Content Of Instructions Research Articles

Health Literacy Assessment of Labeling of Pediatric Nonprescription Medications: Examination of Characteristics that May Impair Parent Understanding

ObjectivePoor quality and variability of medication labeling have been cited as key contributors to medication misuse. We assessed the format and content of labels and materials packaged with common pediatric liquid nonprescription medications. MethodsDescriptive study. A total of 200 top-selling pediatric oral liquid nonprescription medications (during the 52 weeks ending October 30, 2009) categorized as analgesic, cough/cold, allergy, and gastrointestinal products, with dosing information for children <12 years (representing 99% of U.S. market for these products) were reviewed. The principal display panel (PDP) and FDA Drug Facts panel (side panel) of each bottle, and associated box, if present, were independently examined by 2 abstractors. Outcome measures were content and format of active ingredient information and dosing instructions of the principal display panel and Drug Facts panel. ResultsAlthough almost all products listed active ingredients on the Drug Facts panel (side panel), nearly 1 in 5 (37 [18.5%]) did not list active ingredients on the PDP. When present, mean (SD) font size for PDP active ingredients was 10.7 (5.0), smaller than product brand name (32.1 [15.0]) and flavor (13.1 [4.8]); P < .001. Most products included directions in chart form (bottle: 167 [83.5%], box: 148 [96.1%], P < .001); mean (SD) font size: 5.5 (0.9; bottle), 6.5 (0.5; box), P < .001. Few products expressed dosing instructions in pictographic form: 4 (2.6%) boxes and 0 bottles. Nearly all products included the Food and Drug Administration−mandated sections. ConclusionsThe format and content of labels for nonprescription pediatric liquid medications could be improved to facilitate parent understanding of key medication information, including active ingredient information and dosing instructions.

Readability and Content of Postoperative Tonsillectomy Instructions Given to Patients in Scotland, a Completed Audit Cycle

The aim of this study was to assess the impact of the recommendations and interventions of the 2003 audit of 'readability and content of postoperative tonsillectomy instructions, given to patients in Scotland'. A two-cycle audit of readability and content of postoperative tonsillectomy instructions was undertaken. All National Health Service (NHS) hospital wards and associated Otolaryngology Departments in Scotland where tonsillectomies were being performed were contacted. Interventions following the first cycle included the mailing copies of original audit results and conclusions to all ear, nose and throat wards in Scotland, presentation at a National Meeting and publication of results in a peer reviewed journal. While changes had occurred in 61% of the information sheets, and with six of the 31 (19%) postoperative information sheets now being written at or below the recommended reading level, the average reading grade/age required to understand these information sheets still remains above those recommended by patient education experts. In conclusion, the majority of postoperative tonsillectomy information sheets in Scotland remain written at a level above those recommended by patient education experts. The interventions undertaken in this audit were of limited success. The ENT-UK Tonsillectomy Information sheets (2006) are written at reasonable reading levels, have good content levels and we continue to recommend these information sheets.

Influence of interactivity on emotions and enjoyment during consumption of audiovisual fictions

The effect of interactivity, content and type of instructions on emotions and enjoyment in audiovisual fictions was observed in order to obtain data on interactive entertainment 310 university students were randomly assigned to one of six experimental situations, combining: modality of consumption (interactive or non–interactive), content (happy or sad ending) and type of instructions (operative or affective). Then, all subjects were asked about the emotions, enjoyment and gratification they experienced while watching the film. Main results show the existence of differences in some emotions depending on the modality of film perception. The interactive modality produces higher levels of interest, surprise and guilt compared to the conventional modality. Besides, the analysis shows that interactivity, in itself, does not affect enjoyment. These and other findings are discussed in relation to media entertainment.

