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Issue 182 - 18 May 2011

Articles from Journal of Advanced Nursing, May 2011

1. Quality of life in people with venous leg ulcers: an integrative review (pages 926–944)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Objective.  To explore the impact of venous leg ulcers on health-related quality of life and analyse the quality of life instruments that have been used for this topic.
Background.  Venous leg ulcers represent more than 80% of all chronic leg ulcers. Several studies have demonstrated that health-related quality of life is affected in patients with such lesions.
Method.  An integrative review was conducted, together with an additional methodological review of quality of life instruments. Eight electronic databases were searched, and all studies published between 2003 and 2008 were considered in with both qualitative and quantitative approaches and in Spanish, English, French, German and Portuguese. Thus, no restrictions were applied as regards study design.
Results.  Twenty-two studies were included; one used mixed methods, three employed qualitative methods and the remaining articles used a quantitative approach. Pain was the factor most frequently identified as affecting health-related quality of life. The generic instruments most commonly used were Short Form-36 and adaptations, the Nottingham Health Profile and EuroQol-5, whilst the disease-specific tools were Hyland, Cardiff Wound Impact Schedule and Charing Cross Venous Leg Ulcer Questionnaire. Two new instruments were also identified, venous leg ulcer quality of life and Sheffield Preference-based Venous Leg Ulcer 5D.
Conclusions.  The negative impact of venous leg ulcers on health-related quality of life is confirmed in this review. This impact has been measured using a variety of specific health-related quality of life instruments. However, the review findings suggest that the Charing Cross Venous Leg Ulcer Questionnaire is the most appropriate instrument due to its disease-specific psychometric characteristics.

2. Children’s views about obesity, body size, shape and weight; Inequalities and the mental health of young people: a systematic review of secondary school-based cognitive behavioural interventions; Intervention strategies that support self-care activities: an integrative study across disease/impairment groupings; Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse (pages 954–960)
The Joanna Briggs Institute
Journal of Advanced Nursing, Volume 67, Number 5, May 2011

ORIGINAL RESEARCH

3. Reducing the fear of falling among community-dwelling elderly adults through cognitive-behavioural strategies and intense Tai Chi exercise: a randomized controlled trial (pages 961–971)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  To examine the effectiveness of cognitive-behavioural strategies with/without intense Tai Chi exercise in reducing fear of falling among community-dwelling elderly adults.
Background.  Fear of falling is a major health problem among community-dwelling older persons. The prevalence of this fear ranges from 29% to 77%, indicating the importance of developing effective strategies to reduce fear of falling among elderly adults.
Methods.  Data were collected from January to December 2007. A randomized controlled trial with three groups (control, cognitive-behavioural and cognitive-behavioural with Tai Chi). Participants were assessed at baseline for demographic data, falls-related history, and fear of falling. Data on these variables plus falls, mobility, social support behaviour and satisfaction, and quality of life were also collected at 2 and 5 months after interventions.
Results.  Participants in the three groups differed significantly in both measures of fear of falling (F = 20·89, P < 0·001; F = 6·09, P < 0·001) and mobility (F = 30·33, P < 0·001), social support behaviour and satisfaction (F = 3·32, P < 0·05 and F = 6·35, P < 0·001, respectively), and quality of life (F = 16·66, P < 0·001). In addition, participants who received the cognitive-behavioural intervention with Tai Chi had significantly lower fear of falling scores (P < 0·001) and higher mobility (P < 0·001), social support satisfaction (P < 0·01) and quality of life (P < 0·001) than the cognitive-behavioural alone and control groups at 5 months. The three groups did not differ significantly in falls.
Conclusion.  The results of this trial suggest that the cognitive-behavioural intervention with Tai Chi exercise helped community-dwelling elderly adults to enhance their mobility, to manage their fear of falling and to increase their quality of life.

