Small Print Research Articles

Patient perception of contemporary nurse attire: A pilot study

Patients have expressed difficulty accurately distinguishing registered nurses (RNs) from other hospital personnel because standardized uniforms are no longer worn by RNs. According to American studies, such complaints are widespread; moreover, patients' perceptions of nurse caring and competence and of other traits associated with nurses' professional image have been negatively affected by casual, non-conventional attire. As there are no published Canadian studies, we conducted a pilot study to examine patient perception of the nurse uniform. Adult patients viewed photographs of the same RN dressed in eight different uniforms and rated each uniform according to 10 traits associated with nurses' professional image. The white pantsuit scored higher for professionalism than uniforms with small print, bold print, or solid colour, and most patients preferred that the RN dress in white. Our preliminary findings suggest that RN attire warrants further investigation, and we are planning a large-scale, fully powered study to inform patient-driven change to existing uniform policies.

Detail in the small print

Poring over the finer elements of policy documents will not be to everyone's taste, however, as manager you need to have a grasp of what your insurance does, and importantly what it does not, cover you for.

Epilepsia and the rough seas of medical publishing

<i>Epilepsia</i> and the rough seas of medical publishing

Life as a doctor: the small print in the job description

Managers seem to have little understanding of the workload involved in caring for patients. Yasmin Akram considers the pressures of day to day working life for junior doctors

Attributes Associated with Eye Care Use in the United States: A Meta-Analysis

To model the factors that are associated with the use of eye care services among the US population with and without diabetes, stratifying by age group. Meta-analysis. We analyzed data from 3 datasets: the Behavioral Risk Factors Surveillance System combined years 2006-2009, the National Health and Nutrition Examination Survey combined years 2005-2008, and the National Health Interview Survey year 2008. For all 3 datasets, we analyzed data from all survey participants aged 40 years or older who participated in vision-related survey modules. We performed multivariate logistic regression analyses to assess associations between any eye care use within the previous year and 14 indicators of patient demographics and health. We estimated separate regressions for persons with and without diabetes stratified by age group. We combined estimates across datasets using a random effects model estimated using Markov Chain Monte Carlo algorithms. Use of eye care in the previous year and personal factors associated with eye care use. Annual eye care use rates ranged from 46% to 51% in participants without diabetes and 64% to 72% in participants with diabetes. For people with and without diabetes, health insurance, an eye disease diagnosis, and higher income were associated with higher odds of eye care use. Being male was associated with lower odds of eye care use in some diabetes status and age group categories. Other variables, such as more education, being married, black race, Hispanic/Latino ethnicity, health status, heavy drinking, and limited ability to read small print, were associated with eye care use in only some diabetes status and age group categories. Our findings indicate that economic and ocular health factors are associated with the greatest odds of annual eye care use. Access to health insurance and income levels greater than $35 000 US dollars (value at the time of interview) are associated with eye care use independently of other demographic factors.

Visual Performance after Bilateral Implantation of a new Diffractive Aspheric Multifocal Intraocular Lens with a 3.5 D Addition

To evaluate visual performance after implantation of a new diffractive aspheric multifocal intraocular lens (MIOL) with a +3.50 D addition power. A total of 24 cataract patients were bilaterally implanted with the Diffractiva-aA MIOL in 2 ophthalmologic centers and followed for 6 months. Postoperative evaluations included visual acuities (VA) at various distances, defocus testing, contrast sensitivity (CS) measurements, and patient satisfaction questionnaire. Six months postoperatively, binocular uncorrected VA (mean ± SD; logMAR) was 0.00 ± 0.05 (≈ 20/20) for distance, 0.06 ± 0.13 (≈ 20/23) for intermediate (1 m), and 0.00 ± 0.05 (≈ 20/20) for near (40 cm). All patients achieved uncorrected VA of 20/25 or better for distance and near, and 20/40 or better at 1 m. Monocular and binocular defocus curves showed 2 peaks of maximum VA at the distance focus (0.0 D) and the near focus (-2.5 D) and a good range of intermediate vision with the lowest mean acuity being at -1.5 D defocus. Photopic and mesopic CS were within the standard normal range. The majority of patients (n = 22; 91.7%) were spectacle independent; 8.3% (n = 2) reported wearing glasses occasionally for very small print (1 patient) or for watching television (1 patient). Overall, all patients were "very satisfied" (n = 22; 91.7%) or "satisfied" (n = 2; 8.3%) with the procedure. The new Diffractiva-aA MIOL provided a full range of vision from near to far generating highly satisfied, spectacle independent patients with only minimal visual disturbances at night.

