of bilateral same-day cataract surgery for select patients. Natalie Healey explores the pros and cons from patient and provider perspectives.

Daniel Hardiman-McCartney FCOptom, Clinical Adviser for the College, on the vital importance of handheld instruments in the eye examination.

From refractive error to dashed career opportunities, Kim Thomas discusses the lifelong consequences of amblyopia.

Dr Flors Viñuela-Navarro PhD MCOptom and Dr Francisco Viñuela-Rodriguez FAAO discuss the abnormalities of a pituitary tumour and the diagnosis of such space-occupying lesions.

Susan Blakeney FCOptom considers whether optical solutions should be implemented more often.

There are plenty of evidence-based resources to draw on, writes Dr Paramdeep Bilkhu MCOptom, Clinical Adviser for the College.

How do clinicians choose between generic and branded drugs, balancing the need for patient safety against cost? Kathy Oxtoby takes a look.

Objective autorefractors are already a reliable and time-saving complement to optometric care, but Acuity asks if fully automated subjective machines threaten the profession itself.

Acuity looks at the importance of early diagnosis of keratoconus, and how you can help signpost towards effective treatment and manage the patient over the long term.

Kim Thomas explores ocular immune privilege – how does it work, what benefits does it offer and what happens when it goes wrong?

Incomitance in cases of binocular vision defects can be a sign of disease or injury. Sophie Goodchild reminds us of the essentials.

Routine pre-screening may stop serious diseases slipping through the net, writes Helen Gilbert.

Kim Thomas asks what causes acquired colour vision deficiency, and what it can tell us about underlying pathologies.

Natalie Healey explores how optometrists can support the diagnosis and management of cerebral visual impairment.

Evidence suggests that obstructive sleep apnoea increases the risk of normal-tension glaucoma writes Kim Thomas, but is there a causal mechanism?

Adrian O’Dowd examines whether it is time for a change that will enable optometrists to certify patients as visually impaired.

The Deputy Chair of CET Approvers at the GOC on specialising in contact lenses and his decision to sell his independent practice.

Andrew discusses the challenges of running a busy opthalmology department, and how COVID-19 will affect those entering the profession.

Caroline explains her passion for improving lives by volunteering with Vision Aid Overseas.

The multi-skilled optometrist talks us through her career path, which spans academia, clinical practice and industry.

How the camaraderie and clinical challenges in hospital optometry inspire this Consultant Optometrist.

Christian talks about the challenges and rewards of volunteering, and why he chose to go into the sector.

The College’s Clinical Adviser on her award-winning work at Amersham Hospital.

The glaucoma expert on his research and educating the next generation.

The IACLE Contact Lens Educator of the Year has a great love for research and teaching contact lenses and dry eye disease.

The Optometric Adviser to the Scottish Government explains how community practice has informed her career.

Dr Keziah Latham, the low vision specialist, discusses how teaching, research and clinical practice are interlinked.

The historian and curator talks about his 25-year career at the College.

The optometrist who set up an eye care charity for homeless people.

Optometrist and new practice owner Gemma Hill MCOptom on why she chose to work in independent practice, and the challenge of setting up her own business.

Gordon Ilett tells us about his career, his experience on charitable and professional bodies, and his new position as Chair of the Optometric Fees Negotiating Committee.

The former optometrist talks about retraining as an ophthalmologist and why it’s important for both professions to work together.

The senior clinical teaching fellow and higher qualifications expert discusses working in an education role alongside clinical practice.

We speak with Aston University’s Emeritus Professor, and this year’s College of Optometrists President’s Medal winner.

A conversation about clinical care in Northern Ireland and a passion for research.

The academic, who also sits on the College’s accreditation panel for higher qualifications, on the importance of raising standards.

This businesswoman, teacher and examiner is an advocate for higher qualifications and embracing technological changes in optometry.

After visiting his father in prison, Tanjit set up a charity to provide eye care and optical skills training to prisoners.