4. Relationship between sleeping on the night shift and recovery from work among nursing workers – the influence of domestic work (pages 972–981)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  This paper is a report of a study on the association between sleep patterns during work nights and recovery from work among nursing workers, considering domestic work hours.
Background.  Several hospitals allow nursing workers to sleep during the night shift, but this is rarely evaluated from the workers’ health perspective. The need for recovery from work concept can be useful for testing the impact of night work on sleep. Recovery is not a problem if workers have enough time to recover between periods of work. Therefore, domestic work would be likely to interfere in the recovery process.
Methods.  This cross-sectional study was carried out at three hospitals in 2005–2006, through a comprehensive questionnaire. All nursing teams engaged in assistance to patients were invited to participate. Analyses included female night workers with no incidence of insomnia. Participants (n = 396) were classified into those who did not sleep during night shifts, those who slept for up to 2 hours and those who slept for 2–3 hours.
Results.  Binomial logistic regression analysis showed that sleeping on the job for 2–3 hours during night shifts is related to a better recovery from work provided the workers do not undergo long domestic work hours.
Conclusions.  Being allowed to sleep at work during night shifts seemed to contribute to, but was not enough to guarantee, a good recovery from work in the studied population. Recommendations to deal with sleep-deprivation among night workers should consider the complexity of gender roles on the recovery process.
 
5. ‘It’s not me, it’s them’: How lesbian women make sense of negative experiences of maternity care: a hermeneutic study (pages 982–990)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  The paper is a report of one aspect of a hermeneutic study of lesbian women’s experiences of maternity care, specifically interpretations of negative experiences.
Background.  There is a growing body of literature in relation to lesbian women’s experiences of maternity care. Although most commentators discuss the negative experiences encountered by lesbian mothers, there has been no contextual analysis of these expressions of negativity in an increasingly positive environment.
Methods.  The study was undertaken using a qualitative approach using an adapted Gadamerian hermeneutic phenomenology using unstructured interviews with eight women. The interviews took place between November 2007 and March 2008. All of the participants had disclosed their sexual orientation in pregnancy. Snowball sampling was used. The data were then analysed using an iterative hermeneutic framework.
Findings.  The participants not only described their experiences of maternity care as being positive but also offered examples of negative experiences. These were analysed separately to explore the ways in which the women made sense of them in the context of an otherwise positive experience. These experiences were expressed in ways that distanced the negative and that seemed to rationalize behaviour or ascribe it to the health professional.
Conclusions.  Negative encounters with health professionals are processed by women in a way that protects their overall experience. Health professionals in maternity care should consider the impact of negative responses to lesbian mothers and the effect that it has in reducing the overall quality of this significant life event.

6. Nurses’ experiences of uncertainty in clinical practice: a descriptive study (pages 991–999)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  This paper is a report of a qualitative descriptive study of nurses’ experiences of uncertainty in clinical practice.
Background.  Uncertainty as a complex phenomenon is inherent in many nursing and medical encounters and can vary along different dimensions. Despite the existence of studies on the theoretical definitions of uncertainty, few studies have been conducted to explore nurses’ experiences in this regard and strategies employed by them to encounter situations of uncertainty in nursing practice.
Methods.  Semi-structured interviews were conducted in 2009 with 18 female bachelor’s degree nurses working in a teaching hospital in an urban area of Iran. Content analysis was used to identify themes.
Findings.  The data analysis resulted in three main themes: ‘unclear domain of practice’, ‘compatibility with uncertainty’, ‘psychological reactions to uncertainty’. The second theme consisted of two categories: ‘losing sensitivity’ and ‘avoiding trouble’. The themes were not mutually exclusive or independent, but rather overlapping and intertwined. The themes and their related categories summarized the nurses’ experiences of uncertain situations and the way they used to present efficacious care and meet patients’ needs in spite of being immersed in uncertainty.
Conclusion.  Enhanced awareness and increased understanding about uncertainty can be important factors in improving nursing work environment and the quality of care presented to patients. The findings will be helpful for nurse managers to educate and prepare nurses in order to encounter uncertain situations in practice.

