Bruce E. Bowdish

Hypermedia navigation: Profiles of hypermedia users

In this study we explored the use of log files as a window into the process of hypermedia navigation. Although there is a growing body of research addressing theoretical and design issues related to open-ended, non-directive technologies such as hypermedia, relatively few studies have attempted to explain navigational performance. Sixty-six undergraduate students used a multidimensional, computer-based kiosk that could be explored in a nonlinear fashion to find information in response to one of two information-retrieval tasks (simple or complex). Cluster analysis was used to generate performance profiles derived from navigational data captured in log files. Analyses of within-cluster performance profiles, combined with external validation criteria, led to the classification of four different types of navigational performance (models users, disenchanted volunteers, feature explorers, and cyber cartographers). These characterizations were consistent with information-retrieval scores and the external criteria (self-efficacy, perceived utility, and interest). For example, individuals who appeared to take the time to learn the layout of the kiosk also had the highest self-efficacy, while those who used the help screen and watched the most movies had the lowest self-efficacy. Results also demonstrated an interaction between various individual navigational profiles and type of information-retrieval task.

Assessing the professional development needs of public health professionals.

This article describes the major activities associated with designing and implementing a comprehensive, professional development needs assessment of public health professionals in four states of the South Central region of the United States. The instrumentation, research design, and summary results of the needs assessment described in this article may facilitate similar efforts by interested researchers and program developers to assess the public health professional workforce training needs. Results of needs assessments can be useful in designing and evaluating professional development curricula and activities to strengthen public health services in the United States.

Physician Practice Behavior and Practice Guidelines: Using Unannounced Standardized Patients to Gather Data

BackgroundMeasuring actual practice behaviors of physicians, particularly as they relate to established clinical guidelines, is challenging. Standardized patients provide one method of collecting such data.ObjectiveTo demonstrate the use of unannounced standardized patients in gathering data that may address adherence to guidelines in an office setting.DesignUnannounced standardized patients (SPs) simulating an initial type 2 diabetic visit presented to community offices of 32 internists as “real” patients to record physicians’ evaluation and management.ParticipantsUnannounced SPs presented to the office of 32 internists as “real” patients.MeasurementsUnannounced SPs, simulating type 2 diabetics, completed a standardized assessment sheet, based on ADA guidelines to record physicians’ evaluation and management following an initial visit. Patient charts were also reviewed to determine if evaluation adhered to the guidelines.ResultsUnannounced SPs recorded 56 visits with 32 community internists; all SPs remained undetected. All physicians asked SPs about medications. At least 50% of physicians asked about home blood sugar monitoring, last eye exam, smoking, edema, and told patients to stop smoking. Less than 50% of physicians asked about parasthesias, performed fundoscopy, examined feet, referred the patient to a diabetic educator or ophthalmologist, or gave patients suggestions regarding glucose monitoring or exercise. HbA1c was ordered in 78%, metabolic profiles in 86%, and urinalysis/microalbumin in 41% of patients.ConclusionsUnannounced standardized patients can successfully collect important data regarding physician practices in community settings. This method may be helpful in assessing physician adherence to established clinical practice guidelines.

Double Duty: Students' Perceptions of Tulane's MD-MPH Dual Degree Program

Purpose: Although MD-MPH programs exemplify the initiative for collaboration between schools of medicine and public health and address the expanding requirements for effective medical practice, information on such programs is scant. Perspectives and motivations of students enrolled in a 4-year MD-MPH program are explored to benefit existing and new programs as well as to inspire future research. Summary: A questionnaire, based on previously identified themes, was mailed to all 110 students enrolled in the MD-MPH program at Tulane University. The typical respondent felt prepared for the program, expected to practice medicine full time, and expected to practice internationally up to 3 months annually. Perceived enhancements and barriers to dual degrees are addressed. Conclusions: Increased awareness of MD-MPH programs at the undergraduate level might be beneficial. Respondents valued the broader perspectives on the doctor-patient-society triad and additional career opportunities gained through their combined studies. Findings of this study can facilitate program planning and improvement elsewhere.

Emergency preparedness for genetics centers, laboratories, and patients: the Southeast Region Genetics Collaborative strategic plan.

Emergencies occur unpredictably and interrupt routine genetic care. The events after hurricanes Katrina and Rita have led to the recognition that a coherent plan is necessary to ensure continuity of operations for genetic centers and laboratories, including newborn screening. No geographic region is protected from the effects of a variety of potential emergencies. Regional and national efforts have begun to address the need for such preparedness, but a plan for ensuring continuity of operations by creating an emergency preparedness plan must be developed for each genetic center and laboratory, with attention to the interests of patients. This article describes the first steps in development of an emergency preparedness plan for individual centers.