Search

Objective Despite efforts to reduce cancer disparities, Black women remain underrepresented in cancer research. Virtual health assistants (VHAs) are one promising digital technology for communicating health messages and promoting health behaviors to diverse populations. This study describes participant responses to a VHA‐delivered intervention promoting colorectal cancer (CRC) screening with a home‐stool test. Methods We recruited 53 non‐Hispanic Black women 50 to 73 years old to participate in focus groups and think‐aloud interviews and test a web‐based intervention delivered by a race‐ and gender‐concordant VHA. A user‐centered design approach prioritized modifications to three successive versions of the intervention based on participants' comments. Results Participants identified 26 cues relating to components of the VHA's credibility, including trustworthiness, expertise, and authority. Comments on early versions revealed preferences for communicating with a human doctor and negative critiques of the VHA's appearance and movements. Modifications to specific cues improved the user experience, and participants expressed increased willingness to engage with later versions of the VHA and the screening messages it delivered. Informed by the Modality, Agency, Interactivity, Navigability Model, we present a framework for developing credible VHA‐delivered cancer screening messages. Conclusions VHAs provide a systematic way to deliver health information. A culturally sensitive intervention designed for credibility promoted user interest in engaging with guideline‐concordant CRC screening messages. We present strategies for effectively using cues to engage audiences with health messages, which can be applied to future research in varying contexts.

Background The implementation of an electronic health record (EHR) with structured and standardized recording of patient data can improve data quality and reusability. Whether and how users perceive these advantages may depend on the preimplementation situation. Objective To determine whether the influence of implementing a structured and standardized EHR on perceived EHR use, data quality, and data reuse differed for users working with paper-based records versus a legacy EHR before implementation. Methods We used an electronic questionnaire to measure users' perception before implementation (2014), expected change, and perceived change after implementation (2016) on three themes. We included all health care professionals in two university hospitals in the Netherlands. Before jointly implementing the same structured and standardized EHR, one hospital used paper-based records and the other a legacy EHR. We compared perceptions before and after implementation for both centers. Additionally, we compared expected benefit with perceived benefit. Results We received 7,611 responses (4,537 before and 3,074 after implementation) of which 5,707 (75%) were from professionals reading and recording patient data. A total of 975 (13%) professionals responded to both before and after implementation questionnaires. In the formerly paper-based center staff perceived improvement in all themes after implementation. The legacy EHR center experienced deterioration of perceived EHR use and data reuse, and only one improvement in EHR use. In both centers, for half of the aspects at least 45% of responders experienced results worse than expected preimplementation. Conclusion Our results indicate that the preimplementation recording practice impacts the perceived effect of the implementation of a structured and standardized EHR. For almost half of the respondents the new EHR did not meet their expectations. Especially legacy EHR centers need to investigate the expectations as these might be different and less clear cut than those in paper-based centers. These expectations need to be addressed appropriately to achieve a successful implementation.

International audience

Background Inpatient nursing documentation facilitates multi‐disciplinary team care and tracking of patient progress. In both high‐ and low‐ and middle‐income settings, it is largely paper‐based and may be used as a template for electronic medical records. However, there is limited evidence on how they have been developed. Objective To synthesise evidence on how paper‐based nursing records have been developed and implemented in inpatient settings to support documentation of nursing care. Design A scoping review guided by the Arksey and O'Malley framework and reported using PRISMA‐ScR guidelines. Eligibility criteria We included studies that described the process of designing paper‐based inpatient records and excluded those focussing on electronic records. Included studies were published in English up to October 2019. Sources of evidence PubMed, CINAHL, Web of Science and Cochrane supplemented by free‐text searches on Google Scholar and snowballing the reference sections of included papers. Results 12 studies met the eligibility criteria. We extracted data on study characteristics, the development process and outcomes related to documentation of inpatient care. Studies reviewed followed a process of problem identification, literature review, chart (re)design, piloting, implementation and evaluation but varied in their execution of each step. All studies except one reported a positive change in inpatient documentation or the adoption of charts amid various challenges. Conclusions The approaches used seemed to work for each of the studies but could be strengthened by following a systematic process. Human‐centred Design provides a clear process that prioritises the healthcare professional's needs and their context to deliver a usable product. Problems with the chart could be addressed during the design phase rather than during implementation, thereby promoting chart ownership and uptake since users are involved throughout the design. This will translate to better documentation of inpatient care thus facilitating better patient tracking, improved team communication and better patient outcomes. Relevance to clinical practice Paper‐based charts should be designed in a systematic and clear process that considers patient's and healthcare professional's needs contributing to improved uptake of charts and therefore better documentation.