Sean Matthews MCOptom describes a patient attending his Northampton practice who demonstrated how this relatively rare chronic condition requires management within secondary care to prevent permanent loss of vision.

Scott Mackie FCOptom is an independent prescribing optometrist working in primary care. He discusses how to discriminate between a red eye that can be managed and one that has to be referred.

Kathy Oxtoby looks at the intended and adverse effects of corticosteroids, the common concerns patients have, and how to manage a steroid response.

The College’s Guidance for Professional Practice has recently undergone its scheduled three-year update. Daniel Hardiman McCartney FCOptom and Clinical Adviser for the College, says its timely revisions reflect a changing medical and social landscape.

Choroidal naevi are often detected during routine examinations, but it is vital to be aware of the warning signs of something more sinister, writes Mark Gould.

Steve Smethurst asks if clinical appraisals or personal development plans should be introduced for all optometrists.

Clinical Editor Kieran Loft MCOptom and Consultant Eye Surgeon Peter Simcock FRCOphth discuss discriminating between the two.

What are the advantages and disadvantages of Delphi studies, and when should they be preferred to other research methods? Jo Waters talks to those who use them.

Many contact lens wearers reduced their usage during the pandemic, writes Nick Warburton, and opportunities to fit new lenses were restricted. Optometrists have adapted their support, but is it enough to stop drop-outs?

Optometrists can play a crucial role in highlighting the red flags of intraoperative floppy iris syndrome before cataract surgery, says Rima Evans.

A common cause of sight loss in the UK, uncorrected refractive error is easy to remedy, particularly if caught early. So, Kim Thomas asks, why do so many people live with uncorrected refractive error – and what can optometrists do to address it?

Léa Surugue looks at how to carry out effective virtual consultations in a time of social distancing and discusses the clinical and legal pitfalls.

The floodgates have opened for a new era of gene therapy that can treat the inherited causes of eye disease. Becky McCall reports.

Consultant Ophthalmologist Damian Lake looks at the history of corneal collagen cross-linking in treating keratoconus, the current indications for its use, and the most up-to-date refinements to the procedure.

Lockdowns led to cancelled operations and check-ups. Becky McCall looks at the legacy of the pandemic for eye disease and sight loss, and the lessons that have been learned.

Prashant Shah MCOptom PGDipOphth DipClinOptom on the differential diagnosis of OMG when patients present with diplopia or ophthalmoplegia and an existing autoimmune condition.

Amid the upheaval caused by COVID-19, Dr Susan Blakeney FCOptom, the College’s Clinical Adviser, asks if one of the unexpected consequences of the crisis could be positive clinical change.

Is increased screen time causing visual and eye health problems in children? Helen Gilbert reports.

Craig McCoy MCOptom describes a patient with a dislocated crystalline lens.

Why do people access eye care in some areas of the country, and don’t in others? And what are the barriers to accessing optometric services? Erin Dean examines inequalities in eye health.

Beware the pitfalls of assumption, says College Clinical Adviser Susan Blakeney FCOptom.

Kathy Oxtoby introduces the first article in a series on an ageing population and the implications for eye health and the optometry profession in the UK.

With false eyelashes becoming increasingly popular, optometrists should be aware of the risks involved, writes Rima Evans.

Adrian O’Dowd asks if the growing use of topography in community optometry will lead to wavefront analysis gaining traction as a complementary tool.

Madeleine Bailey looks at the cutting-edge research that may one day lead to a diagnostic eye test for Alzheimer’s disease.

Denise Voon MCOptom, Clinical Adviser for the College, on responding to patients and colleagues with compassionate leadership.

Adrian O’Dowd examines why optometrists need to act on behalf of patients who report temporary sight loss in one eye caused by amaurosis fugax, a potentially serious and sometimes overlooked condition.

Research, including work carried out in high-street optometry practices, is driving innovation in clinical practice and at a policy level, writes Mark Gould.

Amblyopia is a binocular disorder but all too often it is treated monocularly. Becky McCall asks if video game play offers a new way forward.