But It's Doctor Recommended and I Read the Fine Print: Antecedents to Drug Companies' Perceived Credibility

Using 2009 National Consumer Survey data from Experian Simmons, the authors found that dependence on doctor recommendations to assess the integrity of advertised drugs and the extent of reading small print in direct-to-consumer prescription drug advertising positively related to consumers' perceived credibility of health information from pharmaceutical companies, which in turn positively influenced willingness to ask their doctor for a specific medicine they saw or heard advertised. The potential effect of small print reading on willingness to request prescription was partially mediated by perceived credibility of information from drug companies. The findings are discussed in light of their practical implications.

RESPONSIBILITY AND THE VALUE OF CHOICE

Imagine that you are struggling to finish a project, with the deadline fast approaching. Nearly done, you are about to print out what you have finished when a dialog box appears on your computer screen telling you that you must download and install an update for some piece of software. Frustrated, you try to make it go away, but it keeps reappearing. So you relent and click on ‘Install’, and your screen is filled with small print listing ‘Terms and Conditions’. You do not have time to scroll through the whole thing. So you click ‘Agree’. The installation begins, and you are relieved that it takes only a few minutes. Soon you are back at work and have finished your project.

Executive Presence: The Intangible Leadership Essential

When executives and administrators rise to leadership on campus, it's only partly through their technical skills. Many began their careers with excellence in academics or athletics, adding expertise in management and budget along the way. But rising stars also bring a less tangible quality: executive presence. They inspire trust and confidence from the moment they enter the room. Panelists at the NACWAA convention in Kansas City MO in October 2012 suggested ways women could enhance their executive presence. Dutch Baughman, executive director of the Division IA Athletic Directors' Association, said we constantly give out messages about ourselves—but not always the message we intend. For example, consider this sign: What message does a passing motorist get from this sign? Does it take work to find the key fact buried in small print on the last line—that the bridge is out? Strangers and associates read you like a highway sign. Do they see you as having sharp edges? Is your large print mostly negative? Is the real message an afterthought? You can control the messages you give out. Baughman's organization runs an annual three-day institute for senior-level associate directors of athletics who have the interest and potential to become athletic directors. One focus of the institute is to help the rising leaders take charge of how they come across. He said, “When they embrace executive presence in all they do, it's amazing!” “All look your best,” Peter Pan warned the lost boys as they got set to enter the house they had built for Wendy. “First impressions are awfully important.” Plato described the mind as a wax tablet into which sights and experiences are pressed, leaving a permanent mark or impression as the wax hardens. We leave impressions wherever we go, based on how we look and what we say and do. Once an impression takes shape, it is difficult to change. First impressions are visual, made before you utter a word. “Seventy percent of impressions are formed in the first four to six seconds,” Baughman said. Then your words and deeds add other impressions like tiles to a mosaic. Impressions develop into opinions: conclusions, judgments or estimations of value, based not on positive knowledge but on how things seem to be. Parts of how people judge you are within your control. He listed dozens of “impression points” that affect your executive presence: He also listed “reaction impression points” that leave a negative impression that's hard to overcome. Avoid: sexist language, other inappropriate language, body piercing, profanity, smoking, tattoos, inappropriate jewelry and furs. She told of her first meeting in 1992 with Dr. Donna Lopiano, former women's AD at the University of Texas and founding head of the Women's Sports Foundation. As associate AD at Purdue University IN, Comstock was attending a basketball tourney at Texas and always dressed well for games. Walking into the gym to meet the great Lopiano, she realized that the two black shoes on her feet didn't match. When she couldn't find a table to hide behind, she quipped, “I just thought I'd try on a couple of different shoes today.” Women get judged on their clothing and hair more constantly than men do. Each woman has her own personal style. As a new VP, Comstock started wearing her hair longer, but decided she didn't like it so cut it short again. She recommended becoming a regular customer at a good store where they will phone you when they get something in your style. Find a good tailor who can make you look professional. “We tend to be in situations where we're the only woman so we need to be disciplined about how we react,” she said. Take care with your self-talk and ignore the chatter around you. She credited mentors, sponsors and successful women for teaching her the tricks of the trade. Presence that inspires trust and confidence goes more than skin deep. You are judged on your credibility as well as your work product, said Anucha Browne Sanders, VP of women's basketball championships at the NCAA. Chairing the panel was Robin Harris, executive director of the Ivy League and newly named NACWAA president. She said executive presence is all about self-confidence. Women look at a new position for which they have nine of the ten qualifications and focus on the one that they lack. Men tend to bluster through and figure they'll learn any skills that they're missing. “Dress is important. I have to dress up whenever I go to a sporting event because some AD may introduce me to their president,” she said. From the surface details that leave indelible impressions to your authentic core, the presence you bring to every interaction is an essential part of leadership. Ignore it at your peril. Contacts: Dutch Baughman, db@d-1a.com Robin Harris, robinharris@ivyleaguesports.com

Hospital exclusion clauses limiting liability for medical malpractice resulting in death or physical or psychological injury: What is the effect of the Consumer Protection Act?