Digital informed consent may better inform individuals about health research and increase participation. In the United States and elsewhere, minorities and rural populations are underrepresented in health research and may benefit from well-designed electronic informed consent (eIC). Seven focus groups were conducted with 50 Caucasian, African American, and rural patients in the United States. Participants were asked their preferences for a paper versus electronic informed consent document. Participants found the e-version easier to use, more interesting, and better for understanding. Minority participants emphasized limited access, computer literacy, and trust barriers to eIC. Rural participants were concerned about accessibility, connectivity, privacy, and confidentiality. People see value in electronic consenting. Researchers should consider barriers to eIC among underrepresented populations before recruitment.

BACKGROUND Computerized surveys present many advantages over paper surveys. However, school-based adolescent research questionnaires still mainly rely on paper-and-pencil surveys as access to computers in schools is often not practical. Tablet-assisted self-interviews (TASI) present a possible solution, but their use is largely untested. This paper presents a method for and our experiences with implementing a TASI in a school setting. METHODS A TASI was administered to 3907 middle and high school students from 79 schools. The survey assessed use of tobacco products and exposure to tobacco marketing. To assess in-depth tobacco use behaviors, the TASI employed extensive skip patterns to reduce the number of not-applicable questions that nontobacco users received. Pictures were added to help respondents identify the tobacco products they were being queried about. RESULTS Students were receptive to the tablets and required no instructions in their use. None were lost, stolen, or broken. Item nonresponse, unanswered questions, was a pre-administration concern; however, 92% of participants answered 96% or more of the questions. CONCLUSIONS This method was feasible and successful among a diverse population of students and schools. It generated a unique dataset of in-depth tobacco use behaviors that would not have been possible through a paper-and-pencil survey.

This article reports our experience in developing a computerized cognitive assessment method in a nurse-led clinic. The assessment and report-writing time and the accuracy of using a computer as an assessment medium were compared with assessments that use the traditional pencil-and-paper method. The attitudes of professionals and service users toward the computerized approach were also collected. The results found that the computerized approach not only helped to reduce the time spent making assessments and writing reports but also improved the accuracy of the assessment when compared with the pencil-and-paper method. Most of the professionals and service users who were interviewed responded positively toward computerized assessments. The experience gained in this study will also help us to standardize our assessment procedures, promote communication among members of the clinical team, and facilitate data management and clinical research.

SummaryStandardizing nursing handoffs at shift change is recommended to improve communication, with electronic tools as the primary approach. However, nurses continue to rely on personally created paper-based cognitive artifacts - their “paper brains” - to support handoffs, indicating a deficiency in available electronic versions.The purpose of this qualitative study was to develop a deep understanding of nurses’ paper-based cognitive artifacts in the context of a cancer specialty hospital.After completing 73 hours of hospital unit field observations, 13 medical oncology nurses were purposively sampled, shadowed for a single shift and interviewed using a semi-structured technique. An interpretive descriptive study design guided analysis of the data corpus of field notes, transcribed interviews, images of nurses’ paper-based cognitive artifacts, and analytic memos.Findings suggest nurses’ paper brains are personal, dynamic, living objects that undergo a life cycle during each shift and evolve over the course of a nurse’s career. The life cycle has four phases: Creation, Application, Reproduction, and Destruction. Evolution in a nurse’s individually styled, paper brain is triggered by a change in the nurse’s environment that reshapes cognitive needs. If a paper brain no longer provides cognitive support in the new environment, it is modified into (adapted) or abandoned (made extinct) for a different format that will provide the necessary support.The “hidden lives” - the life cycle and evolution - of paper brains have implications for the design of successful electronic tools to support nursing practice, including handoff. Nurses’ paper brains provide cognitive support beyond the context of handoff. Information retrieval during handoff is undoubtedly an important function of nurses’ paper brains, but tools designed to standardize handoff communication without accounting for cognitive needs during all phases of the paper brain life cycle or the ability to evolve with changes to those cognitive needs will be underutilized.Citation: Blaz JW, Doig AK, Cloyes KG, Staggers N. The hidden lives of nurses’ cognitive artifacts.