“Sign Right Here and You're Good to Go”: A Content Analysis of Audiotaped Emergency Department Discharge Instructions

The goal of this study is to quantitatively and qualitatively assess the quality and content of verbal discharge instructions at 2 emergency departments (EDs). This was a secondary data analysis of 844 ED audiotapes collected during a study of patient-emergency provider communication at 1 urban and 1 suburban ED. ED visits of nonemergency adult female patients were recorded with a digital audiotape. Of 844 recorded ED visits, 477 (57%) audiotapes captured audible discharge instructions suitable for analysis. Audiotapes were double coded for the following discharge content: (1) explanation of illness, (2) expected course, (3) self-care, (4) medication instructions, (5) symptoms prompting return to the ED, (6) time-specified for follow-up visit, (7) follow-up care instructions, (8) opportunities for questions, and (9) patient confirmation of understanding. Analysis included descriptive statistics, χ(2) tests, 2-sample t tests, and logistic regression models. Four hundred seventy-seven of 871 (55%) patient tapes contained audible discharge instructions. The majority of discharges were conducted by the primary provider (emergency physician or nurse practitioner). Ninety-one percent of discharges included some opportunity to ask questions, although most of these were minimal. Only 22% of providers confirmed patients' understanding of instructions. Verbal ED discharge instructions are often incomplete, and most patients are given only minimal opportunities to ask questions or confirm understanding.

奈良女子高等師範学校における薙刀教育

The purpose of this study was to clarify how naginata education was practiced at the Women's Normal College of Nara (WNCN) from 1911, when naginata was first introduced, to 1946, when it was abolished, based on analysis of historical documents preserved at the WNCN and the book used by the instructor.The main educational purpose of the WNCN, which was founded toward the end of the Meiji era to train women teachers, was to cultivate feminine virtues such as chastity and elegance. Naginata was practiced in order to achieve these virtues through physical and mental training.Naginata education at the WNCN was studied by analyzing the content of instructions drawn up by naginata schools, with a focus on naginata instructors. This revealed that naginata was taught at the WNCN for 35 years, during which three Kyoshin-ryu instructors taught for 25 years and two Tendo-ryu instructors taught from Butokukai for nine years. From 1911 to 1936, naginata was a compulsory extracurricular subject for first- and second-year students and an elective extracurricular subject for third- and fourth-year students. The instruction based on Kyoshin-ryu was unique in that Arai, with support from the college, adapted the lesson forms for teaching at the school, including the use of easy forms, lessons in the early morning, introduction of kangeiko (winter practice), and presenting certificates to diligent students.It is also confirmed that Mitamura Chiyo was installed as a naginata instructor at the WNCN when the discipline was incorporated into the regular curriculum in 1937.The results of this study confirm that naginata education based on Instruction Guidelines for School Gymnastics issued by the Ministry of Education had been practiced at the WNCN before World War II.

Reducing racial bias in the penalty phase of capital trials

Past research (e.g. Lynch & Haney, 2000) has shown that race plays a significant role in juror decision making in the penalty phase of capital murder trials. This study investigates the possibility of reducing juror bias towards Blacks by altering the content of jury instructions. White and non-White participants received trial information and jury instructions in which the defendant's race (Black or White) and the instruction type (standard or simplified) were manipulated. Participants rendered a sentence recommendation, identified factors they considered to be aggravating or mitigating, and responded to instruction comprehension questions. Bias against the Black defendant was significantly reduced when simplified instructions were used and when the defendant was judged by racially diverse jurors. Simplification also led to better comprehension of sentencing instructions. Implications for capital trials are discussed.

The availability and content of dental instrument manufacturers' decontamination information

The effective decontamination of reusable dental instruments is essential to reduce the risks from onward transmission of infectious diseases. There are therefore a number of legislative requirements placed upon manufacturers of medical devices (which includes dental instruments) to provide validated methods for the reprocessing of such devices. The aim of this study was to determine the availability and content of manufacturer's instructions for the reprocessing of reusable dental instruments. A database of reusable dental instruments with details of their manufacturers was collated from information received from three dental hospitals. A questionnaire was sent to all the manufacturers requesting information about the reprocessing instructions for their products. The response from each manufacturer was assessed for the quality of the information and compliance with the British, European and International Standard, BS EN ISO 17664 (2004). The database from the three dental hospitals included over 800 items supplied by 54 different manufacturers/suppliers. Forty protocols were available for assessing compliance with BS EN ISO 17664 (2004). These protocols accounted for 25 (46%) manufacturers covering 300 devices. The majority (90%) of the returned questionnaires did not comply with the required standard and provided insufficient information to allow for the effective decontamination of the instruments. Manufacturers of medical devices are legally required to supply the user with validated instructions to enable effective decontamination of these devices. The information must be in a format as specified in BS EN ISO 17664 (2004). The information obtained in this survey demonstrated that the manufacturers' instructions fall short of the required regulatory requirements. The absence of such instructions increases the risk of cross-infection arising from inadequate cleaning, decontamination and sterilisation.

