Exploring clinician adoption of a novel evidence request feature in an electronic medical record system

Objective: The research evaluated strategies for facilitating physician adoption of an evidence-based medicine literature request feature recently integrated into an existing electronic medical record (EMR) system.Methods: This prospective study explored use of the service by 137 primary care physicians by using service usage statistics and focus group and survey components. The frequency of physicians'' requests for literature via the EMR during a 10-month period was examined to explore the impact of several enhanced communication strategies launched mid-way through the observation period. A focus group and a 25-item survey explored physicians'' experiences with the service.Results: There was no detectable difference in the proportion of physicians utilizing the service after implementation of the customized communication strategies (11% in each time period, P=1.0, McNemar''s test). Forty-eight physicians (35%) responded to the survey. Respondents who had used the service (n=19) indicated that information provided through the service was highly relevant to clinical practice (mean rating 4.6, scale 1 “not relevant”–5 “highly relevant”), and most (n=15) reported sharing the information with colleagues.Conclusion: The enhanced communication strategies, though well received, did not significantly affect use of the service. However, physicians noted the relevance and utility of librarian-summarized evidence from the literature, highlighting the potential benefits of providing expert librarian services in clinical workflow.

Highlights

• The communication strategies implemented during the study did not induce a noticeable increase in questions from physicians through the electronic medical record system.
• Surveyed physicians were generally satisfied with the evidence-based medicine literature request service and noted several resulting changes in clinical practice associated with librarian-provided evidence.
• Survey respondents viewed the monthly “evidence alert” newsletter, one of the communication strategies, as particularly effective, and it has become an integrated facet of the service.

Implications

• Librarians may contribute significantly to effective patient care by providing evidence to support the clinical decision-making process.
• The study''s findings emphasize the complexity of facilitating the adoption of services providing evidence for clinical practice.

     

Evolving data use policy in Trinidad and Tobago: the search for actionable knowledge on educational improvement in a small island developing state

This paper presents a single-country case study of the use of large scale assessment (LSA) data to generate actionable knowledge at school and system levels. Actionable knowledge is data-informed insight into school and system processes that can be used to direct corrective action. The analysis is framed from the perspective of the country’s evolving national policy on data use for educational improvement between 1990 and 2013. Trinidad and Tobago first participated in international large scale assessments (ILSAs) in 1991 but also developed a centralized system of national large scale assessments (NLSAs) in 2004. Analyses of both datasets consistently pointed to low quality and high inequality as the main actionable issues in the education system. NLSA data also hinted at notable variation in performance across schools and education districts. Analyses for and of policy point to the need for multiple school performance measures to better inform site-based, formative action. Over the period, actionable knowledge appears to have had greater impact at school level, with evidence being used by some low-performing schools to improve. However, at the system level, the frequent non-use and misuse of actionable knowledge suggest the need to promote and strengthen structures and processes related to evidence-informed policy-making.     

Which males or females are most at risk and on what? An analysis of gender differentials within the primary school system of Trinidad and Tobago

This paper reviews the work on gendered achievement in the English‐speaking Caribbean, with its often explicit focus on underachieving males. However, patterns of gendered achievement are more likely region‐specific and variegated in some contexts. In Trinidad and Tobago, the full‐scale implementation of national assessments in 2004 provided an opportunity to evaluate mathematics and language performance across the entire pupil population at standards 1 (7‐ to 8‐year‐olds) and 3 (9‐ to 10‐year‐olds). Census data from the high‐stakes 2003 Secondary Entrance Assessment (SEA) administered at standard 5 (ages: 10–11+) were also included in the analysis. Therefore the entire dataset consisted of 52,284 primary school students (26,574 males and 25,710 females). The findings confirmed that female pupils had a statistically significant advantage on all assessments. However, in terms of practical significance, most differentials were negligible to small. Medium‐sized differentials were obtained for pupils of low ability, living in rural educational districts, and on language arts. Male achievement scores were also more variable for lower grade levels, low ability groups and language arts. Paradoxically, in some educational districts secondary school placement opportunities still favoured males. These variegated patterns of gendered achievement may be associated with differences in institutional effectiveness and variations in male socialization practices that are especially evident across the urban–rural divide.     

The Concept of Electrical Resistance: How Cassirer's Philosophy,and the Early Developments of Electric Circuit Theory,Allow a Better Understanding of Students' Learning Difficulties

While students' difficulties concerning the concepts of voltage and intensity have been investigated by many science education researchers, difficulties related to the concept of electrical resistance and circuit are less known. Some researchers in science education even state that students have no preconception about this concept before being taught. Our observations are in disagreement with this assumption. In the first section of this paper the main basic features of the difficulties of students confronted with the concept of electrical resistance are investigated. In the second section we discuss the nature of the electrical resistance concept in the light of Cassirer philosophy while in the third section we give an analysis of this concept going back to its origins in the nineteenth century. Finally, an analysis of the way this concept is taught in French high schools is presented and the first results of a experimentation using an alternative teaching strategy are briefly reported.c     

An International Meta-Analysis of Reading Recovery

ABSTRACT

Reading Recovery is one of the most researched literacy programs worldwide. Although there have been at least 4 quantitative reviews of its effectiveness, none have considered all rigorous group-comparison studies from all implementing nations from the late 1970s to 2015. Using a hierarchical linear modeling (HLM) v-known analysis, we examined if effects differed in the United States versus other nations, if experiments yielded larger effects than quasi-experiments, if the effects changed over time, and if the type of outcome mediated the impact estimates. We also considered the sustained effects of the intervention. After reviewing 203 primary studies, we identified 16 that met our criteria, such as treatment fidelity and experimental or high-quality quasi-experimental design. Based on a random effects model, the estimated overall effect was .59, with larger effects for outcomes based on the Observation Survey (Clay, 2013 Clay, M. M. (2013). An observation survey of early literacy achievement. Portsmouth, NH: Heinemann. [Google Scholar]), and stronger effects in certain literacy domains, such as text reading, print knowledge, and general literacy. Although United States studies produced a larger point estimate (.61) compared to other countries (.52), and experiments (.69) yielded a larger estimate than quasi-experiments (.43), neither difference was statistically significant. Overall, effects did not change over time, but effects based on the Observation Survey did improve significantly from earlier to later studies. We also found that the long-term effect may diminish, but there were too few studies to estimate the sustained impact with confidence. The .59 overall effect places Reading Recovery in the top 10% in terms of impact of early literacy programs reviewed by the What Works Clearinghouse.     

Personality Traits of Women in Team Sports vs. Women in Individual Sports

Abstract

The problem under investigation was to determine if were distinguishing personality traits when women who compete in team sports were compared to women who compete in individual sports. The subjects were chosen from a selected group of 156 women AAU athletes and the 1964 United States Olympic team. Those women who agreed to take part in the study were sent a copy of Form A of the Sixteen Personality Factor Questionnaire, which was the instrument used to measure selected personality factors. Differences between groups were analyzed by means of the t test.

The results indicated that women athletes who compete in individual sports rated higher on the personality factors of dominance, adventurousness, sensitivity, introversion, radicalism, and self-sufficiency and lower on the factor of sophistication when compared to women athletes who compete in team sports. No differences were found in the factors of sociability, intelligence, stability, surgency, conscientiousness, suspecting, guilt-proneness, high self-sentiment, or high ergic tension.