Objective: This scoping review investigates how knowledge and skills are assessed in the information literacy (IL) instruction for students in physical therapy, occupational therapy, or speech-language pathology, regardless of whether the instruction was given by a librarian. The objectives were to discover what assessment measures were used, determine whether these assessment methods were tested for reliability and validity, and provide librarians with guidance on assessment methods to use in their instruction in evidence-based practice contexts.Methods: A scoping review methodology was used. A systematic search strategy was run in Ovid MEDLINE and adapted for CINAHL; EMBASE; Education Resources Information Center (ERIC) (EBSCO); Library and Information Science Abstracts (LISA); Library, Information Science & Technology Abstracts (LISTA); and Proquest Theses and Dissertations from 1990 to January 16, 2017. Forty articles were included for data extraction.Results: Three major themes emerged: types of measures used, type and context of librarian involvement, and skills and outcomes described. Thirty-four measures of attitude and thirty-seven measures of performance were identified. Course products were the most commonly used type of performance measure. Librarians were involved in almost half the studies, most frequently as instructor, but also as author or assessor. Information literacy skills such as question formulation and database searching were described in studies that did not involve a librarian.Conclusion: Librarians involved in instructional assessment can use rubrics such as the Valid Assessment of Learning in Undergraduate Education (VALUE) when grading assignments to improve the measurement of knowledge and skills in course-integrated IL instruction. The adapted Fresno test could be modified to better suit the real-life application of IL knowledge and skills.

Objectives: Multi-institutional research increases the generalizability of research findings. However, little is known about characteristics of collaborations across institutions in health sciences education research. Using a systematic review process, the authors describe characteristics of published, peer-reviewed multi-institutional health sciences education research to inform educators who are considering such projects.Methods: Two medical librarians searched MEDLINE, the Education Resources Information Center (ERIC), EMBASE, and CINAHL databases for English-language studies published between 2004 and 2013 using keyword terms related to multi-institutional systems and health sciences education. Teams of two authors reviewed each study and resolved coding discrepancies through consensus. Collected data points included funding, research network involvement, author characteristics, learner characteristics, and research methods. Data were analyzed using descriptive statistics.Results: One hundred eighteen of 310 articles met inclusion criteria. Sixty-three (53%) studies received external and/or internal financial support (87% listed external funding, 37% listed internal funding). Forty-five funded studies involved graduate medical education programs. Twenty (17%) studies involved a research or education network. Eighty-five (89%) publications listed an author with a master’s degree or doctoral degree. Ninety-two (78%) studies were descriptive, whereas 26 studies (22%) were experimental. The reported study outcomes were changes in student attitude (38%; n=44), knowledge (26%; n=31), or skill assessment (23%; n=27), as well as patient outcomes (9%; n=11).Conclusions: Multi-institutional descriptive studies reporting knowledge or attitude outcomes are highly published. Our findings indicate that funding resources are not essential to successfully undertake multi-institutional projects. Funded studies were more likely to originate from graduate medical or nursing programs.

Objective To assess the state of readiness for the adoption of paperless labeling among a nationally representative sample of pharmacies, including chain pharmacies, independent retail pharmacies, hospitals, and other rural or urban dispensing sites. Methods Both quantitative and qualitative analyses were used to analyze responses to a cross-sectional survey disseminated to American Pharmacists Association pharmacists nationwide. The survey assessed factors related to pharmacists' attitudinal readiness (ie, perceptions of impact) and pharmacies' structural readiness (eg, availability of electronic resources, internet access) for the paperless labeling initiative. Results We received a total of 436 survey responses (6% response rate) from pharmacists representing 44 US states and territories. Across the spectrum of settings we studied, pharmacists had work access to computers, printers, fax machines and access to the internet or intranet. Approximately 79% of respondents believed that the initiative would improve the adequacy of drug information available in their work site and 95% believed it would either not change (33%) or would improve (62%) communication to patients. Overall, respondents' comments supported advancing the initiative; however, some comments revealed reservations regarding corporate or pharmacy buy-in, success of implementation, and ease of adoption. Conclusions This is the first nationwide study to report about pharmacists' perspectives on paperless labeling. In general, pharmacists believe they are ready and that their pharmacies are well equipped for the transition to paperless labeling. Further exploration of perspectives from product label manufacturers and corporate pharmacy offices is needed to understand fully what will be necessary to complete this transition.