Summary of: The availability and content of dental instrument manufacturers' decontamination information

Objective The effective decontamination of reusable dental instruments is essential to reduce the risks from onward transmission of infectious diseases. There are therefore a number of legislative requirements placed upon manufacturers of medical devices (which includes dental instruments) to provide validated methods for the reprocessing of such devices. The aim of this study was to determine the availability and content of manufacturer's instructions for the reprocessing of reusable dental instruments. Materials and methods A database of reusable dental instruments with details of their manufacturers was collated from information received from three dental hospitals. A questionnaire was sent to all the manufacturers requesting information about the reprocessing instructions for their products. The response from each manufacturer was assessed for the quality of the information and compliance with the British, European and International Standard, BS EN ISO 17664 (2004). Results The database from the three dental hospitals included over 800 items supplied by 54 different manufacturers/suppliers. Forty protocols were available for assessing compliance with BS EN ISO 17664 (2004). These protocols accounted for 25 (46%) manufacturers covering 300 devices. The majority (90%) of the returned questionnaires did not comply with the required standard and provided insufficient information to allow for the effective decontamination of the instruments. Conclusions Manufacturers of medical devices are legally required to supply the user with validated instructions to enable effective decontamination of these devices. The information must be in a format as specified in BS EN ISO 17664 (2004). The information obtained in this survey demonstrated that the manufacturers' instructions fall short of the required regulatory requirements. The absence of such instructions increases the risk of cross-infection arising from inadequate cleaning, decontamination and sterilisation.

Discharge Instructions in the Outpatient Setting: Nursing Considerations

More and more patients are receiving increasingly sophisticated medical and nursing care in the outpatient or ambulatory setting. Indeed, patients now accept the idea of going home only hours after surgery, or following other therapeutic and/or diagnostic procedures and interventions. This has come to be and remains the health care delivery norm where there is a demand for greater efficiencies and cost containment. As such, the content and delivery of discharge instructions that outpatients receive from nursing staff is more important than ever. This article will pose and answer some critical questions relative to a nurse's understanding and delivery of effective discharge instructions in the outpatient setting.

The Content of Medical Journal Instructions for Authors

We describe the general and statistical content of the Instructions for Authors of major medical journals. This article reports on 2 observational studies. In study 1, we investigated the online versions of Instructions for Authors of 166 journals from 33 specialties for the presence of content about 15 methodologic and statistical topics. In study 2, we categorized the general content of the online versions of the Instructions for Authors of 35 medical journals. Two abstractors independently assigned the content into 18 categories and counted the total number of words devoted to each category. Interrater reliability of the classification was assessed. Less than half of the 166 Instructions for Authors in study 1 provided any guidance on statistical methods, and the majority failed to cite accepted publication standards such as the International Committee of Medical Journal Editors Uniform Guidelines or CONSORT. Only 13% of journals commented on the content and style of data tables and figures. The 35 Instructions for Authors in study 2 varied greatly in length (mean 3,308; median 2,283; range 885 to 18,927) and, with few exceptions, focused on formatting issues. Forty-three percent of Instructions offered no advice on scientific content, and only 5 journals devoted more than 10% of their words to scientific content. There is great heterogeneity among medical journal Instructions for Authors. Instructions provide little guidance about methodologic and statistical issues, and the advice provided is often contradictory among journals.