7. Symptom clusters and health-related quality of life in people with chronic stable angina (pages 1000–1011)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  This paper reports findings of a study to examine the independent contribution of chest pain, fatigue and dyspnoea to health-related quality of life in people with chronic stable angina.
Background.  People with chronic stable angina experience poorer quality of life in multiple areas including physical and emotional health. Emerging evidence suggests the presence of concomitant symptoms yet there are no systematic studies examining the impact of symptom clusters on quality of life in people with chronic angina.
Method.  Outpatients (n = 134), recruited over a 16-month period in 2000 and 2001, with confirmed coronary heart disease and chronic angina completed reliable and valid questionnaires measuring chest pain frequency, fatigue, dyspnoea and quality of life. The data have contemporary relevance because despite changes in treatment of coronary heart disease, chronic angina remains prevalent worldwide. Hierarchical multiple linear regression was used to examine the symptom cluster of chest pain frequency, fatigue and dyspnoea in predicting quality of life.
Results.  The sample was predominantly white (74·6%), men (59·7%) with a mean age of 63·4 (sd 12·12) years. Controlling for age, gender, social status and co-morbidities, the symptom cluster of chest pain frequency, dyspnoea and fatigue accounted for a statistically significant increase in unadjusted R2 (F of ?, P < 0·05) for the models predicting physical limitation (R2? 24·1%), disease perception (R2? 24·6%), Short Form-36 Physical Component Score (R2? 24·3%) and Mental Component Score (R2? 07·0%).
Conclusion.  Symptom assessment and management of people with chronic stable angina should involve multiple symptoms. Greater fatigue predicted poorer quality of life in multiple areas. As a possible indicator of depression, it warrants further assessment and follow-up.

8. A pilot study of a systematic method for translating patient satisfaction questionnaires (pages 1012–1021)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aims.  This paper is a report of a descriptive comparative pilot study of use of a method that simultaneously tests the content validity and quality of translation of English-to-Chinese translations of two patient satisfaction questionnaires: the La Monica–Oberst Patient Satisfaction Scale and Hospital Consumer Assessment of Healthcare Providers and Systems.
Background.  Patient satisfaction is an important indicator of the quality of healthcare services. In China, however, few good translations of patient satisfaction instruments sensitive to nursing services exist.
Methods.  The descriptive pilot study took place in 2009 and used content validity indexing techniques to evaluate the content, context and criterion relevance of a survey question. The expert raters were 10 nursing faculty and 10 patients who evaluated the two patient satisfaction questionnaires. The experts evaluated the relevance of each item on a scale of 1–4 and the research team compared their responses to choose the most appropriate. Only the nurse faculty experts, who were bilingual, evaluated the quality of the translation using a binary rating.
Results.  The ‘Nurse Rater’ relevance scores of the LaMonica–Oberst Patient Satisfaction Scale and the Hospital Consumer Assessment of Healthcare Providers and Systems were 0·96 and 0·95 respectively, whereas the patient’s overall relevance scores were 0·89 and 0·95. A Mann–Whitney U-test demonstrated that results between the two groups were statistically significantly different (P = 0·0135).
Conclusions.  Using content validity indexing simultaneously with translation processes was valuable for selecting and evaluating survey instruments in different contexts.
 
9. A qualitative analysis of stress, uplifts and coping in the personal and professional lives of Singaporean nurses (pages 1022–1033)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  This paper is a report of a descriptive study of nurses’ experiences of daily stress and coping.
Background.  Much of the research on stress in nursing is quantitative and has focused on only work stressors. Moreover, few studies have examined the uplifting side of living and the role it may play in moderating stress. A theoretical framework on stress and coping, ‘hassles’ and ‘uplifts’ was used to examine nurses’ experiences across their personal and professional lives from a qualitative perspective.
Methods.  A purposive sample of Singaporean hospital nurses (n = 23) identified using a snowball sampling technique, participated in two sets of email interviews in 2009. The qualitative data were analysed using thematic analysis.
Results.  Three themes were identified as constituting daily hassles: (i) time pressures, (ii) nature of nursing work and (iii) multiple roles. Uplifts were expressed in relation to one main theme of feeling good extending across nurses’ personal and professional lives. Three themes were identified as ways of coping: (i) taking time out, (ii) seeking emotional support and (iii) belief systems.
Conclusion.  The interaction between personal and professional life plays a major role in Singaporean nurses’ experiences of stress and coping. However, stress may be ameliorated through effective management and strong familial support. Nurses and employers are recommended to use uplifts and identify ways of coping to minimize attrition and contribute to the development of a healthy workforce.
 