Ethical and legal requirements for healthcare providers in the United States, stipulate that patients sign a consent form prior to undergoing medical treatment or participating in a research study. Currently, the majority of the hospitals obtain these consents using paper-based forms, which makes patient preference data cumbersome to store, search and retrieve. To address these issues, Health Sciences of South Carolina (HSSC), a collaborative of academic medical institutions and research universities in South Carolina, is developing an electronic consenting system, the Research Permissions Management System (RPMS). This article reports the findings of a study conducted to investigate the efficacy of the two proposed interfaces for this system - an iPad-based and touchscreen-based by comparing them to the paper-based and Topaz-based systems currently in use.This study involved 50 participants: 10 hospital admission staff and 40 patients. The four systems were compared with respect to the time taken to complete the consenting process, the number of errors made by the patients, the workload experienced by the hospital staff and the subjective ratings of both patients and staff on post-test questionnaires.The results from the empirical study indicated no significant differences in the time taken to complete the tasks. More importantly, the participants found the new systems more usable than the conventional methods with the registration staff experiencing the least workload in the iPad and touchscreen-based conditions and the patients experiencing more privacy and control during the consenting process with the proposed electronic systems. In addition, they indicated better comprehension and awareness of what they were signing using the new interfaces.The results indicate the two methods proposed for capturing patient consents are at least as effective as the conventional methods, and superior in several important respects. While more research is needed, these findings suggest the viability of cautious adoption of electronic consenting systems, especially because these new systems appear to address the challenge of identifying the participants required for the complex research being conducted as the result of advances in the biomedical sciences.

In the veterinary professional curriculum, methods of examination in many courses are transitioning from the traditional paper-based exams to electronic-based exams. Therefore, a controlled trial to evaluate the impact of testing methodology on examination performance in a veterinary physiology course was designed and implemented. Formalized surveys and focus group discussions were also used to determine student attitudes toward the examination formats. In total, 134 first-year veterinary students and 11 PhD/MS students were administered a total of 4 exams throughout 1 semester (2 on paper and 2 electronically) using a split-halves design. The paper (P) and electronic (E) exams contained 25 identical multiple-choice questions. Students were randomly assigned to two groups and were given exams in one of two sequences (E-P-E-P or P-E-P-E). Participants consented to and completed two anonymous surveys vis à vis their experience. Out of a maximum raw score of 25, the mean score for electronic examinations (20.8; 95% confidence interval, 20.3–21.2) was significantly ( P = 0.01) greater than that for paper examinations (20.3; 95% confidence interval, 20.0–20.7). However, students expressed numerous concerns with the electronic examination format, and, at the completion of the study, 87% preferred to take their examination on paper rather than the electronic format. These data show that student attitudes concerning the examination format are not primarily determined by examination results, and that the additional anxiety related to the electronic examination format plays a large role in student attitudes.

This article reviews the literature on the use of paper diaries for self-monitoring food intake, identifies the strengths and limitations of paper-and-pencil diaries and their new counterpart, the electronic diary or personal digital assistant (PDA), and reports how participants were trained to use a PDA with dietary software in two pilot studies--one with hemodialysis patients and the other with participants in a weight loss study. The report of the pilot studies focuses on the practical issues encountered in training participants in the use of a PDA and addresses the pros and cons of different dietary software programs. Six hemodialysis patients were trained in the first study and seven participants attempting to lose or maintain their weight were trained in the second pilot study. The training focused on how to use a PDA and how to navigate the dietary software to self-monitor food intake. The goals of using the PDA were to improve adherence to the therapeutic diets and to self-monitoring. Lessons learned from the pilot studies are shared.

The co-editors of BioResources note the completion of our first ten years. We think that the journal can be judged as a success based on having achieved an impact factor of about 1.4 each year since 2009 and having reached a publication rate of about 700 articles per year. We strive to be a “people’s journal” serving scientists, students, and society. We plan to continue emphasizing editorial pieces and review articles, which supplement our main service of publishing peer-reviewed articles dealing with the science of lignocellulosic materials, chemicals, and their uses. We also support undergraduate scholarship in our academic department, including tuition payment, opportunities for pre-editing work, and support for undergraduates to attend conferences, etc.

Student peer assessment (SPA) has been used intermittently in medical education for more than four decades, particularly in connection with skills training. SPA generally has not been rigorously tested, so medical educators have limited evidence about SPA effectiveness.Seventy-one first-year medical students were stratified by previous test scores into problem-based learning tutorial groups, and then these assigned groups were randomized further into intervention and control groups. All students received evidence-based medicine (EBM) training. Only the intervention group members received SPA training, practice with assessment rubrics, and then application of anonymous SPA to assignments submitted by other members of the intervention group.Students in the intervention group had higher mean scores on the formative test with a potential maximum score of 49 points than did students in the control group, 45.7 and 43.5, respectively (P = 0.06).SPA training and the application of these skills by the intervention group resulted in higher scores on formative tests compared to those in the control group, a difference approaching statistical significance. The extra effort expended by librarians, other personnel, and medical students must be factored into the decision to use SPA in any specific educational context.SPA has not been rigorously tested, particularly in medical education. Future, similarly rigorous studies could further validate use of SPA so that librarians can optimally make use of limited contact time for information skills training in medical school curricula.