A scheme for schools to have extra pairs of spectacles to improve vision and academic achievement is now being extended to benefit thousands of children, reports Kathy Oxtoby.

Should optometrists be telling their glaucoma patients to give up yoga and quit coffee, or concentrate on more general lifestyle changes instead? Jo Waters asks three leading experts.

Prashant Shah MCOptom PGDipOphth DipClinOptom examines the case of a patient presenting with a homonymous visual field defect eventually diagnosed as a grade 4 brain tumour.

Graphene is the world’s thinnest, strongest and most conductive substance. Already tested in presbyopia treatment, it is a promising candidate for ocular drug delivery, health monitoring and smart contact lenses, writes Kim Thomas.

What ocular complications does Ehlers-Danlos cause and how should optometrists treat patients with this condition? Léa Surugue reports.

Doing the best for your patients isn’t the same as just following procedures, writes Dr Susan Blakeney FCOptom, Clinical Adviser for the College.

Becky McCall looks at headlight dazzle on the roads, and why complaints about glare to optometrists are rising.

A report on a survey carried out by the College and funded by the Department for Transport (DfT) indicates that optometrists have an important role to play in educating and informing older patients about their fitness to drive.

FTP Committee members explain what happens after a complaint is made.

It is rare for respiratory viruses to cause eye infections, writes Kim Thomas, but they may use the eye as a portal of entry. And what is the mechanism behind their travel to the respiratory system?

Thinking about your experiences to gain insights into your practice, improve patient care and the way you work is all part of reflective practice. Sophie Goodchild explores how to bring the learning tool into personal clinical practice. 

Complaints are inevitable, but the College's Clinical Adviser Dr Susan Blakeney FCOptom offers advice on how to defuse them.

A part of the ageing process or an indication of retinal tear or detachment? George Winter talks to experts about how patients presenting with flashes and floaters should be managed.

Jo Waters asks what are the current grading charts optometrists can use, and how to make the most of them.

Half of those with anterior uveitis carry the HLA-B27 antigen on their white blood cells. Kim Thomas explores the role this genetic association plays in eye disorders.

Claire Moulds examines the impact of a power of attorney on the patient relationship.

Independent prescribing optometrists can establish a diagnosis and determine clinical management, providing better care to patients, writes Georgina Wintersgill

The processes around issuing prescriptions can be confusing. Steve Smethurst asks: what’s required from independent prescribers and what differences divide the UK’s four nations?

Increasing demand for intravitreal injections to treat conditions such as wet AMD provides an opportunity for optometrists to widen their portfolio of skills, writes Kim Thomas.

Daniel Hardiman-McCartney FCOptom, Clinical Adviser for the College, on the vital importance of professional judgement.

Many people suffering from hypertension don’t even know they have a problem. But in the right setting, writes Léa Surugue, Optometrists can be part of the solution.

Joining your local optical committee is good for you – and the future of optometry.

Helen Gilbert describes the industry fine-tuning old areas of expertise and picking up new ones during the pandemic.

Kim Thomas looks at the genesis of the eye and the rich variety of optical systems in the animal kingdom.

Interest is growing in the use of low-level light therapy to remedy dry eye disease. Adrian O’Dowd investigates the evidence behind the treatment.

Ocular surface foreign bodies are a frequently encountered form of ocular trauma, and community practice has an important role to play in their removal, reports Steve Smethurst.

Daniel Hardiman-McCartney FCOptom, Clinical Adviser for the College, on how optometrists should attend to their health and mental wellbeing.

As sharps become more common in optometric practice, Léa Surugue shows how to handle the risks.

Deaf children and adults can struggle to access eye care and vision correction. Sophie Goodchild explores how deaf awareness training for optometrists – and other practice staff – could make optometry services more equitable.

The Low Vision Service Wales has proved a lifeline for patients since it was set up 18 years ago. Helen Gilbert explores the secrets behind its success and the lessons other countries can learn.