In 2002 the Supreme Court of Appeal ruling in Afrox Healthcare Beperk v. Strydom held that the common law allows hospitals to exclude liability for medical malpractice resulting in death or physical or psychological injury – except in the case of gross negligence. The effect of this judgment has now been superseded by the provisions of the Consumer Protection Act of 2008, which came into effect in March 2011. The Act states that unfair, unreasonable or unjust contract terms are prohibited and that certain terms and conditions have to be drawn to consumers’ attention and cannot be buried in the small print. It is argued that as a result of the Act, exclusion clauses that unfairly, unreasonably or unjustly protect hospitals from liability for death or bodily or psychological injury caused by the fault of their staff, may be declared by the courts to be invalid and not binding on consumers. They may also be regarded as unconstitutional.

Molecular Biology Techniques Q&amp;A

Molecular Biology Techniques Q&amp;A

Microinsurance and natural disasters: Challenges and options

Providing disaster microinsurance to low income individuals is far from easy. Designing and structuring products so that they can be sold at low cost raises a set of challenges, and even then the level of voluntary purchase can be disappointingly low. Recent innovations in providing agricultural insurance could have broad implications for other disaster microinsurance products. If a market is to be viable governments will have key roles to play, including: approving insurance policy small print and product designs; supporting or leading industry-wide investments in data collection, index design, and loss adjustment capacity; financing sustained public information campaigns; nudging or compelling purchase; and committing to limits on post-disaster financial assistance to the uninsured. If disaster microinsurance prices do not accurately reflect the risks faced, the presence of disaster microinsurance can distort incentives to migrate. However, in the presence of risk-based pricing, it seems plausible that disaster microinsurance could make it easier for people to stay where they are even as their environment becomes more fragile, yet increase post-disaster migration through increasing post-disaster wealth.

The Importance of Rating Scale Design in the Measurement of Patient-Reported Outcomes Using Questionnaires or Item Banks

To investigate the effect of rating scale designs (question formats and response categories) on item difficulty calibrations and assess the impact that rating scale differences have on overall vision-related activity limitation (VRAL) scores. Sixteen existing patient-reported outcome instruments (PROs) suitable for cataract assessment, with different rating scales, were self-administered by patients on a cataract surgery waiting list. A total of 226 VRAL items from these PROs in their native rating scales were included in an item bank and calibrated using Rasch analysis. Fifteen item/content areas (e.g., reading newspapers) appearing in at least three different PROs were identified. Within each content area, item calibrations were compared and their range calculated. Similarly, five PROs having at least three items in common with the Visual Function (VF-14) were compared in terms of average item measures. A total of 614 patients (mean age ± SD, 74.1 ± 9.4 years) participated. Items with the same content varied in their calibration by as much as two logits; "reading the small print" had the largest range (1.99 logits) followed by "watching TV" (1.60). Compared with the VF-14 (0.00 logits), the rating scale of the Visual Disability Assessment (1.13 logits) produced the most difficult items and the Cataract Symptom Scale (0.24 logits) produced the least difficult items. The VRAL item bank was suboptimally targeted to the ability level of the participants (2.00 logits). Rating scale designs have a significant effect on item calibrations. Therefore, constructing item banks from existing items in their native formats carries risks to face validity and transmission of problems inherent in existing instruments, such as poor targeting.