Background Computer-based examinations (CBE) ensure higher efficiency with respect to producibility and assessment compared to paper-based examinations (PBE). However, students often have objections against CBE and are afraid of getting poorer results in a CBE. The aims of this study were (1) to assess the readiness and the objections of students to a CBE vs. PBE (2) to examine the acceptance and satisfaction with the CBE on a voluntary basis, and (3) to compare the results of the examinations, which were conducted in different formats. Methods Fifth year medical students were introduced to an examination-player and were free to choose their format for the test. The reason behind the choice of the format as well as the satisfaction with the choice was evaluated after the test with a questionnaire. Additionally, the expected and achieved examination results were measured. Results Out of 98 students, 36 voluntarily chose a CBE (37%), 62 students chose a PBE (63%). Both groups did not differ concerning sex, computer-experience, their achieved examination results of the test, and their satisfaction with the chosen format. Reasons for the students' objections against CBE include the possibility for outlines or written notices, a better overview, additional noise from the keyboard or missing habits normally present in a paper based exam. The students with the CBE tended to judge their examination to be more clear and understandable. Moreover, they saw their results to be independent of the format. Conclusions Voluntary computer-based examinations lead to equal test scores compared to a paper-based format.

PURPOSE We compared the completeness of data collection using paper forms and using electronic forms loaded on handheld computers in an offi ce-based patient interview survey conducted within the American Academy of Family Phy- sicians National Research Network. METHODS We asked 19 medical assistants and nurses in family practices to administer a survey about pneumococcal immunizations to 60 older adults each, 30 using paper forms and 30 using electronic forms on handheld computers. By random assignment, the interviewers used either the paper or electronic form fi rst. Using multilevel analyses adjusted for patient characteristics and clustering of forms by practice, we analyzed the completeness of the data. RESULTS A total of 1,003 of the expected 1,140 forms were returned to the data center. The overall return rate was better for paper forms (537 of 570, 94%) than for electronic forms (466 of 570, 82%) because of technical diffi culties experienced with electronic data collection and stolen or lost handheld comput- ers. Errors of omission on the returned forms, however, were more common using paper forms. Of the returned forms, only 3% of those gathered electroni- cally had errors of omission, compared with 35% of those gathered on paper. Similarly, only 0.04% of total survey items were missing on the electronic forms, compared with 3.5% of the survey items using paper forms. CONCLUSIONS Although handheld computers produced more complete data than the paper method for the returned forms, they were not superior because of the large amount of missing data due to technical diffi culties with the hand- held computers or loss or theft. Other hardware solutions, such as tablet comput- ers or cell phones linked via a wireless network directly to a Web site, may be better electronic solutions for the future.

Background To see if there is a difference in performance when students switch from traditional paper-and-pencil examinations to computer-based examinations, and to determine whether there are gender differences in student performance in these two examination formats. Methods This study involved first year medical students at the University of Illinois at Urbana-Champaign over three Academic Years 2002–03/2003–04 and 2003–05. Comparisons of student performance by overall class and gender were made. Specific comparisons within courses that utilized both the paper-and-pencil and computer formats were analyzed. Results Overall performance scores for students among the various Academic Years revealed no differences between exams given in the traditional pen-and-paper and computer formats. Further, when we looked specifically for gender differences in performance between these two testing formats, we found none. Conclusion The format for examinations in the courses analyzed does not affect student performance. We find no evidence for gender differences in performance on exams on pen-and-paper or computer-based exams.

We examined participants' reading and recall of informed consent documents presented via paper or computer. Within each presentation medium, we presented the document as a continuous or paginated document to simulate common computer and paper presentation formats. Participants took slightly longer to read paginated and computer informed consent documents and recalled slightly more information from the paginated documents. We concluded that obtaining informed consent online is not substantially different than obtaining it via paper presentation. We also provide suggestions for improving informed consent--in both face-to-face and online experiments.

Investigations were undertaken to discover the effect and importance of technical factors in the Guthrie test and to determine the most satisfactory materials available. These findings were used in setting up the screening service for phenylketonuria for the South West Metropolitan Region.