Summoning White Bears or Letting Them Free: The Influence of the Content of Control Instructions on Target Thought Frequency

In the clinical literature, thought suppression is considered to play a role in the development of intrusion-related psychiatric syndromes, such as obsessive-compulsive disorder, acute or posttraumatic stress disorder, phobias, and addiction. This assumption goes back to a study by D. M. Wegner, D. J. Schneider, S. R. Carter, and T. L. White (1987) in which participants were asked to suppress thoughts of a white bear, an assignment that proved to be nearly impossible to complete. The present two studies sought to explore the influence of the content of control instructions on intrusion frequency in thought suppression experiments. Notably, during nonsuppression (i.e., control) periods, participants can either be instructed to think about white bears (i.e., expression instruction), or to think of anything including white bears (i.e., liberal instruction). Results indicated that expression instructions resulted in an increased number of target thoughts, while liberal instructions did not. Implications for the interpretation of thought suppression findings are discussed.

Ballot Design and Unrecorded Votes on Paper-Based Ballots

The 2000 presidential election focused attention on the problem of unrecorded votes, in which a person casts a ballot but fails to record a valid vote for a particular contest. Although much recent research has evaluated voting technologies and their effects on unre- corded votes, there has been little research on the effects of ballot design. We argue that the same theories used to design and evaluate self-administered surveys can be used to analyze ballot features. We collect and code paper-based ballots used in the 2002 general election from 250 counties in 5 states. We code the ballots in terms of several graphic design elements, including the content and location of ballot instructions and the layout of candidate names and office titles. Our analysis suggests that several ballot features are associated with unre- corded votes (both overvotes and undervotes) in the gubernatorial con- tests. We also find that ballot design features exacerbate the racial disparity in unrecorded votes. Ballot design can be an important factor in determining whether voters are able to cast a ballot accurately, which can influence the legitimacy of elections. The 2000 presidential election and the Florida recount controversy illumi- nated the phenomenon of unrecorded votes (in which some voters come to polling places but fail to cast a valid vote for a particular contest). Roughly 2 million voters (almost 1 out of every 50 to cast a ballot) failed to cast a valid vote for president in the 2000 election (Caltech/MIT Voting Technology Project 2001). The Florida imbroglio prompted a new wave of research on election administration and a flurry of election reform laws in Congress and

Vision-based urban navigation procedures for verbally instructed robots

When humans explain a task to be executed by a robot they decompose it into chunks of actions. These form a chain of search-and-act sensory-motor loops that exit when a condition is met. In this paper we investigate the nature of these chunks in an urban visual navigation context, and propose a method for implementing the corresponding robot primitives such as “take the nth turn right/left”. These primitives make use of a “short-lived” internal map updated as the robot moves along. The recognition and localisation of intersections is done in the map using task-guided template matching. This approach takes advantage of the content of human instructions to save computation time and improve robustness.

Event based and time based prospective memory in Parkinson’s disease

Background: Patients with Parkinson’s disease have been reported to have retrospective memory impairment, while prospective memory, which is memory for actions to be performed in the future, has not yet...

Re-engineering Payment Systems for the E-world

Payment systems are undergoing rapid changes stimulated largely by technological progress. Distributed network technology, real-time processing and customers’ willingness to use electronic banking interfaces will further reshape payment systems during the coming years. Internet and e-commerce will have a major impact on payment systems. This paper presents the current developmental trends. It analyses the need to develop payment standards and the content of payment instructions in order to fully automate the payment process. Since interbank settlements comprise an essential part of payments, they should be made an integral part of the payment process within the Internet environment. With cross-border payments increasing in importance, any new developments should take an international perspective. Payment system development requires cooperation between the banks and other participants involved. In order to build the necessary consensus, banking industry organizations as well as central banks and other regulators will need to work together to re-engineer the present payment systems, making full use of the possibilities created by modern technology.

The participation of pharmacists in a team to introduce a clinical pathway to laparoscopic cystectomy in obstetrics and gynecology.