10. Staff nurses’ sites of choice for administering intramuscular injections to adult patients in the acute care setting (pages 1034–1040)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  The aim of this descriptive, correlational study was to determine intramuscular injection sites presently being used by acute care nurses in one Canadian province and factors that contribute to site selection.
Background.  Intramuscular injections are routinely administered by nurses in acute care settings. Recent nursing literature recommends that the ventrogluteal site, rather than the dorsogluteal site, should be used for these injections, although evidence in the literature to support this claim is lacking.
Method.  A convenience sample of nurses employed in acute care settings was accessed through a database at the professional association. Six hundred and fifty-two nurses were sent a questionnaire. Two hundred and sixty-four questionnaires were returned giving a response rate of 42·2%. Data were collected during 2007.
Findings.  Nurses are preferentially using the dorsogluteal site over the ventrogluteal site, and site selection varied significantly with age, level of preparation, years in nursing and knowledge of nerve injury as a complication with the selected site.
Conclusions.  Nurses are not preferentially using the ventrogluteal site for intramuscular injections to adults as recommended in recent nursing literature. Additional research on the safety of a properly mapped dorsogluteal site is needed.
 
11. Information needs of Chinese surgical patients on discharge:a comparison of patients’ and nurses’ perceptions (pages 1041–1052)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aims.  This paper is a report of a descriptive study of Chinese abdominal surgical patients’ and nurses’ perceptions of discharge information needs.
Background.  Discharge from hospital poses a potential threat to surgical patients’ lives because they have to cope in daily life with the consequences of the illness and surgery. Recent studies indicate that nurses often underestimate or inappropriately perceive patients’ discharge information needs. Few studies have examined the discharge information needs of patients who have undergone abdominal surgery, and research in Asian populations is particularly scarce.
Methods.  A descriptive qualitative study was conducted in 2008. Semi-structured interviews were performed with a convenience sample of 16 patients who had undergone an abdominal surgery and their 16 nurses in a regional general hospital in Hong Kong.
Results.  Results of content analysis indicated that to both the surgical patients and their nurses, three similar categories of information needs on discharge were health concerns upon discharge, addressing patients’ information needs, and obstacles that hindered information seeking. Specific needs related to finance, knowledge of illness, psychological support and role of diet and traditional Chinese medicine perceived as important by the patients were underestimated by the surgical nurses and revealed important issues in providing holistic and culture-specific nursing care for surgical patients upon discharge.
Conclusion.  Surgical patients’ information needs on finance, illness condition, psychological support and cultural practices were found not to be accurately and adequately understood by their nurses. Nurses should give culturally specific and appropriate predischarge education in terms of promotion of recovery from surgery, health maintenance practice and psychological support.
 
12. Data-based nurse staffing indicators with Bayesian networks explain nurse job satisfaction: a pilot study (pages 1053–1066)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  This paper is a report of a pilot study to examine the relationship of nursing intensity, work environment intensity and nursing resources to nurse job satisfaction.
Background.  There is an ever increasing amount of information in hospital information systems; however, still very little of it is actually used in nursing management and leadership.
Methods.  The combination of a retrospective time series and cross-sectional survey data was used. The time series patient data of 9704 in/outpatients and nurse data of 110 nurses were collected from six inpatient units in a medical clinic of a university hospital in Finland in 2006. A unit-level measure of nurse job satisfaction was collected with a survey (n = 98 nurses) in the autumn of 2006. Bayesian networks were applied to examine a model that explains nurse job satisfaction.
Results.  In a hospital data system, 18 usable nurse staffing indicators were identified. There were four nurse staffing indicators: patient acuity from nursing intensity subgroup, diagnosis-related group volume from work environment subgroup, and skill mix and nurse turnover from nursing resources subgroup that explained the likelihood of nurse job satisfaction in the final model. The Bayesian networks also revealed the elusive non-linear relationship between nurse job satisfaction and patient acuity.
Conclusion.  Survey-based information on nurse job satisfaction can be modelled with data-based nurse staffing indicators. Nurse researchers could use the Bayesian approach to obtain information about the effects of nurse staffing on nursing outcomes.
 