Cannot cannulate

Cannot cannulate

Tough decisions

David Buckton, Director of South Essex Insurance Brokers, demystifies the small print surrounding euthanasia on humane grounds

''Guess at the Rest'': Cracking the Hogarthian Code (review)

Reviewed by: ''Guess at the Rest'': Cracking the Hogarthian Code Kate Grandjouan Elisabeth Soulier-Détis, “Guess at the Rest”: Cracking the Hogarthian Code (Cambridge: The Lutterworth Press, 2010). Pp. 232. £28.00. In “Guess at the Rest” Elisabeth Soulier-Détis focuses on the serial prints that Hogarth published between 1732 and1747, finding them full of Masonic symbols. These are “too numerous to be discarded as mere coincidence” (19). Furthermore, they are “not just scattered at random” (21) but are intertwined with the biblical and mythological iconographies that are a feature of each narrative sequence. Thus, the presence of paintings on a back wall; or the symbols placed around the borders of prints; or even more obliquely, the ways in which a secular narrative could function as a parody of a biblical source, gain “coherence and unity” (200) when read in relation to Masonic materials. According to Soulier-Détis, Freemasonry provided Hogarth with a means of topically recycling biblical and classical subjects. The main thrust of her argument, however, is concerned with demonstrating how the prints can be understood as Masonic documents that record history and ritual. [End Page 336] Each series is given a new title that corresponds to its secret Masonic agenda. A Harlot’s Progress is called the “Progress of Early British Masonry,” and the tragic life of a London prostitute is understood as an allegory for the creation of the First Grand Lodge in London. A Rake’s Progress becomes “The Path to Unity between ‘Antients’ and ‘Moderns,’” for it comments upon an internal dispute between two Masonic factions. In Marriage à la Mode (or “The Union of Mercury and Silver”), the doomed marriage of two incompatibles is used to encode another topical debate, this time the relationship between alchemy and Freemasonry. Industry and Idleness becomes “Fake and Genuine Freemasonry,” offering a critique of the fashionable and insincere newcomers who were infiltrating lodges in the 1740s. That Hogarth was a Freemason is a biographical fact. He joined a London lodge in November 1725, at a time when the movement was becoming fashionable. By 1738 he had risen to a position of authority; his name is listed as a “Grand Stewart” in the New Book of Constitutions published that same year. Becoming a Freemason has been considered an adroit move by his biographers. Mostly, however, any discussion of Hogarth’s Freemasonry has occurred in the context of a small satirical print of 1724 called The Mystery of Masonry Brought to Light by the Gormogons. Apart from several portraits of known Freemasons and a few explicit references to Masonry in a couple of graphic satires published in the late 1730s, the subject has been considered a minor fact of the artist’s early life and has been passed over in silence by scholars. Therefore, the author’s claim that Hogarth was so immersed in Freemasonry and so “conversant” (14) with its symbology, and that he had its “motifs in mind when holding the burin” (14) is a fascinating hypothesis. She returns us to scrutinizing the prints with an alternative set of questions, although she has a difficult argument to make. In effect, Soulier-Détis is arguing that Masonic symbology is hidden from the general viewer, but that it would have been “clearly visible” (18) to a Freemason, who would have seen the motifs in an alternative context. Visual codes (mostly of a religious and allegorical nature) have protected them, and unraveling them means ignoring the explicit narrative and analyzing numerous details and connecting them into counter-narratives that stand in stark contradiction to established and/or self-evident readings. These peculiar asymmetric relationships between what is visually obvious but symbolically opposite applies in particular to the Harlot’s Progress and the Industrious and Idle Apprentice, because for Freemasons “all the negative signs of poverty, disease and death” would be read “as positive tokens of rebirth and regeneration” (61). Thus, Moll’s tawdry life, her imprisonment, and her subsequent death are understood to encode the triumphant progression of Masonry in England and her accession—as an allegorical symbol for the movement—to the elevated rank of Grand Master. Meanwhile, Frances Goodchild, the good apprentice who works hard...