Which elements are key to the process of shared decision-making between clinician and patient? Georgina Wintersgill reports.

Georgina Wintersgill asks how patient research on symptoms online impacts on practice, and how you can assess the evidence that supports the right treatment recommendations.

Becky McCall discusses how managed clinical networks enhance regional eye health services.

As many people turned to DIY and gardening to occupy the months at home during lockdown, eye injuries predictably increased – with data suggesting a threefold rise in presentation to emergency eye care. Becky McCall asks how to best manage cases of eye injury.

Ageing and eye health series

Adrian O’Dowd investigates whether genetic nurture plays a significant role in childhood development of myopia alongside a person’s built-in genetics.

The COVID-19 pandemic means optometrists are facing extremely stressful situations. Kathy Oxtoby explores the range of services available in different settings to support mental welfare.

Kim Thomas weighs up the risks and rewards of minimally invasive surgical techniques.

In the lead up to National Eye Health Week 2019, we have created a short explainer video outlining what an optometrist does, and a colourful poster which shows which professionals a patient might encounter in an optometric practice. These resources are now available to access, use and share below.

The National Eye Health Week campaign has been running for more than 25 years, and takes place from 23 to 29 September this year. There’s never been a better time to engage with the opportunities it brings.

The College’s Clinical Adviser, Susan Blakeney FCOptom, looks back at how technology – guided by sensible clinical judgement – has been used to improve optometric practice over the decades.

How do you incorporate occasional wear contact lenses into your everyday practice this summer? Kathy Oxtoby reports on how to introduce the concept to your patients, and the benefits this can bring for them and for your business.

Case study: Specialist optometrist Andrew J Morgan FCOptom discusses a case of ocular ischaemic syndrome and its differential diagnoses, central retinal vein occlusion and diabetic retinopathy.

Ocular cancers are uncommon but serious. Thankfully, there are world-class specialist centres here in the UK. Carina Bailey looks into the service they provide.

A&E optometrists can see everything from DIY mishaps to domestic violence in a day's work, writes Steve Smethurst.

The new discipline of oculomics uses machine learning to detect biomarkers of systemic health in the eye. Kim Thomas asks: how does it work, what are its ethical implications, and will it be the future of the profession?

Clinical case studies can make a small but important contribution to the sum of clinical knowledge. Why do we need them, asks Kim Thomas, and how do you write one?

Evaporative dry eye resulting from meibomian gland dysfunction has been difficult to treat, writes Kim Thomas. But intense pulsed light therapy is being increasingly deployed to tackle it. So does it really work?

Heart attacks transiently increase in number when the clocks go forward. Diabetic retinopathy and glaucoma can interfere with the body’s sleep-wake cycles. Becky McCall examines the relationship between the eye and sleep.

Three optometrists talk about the skills and experience needed to become an effective supervisor.

Kathy Oxtoby looks at the role of the Physician Associate – and why one might be contacting an optometrist soon.

Kaye McIntosh on tackling the lack of standardisation when sharing ophthalmic images.

Pressure on optometrists to treat glaucoma is likely to grow as case numbers are predicted to rise 44% by 2035. Beta blockers will remain a part of the fight ahead, as Adrian O’Dowd reports.

How optometrists can make efforts to minimise their plastic waste.

Reducing the carbon footprint of optometry is increasingly crucial but, asks Steve Smethurst, how can we do it effectively?

Don Williams MCOptom MSc DipTp (IP) PgDip Refractive & Cataract Surgery Prof Cert Med Ret Prof Cert Glauc examines the case of an IOL dropping into the vitreous cavity and resting on the retina.

Kathryn Marshall MCOptom, an optometrist working in community practice in Scotland, describes the surgical complications that can lead to reduced visual outcomes.

Georgina Wintersgill asks what optometrists should consider when seeing pregnant women.

How should optometrists tackle presbyopia solutions with patients, ask Georgina Wintersgill and Kieran Loft MCOptom.