13. Work-related injury in the nursing profession: an investigation of modifiable factors (pages 1067–1078)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  This paper is a report of a correlational study of the relationships between work-related injury-risk events and modifiable risk factors in a nursing population after controlling for socioeconomic factors.
Background.  Nurses are at high risk for work-related injury. Work-related injury is strongly influenced by psychosocial factors and physical job-related exposures, but the magnitude of effect from modifiable factors remains unclear.
Method.  Data were based on the Work Outcomes Research Cost-benefit survey conducted in Australia during 2005 and 2006. The study sample of 5724 represented ~14% of nurses in Queensland, Australia. Logistic regression was used to determine the magnitude of association of psychological distress (represented by the Kessler 6 score: six-item scale of psychological distress), the number of health conditions and various socioeconomic factors with work place injury.
Results.  High psychological distress was associated with a 5% probability of injury. As the number of health conditions increased, the probability of injury increased; 3 and =6 health conditions increased the chance of injury by 5% and 15% compared with no health conditions. Compared with the total sample, nurses who reported high levels of psychological distress demonstrated greater sensitivity to the number of health conditions. Computation of the marginal effects showed little difference in the likelihood of injury when the total sample was compared with nurses with <5 years of work experience.
Conclusion.  Effective occupational health and safety workplace programmes that target modifiable factors such as psychological distress and physical health conditions may improve the health capital of nurses and productivity levels within the professio
 
14. Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey (pages 1079–1090)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  This paper is a report of a study to identify factors influencing advanced practice nurses’ contribution to promoting evidence-based practice among front-line nurses.
Background.  Despite widespread recognition that care should be evidence-based, nurses experience challenges implementing evidence-based practice. As opinion leaders, advanced practice nurses can influence the practice of front-line nurses by promoting research use. Little is known about how advanced practice nurses use evidence and their influence on care given by front-line nurses.
Method.  A cross-sectional survey of 855 advanced practice nurses working in 87 hospital/primary care settings in England. The questionnaire examined understandings of evidence-based practice, sources of evidence used, ways of working with front-line nurses, perceived impact on front-line nurses, skills in evidence-based practice and barriers to promoting evidence-based practice. Data were collected in 2005 and analysed using descriptive statistics. Comparisons were made between advanced practice nurses with Masters qualifications and those with lower qualifications.
Findings.  Advanced practice nurses used different sources of evidence. They engaged in various activities to promote evidence-based practice and had a positive influence on front-line nurses’ practice. Advanced practice nurses’ skills in evidence-based practice varied with few considering themselves expert. Advanced practice nurses with Masters qualifications perceived themselves to be more skilled in all aspects of evidence-based practice than those with lower qualifications.
Conclusion.  Advanced practice nurses are well placed as clinical leaders to promote evidence-based practice by frontline nurses but require further development of their skills in evidence-based practice. In order to maximize their potential, advanced practice nurses require Master’s preparation.
 
15. The effect of nurse-facilitated family participation in the psychological care of the critically ill patient (pages 1091–1101)
Journal of Advanced Nursing, Volume 67, Number 5, May 2011
Abstract:

Aim.  This paper is a report of a Neuman systems model-guided study of the effects of nurse-facilitated family participation in psychological care on the extent of patient delirium and psychological recovery following critical illness.
Background.  Psychological disturbances resulting from critical illness have been well documented in international literature. Few studies have tested interventions designed to alleviate such disturbances.
Methods.  A comparative time series design was used. A total of 170 critically ill patients and families participated in the study – 83 in the control group and 87 in the intervention group. Data were collected during critical illness and subsequent recovery using the Therapeutic Intervention Scoring System-28, Intensive Care Delirium Screening Checklist and the Sickness Impact Profile. The study was carried out in Northern Ireland, data collection taking place from January 2004 to December 2005.
Results/findings.  Nurse-facilitated family participation in psychological care did not significantly reduce the incidence of delirium among patients in critical care, but patients receiving intervention demonstrated better psychological recovery and wellbeing than the control group at 4, 8 and 12 weeks after admission to critical care.
Conclusion.  Nurse-facilitated family participation in the psychological care may strengthen the lines of defence and resistance against the stressors experienced by the patient during critical illness and improve psychological recovery.

