Rural providers' access to online resources: a randomized controlled trial     

Jonathan D. Eldredge  Laura J. Hall  Karen R. McElfresh  Teddy D. Warner  Tiffany L. Stromberg  Jaren Trost  Devin A. Jelinek 《Journal of the Medical Library Association》2016,104(1):33-41

Objective

The research determined the usage and satisfaction levels with one of two point-of-care (PoC) resources among health care providers in a rural state.

Methods

In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants'' attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA), paired t tests, and Cohen''s d statistic to compare pre- and post-study effects sizes.

Results

Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to “about right amounts of information” at the completion of the study. DynaMed users reported a Cohen''s d increase of +1.50 compared to AccessMedicine users'' reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen''s d.

Conclusion

Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine.Keywords and Medical Subject Headings (MeSH) Clinical Decision Support Systems, Computer-Assisted Decision Making, Decision Making, Evidence-Based Library and Information Practice, Evidence-Based Practice, Health Status Disparities, Health Care Disparities, Information Divide, Information-Seeking Behavior, Medically Underserved Area, Nurse Practitioners, Nurses, Physician Assistants, Physicians, Public Health Nurses, Randomized Controlled Trial as Topic, Service Learning, Vulnerable PopulationsHealth care practitioners regularly seek to incorporate valid information into their evidence-based decisions. Electronic information resources now provide easy access to current health information and summarized forms of evidence to support clinical decision making.

Access effects on health care

Health care providers who are affiliated with well-funded institutions benefit from access to a variety of high-quality information resources to support their evidence-based practices. Practitioners who are not affiliated with academic health sciences centers rarely have access to these same resources due to prohibitively high licensing costs. Ely et al. report that not having access to easy-to-use, high-quality, current information can negatively affect sound clinical decision making. [1].Patients in Isaac et al.''s study who were admitted to hospitals that had access to an electronic evidence-based resource experienced reduced length of stay and lower risk-adjusted mortality rates for prespecified conditions [2]. That study was validated on a broader scale by a multicenter investigation on the utilization of information resources by practitioners [3].Primary health care practitioners who are not affiliated with academic health sciences centers, particularly those who practice in rural or remote areas, often articulate the need for increased access to health information resources. The authors'' literature search and review of 114 of the most relevant research articles about the information needs and information-seeking behavior of health care practitioners suggested that these professionals most value speed and accuracy. For example, they likely would prefer to use point-of-care (PoC) resources for quickly and accurately answering their clinical questions.

Desirability of point of care

PoC resources quickly guide physicians through the diagnosis, treatment, and management of commonly encountered clinical conditions. PoC resources can present compilations of highly authoritative, often evidence-based, information. Physicians can answer more questions and revise clinical decisions more often using these PoC resources [4]. Meanwhile, many health care practitioners still rely on textbooks familiar to them from their professional training programs, despite their potentially dated contents [5–14].

Limited access in rural New Mexico

A randomized controlled trial involving public health practitioners across the rural state of New Mexico reported many barriers in accessing valued information resources [15, 16]. In another study, researchers in New Mexico set out to determine and analyze information needs of health care practitioners who were not affiliated with an academic center. Fifty-one interviews of rural physicians, nurses, physician assistants, and nurse practitioners showed both a need and desire for access to information resources [17].

Goals and hypothesis

This study sought to determine which rural health care providers found more useful in answering everyday clinical questions: electronic PoC DynaMed, which is more clinically oriented, or electronic PoC AccessMedicine, which consists primarily of a health sciences textbook collection. We hypothesized that free access to the explicitly clinical format of the PoC resource DynaMed would result in more extensive use than a baseline of zero over a six-month period than the electronic PoC textbook collection AccessMedicine. We felt this would be due to greater utility of DynaMed in clinical practice. We also predicted that clinicians using the clinically oriented PoC would express higher levels of satisfaction than those using the textbook-based PoC and that clinicians using these PoC resources would prefer using them over other information resources.  相似文献   

The Communication Privacy Management of Adopted Individuals in Their Social Networks: Disclosure Decisions in Light of the Discourse of Biological Normativity     

Haley Kranstuber Horstman  Maria Butauski  Lauren Jean Johnsen  Colleen Warner Colaner 《Communication Studies》2017,68(3):296-313

Although adoptees are often stigmatized for their nonnormative identity, adopted individuals must communicate with nonfamily members to integrate their adoptive identity into their definition of self. In the current study, adult adoptees (n = 25) were interviewed about their processes for disclosing their adoptive status in their social networks. Drawing upon communication privacy management (CPM) theory, inductive analyses demonstrated that adoptees created motivational and contextual criteria to enact privacy rules surrounding adoption. Adoptees maintained privacy to avoid messages of “difference,” insensitive comments, imperviousness, and negative opinions about adoption. Adoptees disclosed about their adoption to build relational closeness and to educate/advocate for adoption. These privacy decisions were undergirded by the societal assumption that families are biologically linked or the discourse of biological normativity (Suter et al., 2014).  相似文献   

Cardboard Cities,Real Mathematics: Employing Quantitative Literacy to Study Gentrification in NYC     

Forest Fisher  Jared Warner  Nate Mickelson 《PRIMUS》2019,29(9):908-927

Abstract

Gentrification is a complex issue with very real repercussions for urban youth. Games make learning fun and provide a way for students to explore complex systems through recursive play. We describe a board game designed to help students explore ratios and proportional reasoning while simultaneously engaging the causes and effects of gentrification. Situated within a multidisciplinary first-semester learning community course, the game provides a model for later experiential learning opportunities as students are asked to study the effects of gentrification in one New York City neighborhood.  相似文献   

Does grade inflation affect the reliability of grades?     