Himali Shah MCOptom Prof Cert Med Ret, Resident Optometrist at Asda Opticians Coventry, on a diabetic patient who suffered reduced visual acuity after cataract surgery.

Adrian O’Dowd looks at why glaucoma is still undetected in some cases and how optometrists can sharpen up their practice.

Jo Waters asks what optometrists need to consider when seeing LGBT+ patients, and how to make your practice more welcoming.

Becky McCall looks at how the latest research has linked air pollution with eye health, and the advice to give patients on how to protect themselves.

Asking patients what they want, videoing consultations and customer service. The College’s Clinical Adviser Dr Susan Blakeney FCOptom provides some food for thought.

A safe space with a culture of transparency can prevent whistleblowing issues in the first place, writes Kim Thomas. But what should optometrists do if they need to highlight malpractice?

We are all guilty of unconscious bias, but recognising our hidden prejudice is the first step to better patient relationships, writes Kathy Oxtoby.

Rima Evans looks at the work of those offering practical support and rehabilitation for people with visual impairment

Often presenting as eyelid-based lesions, basal cell carcinoma has a good prognosis – but can pose a high risk to the eyes and surrounding tissues if left untreated. Optometrists are well placed to help with early detection and referral, Helen Bird learns.

New NICE guidance states that selective laser trabeculoplasty rather than eye drops should be a first-line treatment for glaucoma. Kim Thomas asks what this means for optometrists – and their patients.

Smartphone and tablet vision tests are widely used by optometrists and patients in the US, while robust legislation prevents their use in the UK. But will this always be the case? Carolyn Scott looks for answers.

Visual impairment is common after a stroke, but optometrists can help patients rehabilitate optically and by recommending effective online therapies, writes John Windell.

Regardless of the disability, it's an optometrist's fitness to practise that counts, writes John Windell.

The eye is second only to the liver as the most common site to be affected by drug toxicity.

As the NHS digs deep to clear the backlog of routine ophthalmology consultations, Jo Waters asks optometrists and other experts how they are managing long patient waiting times.

Dr Paramdeep Bilkhu MCOptom, Clinical Adviser for the College, on why PPE should remain on the front line of optometric practice.

How women are taking the lead In optometry and changing the face of the profession.

Four optometrists who have appeared as expert witnesses spoke to Martha Henriques about what it means to assume this responsibility.

The College’s Clinical Adviser Dr Susan Blakeney FCOptom on defensive practice gone mad, and how to manage patients who buy lenses online.

In the final part of our series on ageing, Adrian O’Dowd looks at how technology will play a vital role in eye care for older people.

What are the potential benefits of home glaucoma monitoring – and the challenges to be overcome? Juliette Astrup reports.

Kathy Oxtoby asks what optometrists need to know about antimicrobial resistance.

Becky McCall looks at the eye health risks of cosmetic surgery and make-up in and around the eye.

A new series of global consensus reports provides guidance on evidence-based practice for all aspects of prescribing and fitting contact lenses. Sophie Goodchild looks at how this could change the patient journey.

Daniel Hardiman-McCartney MBE FCOptom on how artificial intelligence will reshape the role of optometrists and ophthalmologists –but not take away their jobs.

With the number of people living with dementia on the rise, Becky McCall asks: how can practitioners ensure that these patients get the eye care they need?

The average age of those with symptoms of posterior cortical atrophy is 58. Kathy Oxtoby asks how optometrists can spot the signs.

Diabetes and its complications account for around 10% of the NHS budget and are projected to swallow up more. Léa Surugue asks what the future holds for national diabetic eye screening.

Papilloedema in its early stages isn’t always easy to spot – and the consequences of getting it wrong can be catastrophic. Steve Smethurst asks: how should optometrists approach diagnosis and referral?

Himali Shah MCOptom, Resident Optometrist at Specsavers, Leicester North, discusses a case of a patient presenting with vitreomacular traction.