In the Department of Obstetrics and Gynecology at our hospital, a team of doctors, pharmacists, nurses, and other medical staff was established to prepare a clinical pathway for laparoscopic cystectomy. Various data on clinical charts including the use of drugs were collected from 57 patients by pharmacists and nurses. Based on the analysis of these data, hospitalization period, method of preoperative bowel preparation, time to initiation of food intake, duration of antibiotic administration, and time and content of pharmaceutical instructions to patients of dosage and administration were determined. Criteria for variances requiring the doctor's directions were determined for fever, wound pain, and vomiting. The clinical pathway established here allows of not only the efficient and uniform care of patients, but also the active exchange of opinions among members of the medical team. Moreover, most patients who replied to a questionnaire said that they were at ease during hospitalization because they had received detailed information about the clinical pathway including the use of drugs before surgery. Thus, the participation of pharmacists on a medical team that is introducing a clinical pathway is particularly important because the use of drugs and pharmaceutical care are an important part of good patient care.

Instruction begins in the home: Relations between parental instruction and children's self-regulation in the classroom.

The study examined the effectiveness of 3 aspects of parental instruction for predicting children's self-regulation in school. Fathers, mothers, and their children (52 families) were visited in their homes the summer before the child entered 3rd grade. Metacognitive content (task and strategy information), manner of instruction (small steps at an appropriate pace), and emotional support were coded from parents' instructions to their children for a problem-solving task. Children's self-regulatory behaviors in the classroom were assessed the following school year. Two patterns of relations were observed. Manner of instruction predicted children's attention to instructions and help-seeking in the classroom. Metacognitive content of instructions did not predict these aspects of self-regulation. In contrast, metacognitive content of instructions presented in an understandable manner with emotional support predicted children's monitoring and metacognitive talk.

Re-Engineering Payment Systems for the E-World

Payment systems are undergoing rapid changes stimulated largely by technological progress.Distributed network technology, real-time processing and customers' willingness to use electronic banking interfaces will further reshape payment systems during the coming years.Internet and e-commerce will have a major impact on payment systems. This paper presents the current developmental trends.It analyses the need to develop payment standards and the content of payment instructions in order to fully automate the payment process.Since interbank settlements comprise an essential part of payments, they should be made an integral part of the payment process within the Internet environment.With cross-border payments increasing in importance, any new developments should take an international perspective. Payment system development requires cooperation between the banks and other participants involved.In order to build the necessary consensus, banking industry organizations as well as central banks and other regulators will need to work together to re-engineer the present payment systems, making full use of the possibilities created by modem technology. Key words: payment systems, settlement systems, RTGS, payment system integration

Consumers and self-assembly products: problems and solutions

Children sometimes have accidents when using large items of play equipment, and whilst many are due to poor design or lack of supervision, some are due to inadequate or incorrect assembly. OBJECTIVES To examine the possibility of incorrect assembly and identify the consequences of errors and the resultant increase in hazards. METHODS The study collected accident statistics, surveyed the market and reviewed the literature. A variety of equipment was purchased and the instructions evaluated. Finally, trials with users were completed where the assembly procedure, time taken, errors made and subjective ratings were recorded. RESULTS Little literature was found but accident data from the UK, US and Australia showed minor injuries possibly attributable to assembling the product. Expert appraisals were conducted on 40 products to assess the instructions, assembly process and design, as well as the hazards presented during assembly and in use. Trials involving 100 representative subjects allowed observation of the assembly of products. The results showed a number of minor problems and hazards with the products. CONCLUSIONS The following improvements were recommended: • Standards applying to products requiring self-assembly should address the self-assembly process; • Accurate and meaningful information should be provided on the packaging;• Attention should be paid to the presentation and content of the product instructions • Products should be designed so that the assembly process is possible, relatively easy and safe to complete; Product components should be well designed, well machined and strong enough for the intended purpose. Furthermore, consumers must recognise their duty to make sensible purchases and to be responsible during assembly and use.

Conversation and Cooperation in Social Dilemmas

This article presents an analysis of 35 years of published experiments testing decision making in prisoners' dilemmas. The objective is to begin to reconnect the theory and the evidence of rational behavior by accumulating the experience of the laboratory and examining this record for those factors that consistently altered subjects' choices. It is shown that a model of pure self-interest is usually inconsistent with the results of experimental decision making, predicting either the wrong sign, as in the case of monetary stakes, or ignoring influential variables, such as the content of instructions. This incongruity is widest with respect to the role of language in encouraging cooperation.