Jason Millman  Simeon P. Slovacek  Edward Kulick  Karen J. Mitchell 《Research in higher education》1983,19(4):423-429

Two studies were conducted to examine the effect of grade inflation on the piling up of grades in fewer grade categories and on the reliability of grade point averages (GPAs). In all comparisons, grades were more bunched after grade inflation, which in turn, was associated with only slight, nonsignificant decreases in GPA reliability. As expected, grades were more bunched when the traditional 5-point letter scale was used than when plus and minus grades were also allowed. In the latter case as well, grade inflation seemed to have had very little effect on the reliability of GPAs. GPA reliability began to suffer, however, for graduate programs in which almost all grades were placed into just two categories, A and B.  相似文献   

Which ingroup,when? Effects of gender,partisanship, veteran status,and evaluator identities on candidate evaluations     

Molly M. Hardy  Calvin R. Coker  Michelle E. Funk  Benjamin R. Warner 《Communication quarterly》2019,67(2):199-220

Military service is acknowledged as one of many elements voters use to evaluate candidates, but it has primarily been studied as a univariate element of a candidate’s biography. This project experimentally manipulates veteran status, gender, and partisanship as potentially interactive heuristics for evaluation of a hypothetical candidate specifically regarding military issues. We found an almost universal benefit enjoyed by veterans over civilians regardless of whether the candidate was a member of the participant’s partisan ingroup or outgroup. We also found little evidence of a gender penalty, and even a benefit for women candidates who were veterans, though this benefit was restricted to evaluations from Republican women. We also found that Democratic respondents assigned a penalty to outgroup veteran men candidates. We explain these nuanced findings in the context of moderation by gender mis/alignment between participant and candidate. Implications of the study are offered.  相似文献   

Technical Communication Coaching: A Strategy for Instilling Reader Usability Assurance in Online Course Material Development     

Robbin Z. Warner 《Technical Communication Quarterly》2017,26(3):300-313

ABSTRACT

Online course material development requires much writing, often catching faculty by surprise because of either the sheer volume or the specialized role and function of writing in an online only and multimodal environment. technical and professional communication (TPC) faculty are uniquely suited to coach faculty in producing readable writing for online courses. This article explores the professional development strategies and coaching skills necessary for TPC instructors and/or practitioners to serve in this role in online course development training.  相似文献   

Counsellor bias against shorter term counselling? A comparison of counsellor and client satisfaction in a Canadian setting     

Ronald E. Warner 《International journal for the advancement of counseling》1995,18(3):153-162

The American counselling/psychotherapy outcome research documenting the effectiveness or brief, time-limited treatments is substantial, however, this appears to have had little influence on changing the views of practitioners. One respected researcher has concluded, for example, that a science/practice schism has developed where practitioners continue to believe that brief counselling is superficial and to underestimate the effects of their own shorter-term work. A study was undertaken to determine if counsellors at a large urban Canadian university counselling centre also had lower expectations of change for those clients who received fewer treatment sessions. It was found that the counsellors significantly underestimated treatment gains relative to their clients' reports, and that this discrepancy was greater for those clients seen for fewer sessions. Counsellor satisfaction was also lower with clients seen for fewer sessions. These findings suggest that, like their American counterparts, Canadian counsellors tend toward a practitioner bias against shorter-term treatment based on misconceptions about its efficacy.  相似文献   

Religious Education into the Second Century   总被引：1，自引：0，他引：1  

Sharon Warner 《Religious education (Chicago, Ill.)》2013,108(4):370-372

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Increasing Access for Economically Disadvantaged Students: The NSF/CSEM & S-STEM Programs at Louisiana State University     

Zakiya S. Wilson  Sitharama S. Iyengar  Su-Seng Pang  Isiah M. Warner  Candace A. Luces 《Journal of Science Education and Technology》2012,21(5):581-587

Increasing college degree attainment for students from disadvantaged backgrounds is a prominent component of numerous state and federal legislation focused on higher education. In 1999, the National Science Foundation (NSF) instituted the ??Computer Science, Engineering, and Mathematics Scholarships?? (CSEMS) program; this initiative was designed to provide greater access and support to academically talented students from economically disadvantaged backgrounds. Originally intended to provide financial support to lower income students, this NSF program also advocated that additional professional development and advising would be strategies to increase undergraduate persistence to graduation. This innovative program for economically disadvantaged students was extended in 2004 to include students from other disciplines including the physical and life sciences as well as the technology fields, and the new name of the program was Scholarships for Science, Technology, Engineering and Mathematics (S-STEM). The implementation of these two programs in Louisiana State University (LSU) has shown significant and measurable success since 2000, making LSU a Model University in providing support to economically disadvantaged students within the STEM disciplines. The achievement of these programs is evidenced by the graduation rates of its participants. This report provides details on the educational model employed through the CSEMS/S-STEM projects at LSU and provides a path to success for increasing student retention rates in STEM disciplines. While the LSU??s experience is presented as a case study, the potential relevance of this innovative mentoring program in conjunction with the financial support system is discussed in detail.  相似文献   

Getting ready for 1999: Ideas for Canada's politics and government     

James C. Simeon 《Interchange》1994,25(1):121-124

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