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

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.     

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

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.     

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

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.     

University Students and Parents Together: Expanding Undergraduates' Experiential Base

Preservice teachers have few opportunities to work directly with parents prior to classroom teaching. This experiment allows seniors pursuing early childhood certification to gain experience working with parents of young children.     

Ecofeminism and the Science Classroom: A Practical Approach

This paper examines a practical application of ecofeminism for classroom educators, particularly, science educators. Ecofeminism is often, but not exclusively, linked to projects aimed at assisting men, women and children in developing areas to organize and define development projects for their community. Mainstream applications of ecofeminism for science educators are frequently omitted from science education literature. This article gives the reader a basic understanding of ecofeminist theory as it applies to science education. Direct examples from classroom practices suggest five key points in the application of ecofeminism for classroom use.     

Moral rights protection for the visual arts

Beginning in 1979, certain states extended extra copyright protection, known as “moral rights” protection, to visual artists. Moral rights protection, which was incorporated into U.S. copyright law in 1990, ensures that works cannot be altered in a manner that would negatively impact the reputation of the artist. Using difference-in-differences regression strategies, we compare artists and non-artists in states with moral rights laws to those in states without these laws, before and after the laws are enacted. This enables us to test the impact of the laws on the behavior of artists, consumers, and policy makers. Our analysis reveals that the average artist’s income falls by around $4000 per year as a result of moral rights legislation, but we find no impact of the laws on artists’ choices of residence or on state-level public spending on the arts.     

Social Inclusion of Children with Persistent Challenging Behaviors

Early Childhood Education Journal - Children in early childhood classrooms (i.e., preschool through early elementary) who engage in persistent challenging behaviors often show social-emotional...     

Three recommended inclusive language guidelines for scholarly publishing: Words matter

• Inclusive language will make scholarly publishing more accurate and more respectful, and it has the potential to help authors reach a wider audience.
• JAMA and the JAMA Network journals, the American Chemical Society and the Coalition for Diversity and Inclusion in Scholarly Communications have free guides on inclusive language, formatting and images.
• The guides provide principles and rationale, as well as examples of preferred language, in order to equip people with knowledge to choose the most inclusive words even as terminology preferences change.