Searching for giants in the small print

It seems that there is never a shortage of things to write about. maybe I am just getting older and grumpier – and I have certainly been accused of just that – but I seem to be questioning more and more these days. so I was thinking about the revised Early Years Foundation Stage (eYFs), as last revealed (who knows what the next version will be like... if you do, don’t be shy). In truth, I was thinking, in particular, about the pioneers of education, thanks to an email from a potential contributor, and a question began to unravel in my mind. Now, I haven’t had the time to look into this question in any great depth, so I thought I might give you some homework (I know, I know... let’s call it ideas for consideration in moments of reflection on your practice. Okay, that doesn’t sound much better). so, I was thinking of Comenius and Froebel, and I was thinking of margaret and Rachel macmillan, and susan Isaacs and Loris malaguzzi, and I started thinking of the people I have worked closely with over the years, the names on the left of this page, the members of my editorial board who have given guidance, not just to me, but also to many many practitioners over the years, and I was thinking of the people I have met or had the pleasure of hearing talk, people like Lilian Katz (see page 46 of this issue) and Colwyn trevarthen, and I couldn’t help but wonder whether I will find any of their messages, their knowledge, their experiences or their beliefs in the revised eYFs. And, if not, I was thinking, then that would be a crying shame, for you as members of the workforce, for children especially, and for parents, such as myself, who have a child or children in the ‘system’. so, what do you think? We hold certain people up as great pioneers, both past and present, who have shaped our understanding of children, childhood, children’s services, child development and learning, but can you match the pioneering work/belief to the revised eYFs? It might offer food for thought the next time you engage in personal or setting-level reflective practice? We will not have too much longer to wait until the final version of the framework is released, and I am maintaining some level of confidence that what we get will be an improvement on what was released for consultation in 2011. No-one will be entirely happy with the framework, but from my point of view, I would like to see more understanding of a child’s need to be a child, a deeper level of humanity and kindness on show. Oh, and more than just ‘adequate’ funding, plus a change in the way funding is applied, to really make sure settings can fully support children, families and staff in ensuring that every child matters, and that every child (disadvantage does not just stem from economic factors, just ask any teacher whose children come from largely middleclass families!) is given the encouragement, understanding, belief, security and time, to learn and develop in the way that suits them best, and that uses their own many intelligences to encourage a lifelong disposition to be curious, inventive, questioning, joyful, explorative and confident in their own abilities. Editor Neil Henty MSc Consultant editor Jessica Waterhouse MA, early years teacher, Cypress Infant School, London

Missing ingredients in cause-related advertising

In traditional cause-related marketing (CRM) campaigns, marketers focus on a promoted product and ads contain CRM messages only in small print at the bottom. Some recent marketers have chosen to highlight the cause, with the product taking a lesser role in the advertising copy. The purpose of this research is to compare these two execution styles. Moderating effects of product type and cause framing are considered. Experimental results indicate that a cause-focused ad is more effective in hedonic product promotion and a product-orientated ad is more effective in utilitarian product promotion. An other-benefit appeal facilitates the effects of a cause-related ad to individuals with a hedonic tendency towards the product, and a self-related appeal enhances the effects of a product-orientated ad to those with a utilitarian tendency towards the product. The findings underscore the importance for marketers to learn more about how visuals work, and in turn suggest how practitioners can avoid negative consumer reactions to their cause-related ads.

WHO Classification Sparks Debate Over Cell Phone Safety

F ar from settling the question of whether cell phones cause cancer, the latest pronouncement by the World Health Organization that cell phones could “possibly” be carcinogenic has left a wake of confusion and consternation. In July ’ s The Lancet Oncology , the WHO ’ s International Agency for Research on Cancer (IARC) announced that it had classifi ed radiofrequency (RF) electromagnetic fi elds — such as those that wireless phones emit — as “possibly carcinogenic to humans” based on an increased risk of glioma and acoustic neuroma. The move came barely a year after the huge Interphone study found no increased risk of cancer from more than 10 years of cell phone use. But the Interphone results, published here in the Journal ( see J. Natl. Cancer Inst. 2010; 102:13), suggested there might be some risk for people with the heaviest use. The National Cancer Institute, the American Cancer Society, and other organizations were at pains to update their online information and reassure worried consumers that the WHO action was not based on any clinically meaningful new evidence but merely on an evaluation of the existing literature. Experts repeated the familiar mantra “more research is needed,” even as newspaper headlines warned of the potential risk. Some observers missed the small print. The IARC ’ s 2B classifi cation — “possibly carcinogenic to humans” — was based only on “limited evidence of carcinogenicity.” According to IARC, that means: “A positive association has been observed between exposure to the agent and cancer for which a causal interpretation is considered . . . to be credible, but chance, bias, or confounding could not be ruled out with reasonable confi dence.” As Jonathan Samet, M.D. , overall chair of the IARC working group and chair of preventive medicine at the University of Southern California, told a press conference in Lyon, France, on May 31, the classifi cation means “there could be some risk, and therefore we need to keep a close watch for a link between cell phones and cancer risk.”

Print Still Matters in an e-Learning World, and Training Companies Need to Properly Manage It

This report demonstrates how the application of Behavioral Systems Analysis (BSA) methods assisted in assessing a small training company's Print Production Management (PPM) system. PPM is the process by which printed materials are conceptualized, estimated, released to a commercial printer, proofed, and delivered to the client. The current PPM process had not been evaluated or updated to reflect shifts in both the training and printing industries. The assessment found that the unrevised process was becoming obsolete, hindering performance, and costing the organization time and money. Recommendations were made for staffing and workflow, and implementation of tools were developed to support performance and contribute to successful execution of projects with printed elements. This report includes a follow-up evaluation made eight months after study completion.