Summaries of two research papers from a recent issue of Optometry in Practice.

Summaries of two research papers from a recent issue of Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Summaries of recent papers from Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Summaries of two research papers from a recent issue of Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Here we summarise three research papers from a recent issue of Optometry in Practice.

Summaries of two research papers from a recent issue of Optometry in Practice.

Understanding patient psychology will enable more satisfying consultation experiences – and more appropriate treatment outcomes, says Carina Bailey.

Clinical Adviser for the College Daniel Hardiman-McCartney FCOptom on the epidemic of fake news that has accompanied COVID-19.

Exciting opportunities abound for the optical profession in the new Health and Care Bill, but there are caveats too, reports Jo Waters.

The use of evidence-based optometry is encouraged, but research can be hard to decipher. We break down some commonly used terms.

Professionalism – ethical, patient-centred, communicative behaviour – is just as essential as any other dimension of practice, says Becky McGall.

Is the “reduce, reuse, recycle” trope realistic when it comes to optical products? Kaye McIntosh explores some of the ways in which manufacturers are reducing their footprint while equipping optometrists with the products essential to their business.

Daniel Hardiman-McCartney FCOptom, Clinical Adviser for the College, on delegation, supervision and clinical leadership.

Professor Leon Davies FCOptom reveals the professional passion that has driven him throughout his career, and his ambitions as College President.

Daniel Hardiman-McCartney MBE FCOptom, Clinical Adviser for the College, on the vital importance of effective communication, both with colleagues and with the people we serve.

Adrian O’Dowd explores the more uncommon ocular side effects of newer pharmacological treatments and how to identify them.

Daniel Hardiman-McCartney on harnessing the momentum generated in response to the pandemic.

The College’s Clinical Adviser Dr Susan Blakeney FCOptom on the lessons learned from a case of quadrantopia.

Brush up your knowledge on one of the most remarkable parts of the eye. Kimi Chaddah explores the cornea’s anatomy, its capacity for healing, and promising research avenues in corneal innervation.

Compassion fatigue has peaked during the pandemic. Becky McCall asks how we recognise the signs and how we can all act to stop its spread.

Swimmers and contact lens wearers must be aware of the health hazards arising from wet contact lenses. Rima Evans reports on how optometrists can assess and manage patients’ risk of eye infection.

With the global prevalence of myopia predicted to reach 50% and rates in the UK rising, should optometrists be embracing myopia management techniques? Madeleine Bailey reports.

What complications does undiagnosed diabetes cause, and what is the role of optometrists in detecting and preventing this condition? Kathy Oxtoby reports.

Head-mounted displays using virtual reality are at the leading edge of research into visual field testing. Carina Bailey reports on developments.

Does vitamin D play a role in reducing the risk of COVID-19 infection, and what does this mean to the UK’s BAME communities? Mike Bowen, Director of Research at the College of Optometrists, considers the evidence.

As age-related macular degeneration progresses, part of the visual cortex starts to atrophy. But which way does the causal relationship work, asks Kim Thomas, and what does it mean for treatments focused on the retina if the brain has entered an irreversible decline?

Since October 2017, NICE has issued two new clinical guidelines and one update concerning the three most common age-related causes of sight loss. Madeleine Bailey looks at what it means for you – and NHS eye services overall

Léa Surugue asks how optometrists should broach clinical top-up fees in the consulting room, and how to avoid alienating patients with the “hard sell”.

The College’s Clinical Adviser Dr Susan Blakeney FCOptom deals with anonymous enquiries and her favoured order of routine tests.

Read, download and print Acuity's hand-washing infographic.

Adrian O’Dowd asks how optometrists should respond to a rise in the rate of retinoblastoma in children across Europe.

Becky McCall asks how shifts in working practices caused by the COVID-19 pandemic might change the ophthalmic services workforce.

Despite compulsory safeguarding training every two years, optometrists can still feel unsure of their duties. Kathy Oxtoby looks at what to do if you suspect a patient requires safeguarding.