Journals - Table of Contents

16. From Registered Nurse Journal, Vol 23 No 2, March/April 2011
PRESIDENT'S VIEW

16A. Influencing healthy public policy through politics
EXECUTIVE DIRECTOR'S DISPATCH
16B. Fighting for Medicare
ARTICLES
16C.
Make your voice heard- using media to communicate your message
16D. Faithfully Yours [Parish nurse Gloria Wiebe hopes her services will help the church to reclaim its position in the community]
16E. Talking politics - RNs meet with MPPs in advance of Ontario's fall election
16F. Where are they now? [RNJ catches up with three members who have thrown  their hats into the political ring]
16G. The fix [RNs offer harm reduction services as the first line of defence against a life of addiction]

Conferences, Seminars, Training Courses

17. PHA Conference 2011: Creating our future now
The three themes for the conference are vision, sustainability and diversity. We want to explore our vision for our future, solutions we can find today that will help protect further generations, how we can build community resiliency and how we can positively embrace our diversity
Date: 31 August – 2 September 2011
Venue: Lincoln University, Christchurch
Hosted by the Canterbury-West Coast branch of the PHA        
More information: http://www.pha.org.nz/phaconference.html

18. The Critical Role of Nurses for Improved Patient Safety and Care
A Cornell ILR Healthcare Transformation Project Webcast
Webcast Date:
  Thursday, June 9, 2011
Time:  2:00 - 3:00 (EST)
This webcast is free of charge.
To achieve the goals of healthcare reform legislation -- improving access and quality of care -- the Obama administration has announced the creation of the Partnership for Patients. 
Hospital nurses and their unions will have an increasingly critical role to play in this push to find ways to reduce hospital-acquired infections, hospital accidents and readmission rates, and to create integrated delivery systems. Working with hospital administrators and other healthcare providers, nurses need to assume significant leadership roles to improve patient care and safeguard patient safety. In this June 9 webcast, healthcare executives and experts will provide multiple perspectives on how nurses, nurses’ unions, and frontline staff contribute to providing high-quality patient care. Suggestions for ways to deepen the involvement of nurses and nurses’ unions also will be shared.
Panelists include
• Norma Amsterdam, Executive Vice President and Director of Nurses Division of SEIU 1199, New York City
• Paul Clark, Professor and Head, Department of Labor Studies and Employment Relations and Professor of Health Policy and Administration at Pennsylvania State University
• Sondra Olendorf,Executive Vice President, Operations and Community Relations at Maimonides Medical Center, Brooklyn, NY • Tom Smith,Vice President, Nursing and Patient Services at Maimonides Medical Center, Brooklyn, NY
This is the second in an ongoing series of webcasts produced by the Cornell University ILR School’s Health care Transformation Project. The series focuses on issues pertinent to the delivery of healthcare today.

News National

19. Medicine labels - keeping it clear
In Britain, there's a move to make the labels on medicines easier to read: The switch to clearer language will help make sure that patients take their medicines as they should. If this does not happen, the drugs are likely to be less effective and may not work at all. Patients also run the risk of getting unpleasant side effects, which in some cases may cause serious harm. The change has been informed by a research project run by the University of Leeds, who user tested labels before and after plain English changes.
Posted by Judy Knighton at 4:53 PM
http://write-clearly.blogspot.com/


20. Reading and writing for health
People looking for health information have to decide where to get their information from. Health information is everywhere—in advertising, magazines, television dramas, in brochures in the GP’s waiting room and fact sheets at the pharmacy, and on the internet. But it’s not all easy to read.
http://write-clearly.blogspot.com/

 

 

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