Cognitive engineering

Statistics: Methods and Applications.

This book attempts to achieve a difficult goal: to teach statistics to the novice so as to impart a liking and understanding of statistics. The book is geared toward a medical audience, since most examples are from the medical literature. The structure of the book consists of the following elements in each chapter: a small number of statistical rules of thumb, followed by a nontechnical explanation, a demonstration of how to work through the mechanics of doing the statistical test in question, a summary, and sample problems to be solved by the reader. (The answers, with explanations, are provided in an appendix.) Although a variety of univariate statistics are included, certain topics that are important in medical research are not. For example, there is little or no discussion of multiple regression, life-table techniques, or pooling of studies. These omissions, especially of multiple regression, are unfortunate. The Primer was derived from

Primer of Biostatistics

Although interruptions are daily occurring events for most working people, little research has been done on the impacts of interruptions on workers and their performance. This study examines the e Vects of interruptions on task performance and its regulation, as well as on workers’ psychological and psychophysiological state. Two parallel experiments were carried out in the Netherlands and in Russia, using a common conceptual framework and overlapping designs. Employees with relevant work experience carried out realistic text editing tasks in a simulated o Yce environment, while the frequency and complexity of interruptions were experimentally manipulated. It was hypothesized that interruptions: (i) would cause a deterioration of performance; (ii) evoke strategies to partially compensate for this deterioration; (iii) aVect subjects’ emotions and well-being negatively; and (iv) raise the level of eVort and activation. It was also hypothesized that greater frequency and complexity of interruptions would enhance the expected e Vects. The hypotheses are only partially cone rmed. The results show that, contrary to what was expected, interruptions cause people to perform the main task faster while maintaining the level of quality. Participants develop strategies enabling them to deal e Vectively with the interruptions, while actually over-compensating the potential performance decline. Interruptions do have a negative impact on emotion and well-being, and lead to an increase of e Vort expenditure, although not to an increase in activation. Thus the improved performance is achieved at the expense of higher psychological costs. Greater complexity evoked more favourable responses among the Dutch participants and more unfavourable ones among the Russian participants. These diVerences are interpreted in terms of the participants’ professional background. The research demonstrates that the e Vects of interruptions reach beyond the execution of additional tasks and the change of work strategies. Interruptions appear to have an after-e Vect, ine uencing the workers’ subsequent readiness to perform. Detailed analysis of the activity in the interruption interval, focusing on

Temporal factors in mental work: effects on interrupted activities

Objectives To systematically review the peer-reviewed literature on interruptions in healthcare settings to determine the state of the science and to identify the gaps in research. Methods Inclusion criteria were determined, and the online databases PubMed and Web of Knowledge-CrossSearch were searched. Results Thirty-three papers were reviewed. Several important findings were identified: (1) interruptions occur frequently in all healthcare settings, (2) an important gap exists: only seven studies examined outcomes related to interruptions, (3) interruptions in healthcare have only been studied from the viewpoint of the person being interrupted and (4) few studies explicitly or implicitly examined the cognitive implications of interruptions. Conclusions The high frequency of interruptions coupled with information content may simply be indicative of the high need for constant communication and coordination in healthcare. Many interruptions may be necessary for safe, high-quality care; thus, trying to eliminate all interruptions is unwise. That said, there may be situations, such as during high-risk procedures, when limiting interruptions may be warranted. Taking a complex sociotechnical systems approach will help researchers view interruptions more holistically and will result in more comprehensive studies that take into account the complexity of interruptions and the many variables in healthcare settings.

https://qualitysafety.bmj.com/content/qhc/19/4/304.full.pdf

Interruptions and distractions in healthcare: review and reappraisal

An interruption was found to have no consistent definition in either healthcare or nonhealthcare literature. Walker and Avant's 8-step method of concept analysis was used to clarify, define, and develop a conceptual model of interruption. The analysis led to the identification of 5 defining attributes that include (1) a human experience; (2) an intrusion of a secondary, unplanned, and unexpected task; (3) discontinuity; (4) externally or internally initiated; and (5) situated within a context. Use of the defining attributes will be extended to form a category of interruption within a taxonomy of activity.

A concept analysis of the phenomenon interruption.

Background
Thousands of children experience cardiac arrest events every year in pediatric intensive care units. Most of these children die. Cardiac arrest prediction tools are used as part of medical emergency team evaluations to identify patients in standard hospital beds that are at high risk for cardiac arrest. There are no models to predict cardiac arrest in pediatric intensive care units though, where the risk of an arrest is 10 times higher than for standard hospital beds. Current tools are based on a multivariable approach that does not characterize deterioration, which often precedes cardiac arrests. Characterizing deterioration requires a time series approach. The purpose of this study is to propose a method that will allow for time series data to be used in clinical prediction models. Successful implementation of these methods has the potential to bring arrest prediction to the pediatric intensive care environment, possibly allowing for interventions that can save lives and prevent disabilities.

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Time series analysis as input for clinical predictive modeling: Modeling cardiac arrest in a pediatric ICU

Clinical communication failures caused 60% of sentinel events reported by the Joint Commission on Accreditation of Healthcare Organizations. The difficulties of communication have been the primary cause of errors leading to patients' death. For analysing medical error events, uncovering the patterns of clinical communication, this paper reports the design and development of clinical communication ontology. The ontology contains eight axes and was validated using ten medical error cases, where communication was the main factor. The coding process demonstrates that the ontology can be used as a guideline for future medical error reporting system, through which the root cause of medical error due to communication will be revealed in a clear pattern. This ontology contributes to the generation of proper interventions and effective strategies for reducing medical errors.

Clinical communication ontology for medical errors.

Cognitive artifacts--information displays that inform thought processes and increase knowledge--fulfill a fundamental role in distributed cognition. Cognitive work--the mental processes of selecting and evaluating data, reasoning, and making decisions--is guided and informed by cognitive artifacts, especially in clinical areas. The importance of cognitive artifacts to cognitive work suggests the need to study and comprehensively understand cognitive artifacts prepared and used by the clinical nurses and how these documents influence and guide nursing practice. This article identifies and describes the attributes of effectively constructed cognitive artifacts using the concept analysis process described by Walker and Avant.

Concept analysis of cognitive artifacts.

A critical step towards reducing errors in health care is the collection and assessment of medical error data so that potential harms to patients can be identified and steps taken to prevent or mitigate them. However, no standardized framework for classifying and evaluating such data currently exists. This paper describes our efforts in developing a comprehensive medical error ontology to serve as a standard representation for medical error concepts from various existing published taxonomies. Eight candidate taxonomies were selected from the published literature and merged to create a reference ontology consisting of 12 multidimensional axes that encompass all the aspects of a medical error event. The ultimate goal of the project is to use the medical error ontology to identify strategies for preventing future adverse events in health care.

/pdf/development-of-a-comprehensive-medical-error-ontology-7j548qbbbf.pdf

James P. Turley

Papers

A concept analysis of the phenomenon interruption.

Time series analysis as input for clinical predictive modeling: Modeling cardiac arrest in a pediatric ICU

Clinical communication ontology for medical errors.

Concept analysis of cognitive artifacts.

Development of a Comprehensive Medical Error Ontology