To determine the impact of glycemic control, gender, and other relevant parameters on cognitive function during exposure to different blood glucose levels in patients with insulin-dependent diabetes ...mellitus (IDDM), we examined neuropsychologic function during experimentally induced periods of hyperglycemia and hypoglycemia.
We studied 20 men and 22 women, aged 18 to 44 years, with IDDM duration of 3 to 14 years and HbA1 values ranging from 5.8% to 18.0% (nondiabetic range 5.4% to 7.4%). We used a controlled experimental setting involving tests of sensory perceptual processing, simple motor abilities, attention, learning and memory, language, and spatial and constructional abilities at plasma glucose levels of 2.2, 5.6, 8.9, 14.4, and 21.1 mmol/L. Patients were blind to the glucose level. Tests used at each glucose level included reaction time (simple and choice), digit vigilance, trail making part B, word recall, digit sequence learning, and verbal fluency.
All aspects of neuropsychologic function were diminished at 2.2 mmol/L when compared with basal levels of performance at 8.9 mmol/L. whereas no alterations were observed at 14.4 or 21.1 mmol/L. Tests involving associative learning, attention, and mental flexibility were the most affected during hypoglycemia. Glycemic control was not correlated with neuropsychologic function at any glucose level. Women demonstrated less of an impairment in neuropsychologic function than men at 2.2 mmol/L.
Cognitive function in IDDM patients was generally well-preserved even at substantially elevated blood glucose levels. Deficits in ail relevant areas of cognitive function occurred during hypoglycemia (2.2 mmol/L). irrespective of prior glycemic control, and women with IDDM were less cognitively impaired than men with IDDM during hypoglycemia.
Understanding the strengths and weaknesses of a technology in the context of the distributed system in which it is working is critical to assessing and improving the performance of that system. ...Taking a systems approach requires knowledge about how all agents in a system work together to achieve the goals of that system. With these aims, the alerting mechanism of infusion pumps containing Dose-Error Reduction Software (DERS) was studied to determine its effectiveness in the Intensive Care Units (ICU's) of three hospitals. In 1,146 of the 9,557 pump alerts (12.0%), the alert caused the clinician to change the input. Of these, 1,030 were changed to within the hospital's recommended dosing limits. The alert was overridden for 8,400 (88.0%) of the alerts. The data show that this technology successfully informed clinicians over 1000 times that unintended doses had been inputted and stopped those doses from reaching the patient, thereby averting potential Medication Events. The data also suggest that, because nearly 90% of the alerts were overridden, a well-intended and valuable alert may be perceived by the clinicians as a false alarm and may be overlooked. Another key finding from this analysis was that clinicians may have used potentially unsafe workarounds to administer intravenous drug boluses (i.e., more rapid infusion of a defined dose or volume) and to keep the patient's line active between infusions. In a separate parallel study, clinician self-report of potentially harmful medication events was studied. During 559 hours of direct observation, clinicians detected 27 (IV and non-IV) medication events. All of the reported events were outside of the scope of what DERS technology was designed to detect. In addition, during the same time period the technology detected five potentially harmful IV medication events that the clinicians did not report. The results of these two studies indicate two possible classes of solutions that could reduce the impact and likelihood of medication administration errors. One class of solutions involves the procedures and policies of the hospital, ensuring that process and technology implementations are optimally tuned, taking human performance and the current practice of the clinicians into account. The other class of solutions involves using new strategies and technologies to ensure that each system agent has access to other agents' perspectives, and the broader system's perspective. Studies such as these can provide insight into the use of safety technology during critical care processes and provide direction for future research, including more effective design of alerting mechanisms of ICU devices.
"4 In these cases, the ITC would require the presiding ALJ to: (1) order discovery taken early on a potentially dispositive issue, such as the existence of a domestic industry (which is a mandatory ...showing by any complainant seeking relief in the ITC under Section 337); (2) conduct an early hearing on the potentially dispositive issue, if necessary; and (3) issue an initial determination within 100 days of institution.5 Some believed that the use of the pilot program would or should be limited to threshold jurisdictional issues, such as domestic industry, importation, and/or standing. Since its initiation in 2013, the ITC has ordered the pilot program on only five occasions. To reach this conclusion, the ALJ focused on the lack of evidence that "accessing a track" through a hierarchy or "playing a plurality of tracks associated with the selected subcategory" are inventive concepts.14 Again referencing the specification, the ALJ noted that the patent itself acknowledges that playing tracks or a group of tracks (e.g., an album) is routine, reinforced by the fact that there are no flowcharts or computer codes provided in the patent for those activities.15 Distinguishing the '433 patent from the patents previously held eligible by the Federal Circuit, the ALJ held that "applying a well-known abstract idea in a particular technological setting, as the '433 patent claims do, cannot render a claim patent-eligible.
This study used Pathfinder, a psychological scaling technique, to assess underlying cognitive structure associated with mastery of relevant knowledge necessary for anesthesiology decision-making. Our ...study revealed this approach to be a valid method to assess the tacit knowledge that underlies clinical expertise. A set of concepts associated with a decision-to-extubate scenario was derived from expert interviews. Participants included nine attending anesthesiologists, seven first-year anesthesiology residents, and eight second-year anesthesiology residents. Pathfinder was applied to participants' pairwise relatedness judgments of the clinical concepts in the context of the scenario. Experts' data were aggregated to form an expert referent structure. Student anesthesiologists were assessed based on comparison of their structures to this referent. These comparisons yielded a knowledge score that was highly correlated with residents' exam grades. This finding supports our position that Pathfinder is a valid knowledge assessment method and, as a complement to current exams, can be applied to assess a student's deep understanding of anesthesiology concepts.
Effective communication between clinicians is a crucial component of safe care. High-quality communication may be especially critical during care transitions between clinicians (handoffs). In a ...two-year quasi-experimental Quality Improvement project, we are using simulation learning to evaluate and improve communication between anesthesia providers and nurses as care is transitioned from the operating room to the post-anesthesia care unit (PACU). Using a multiple baseline, staggered entry, prospective cohort design with repeated measures, we are introducing a training intervention and evaluating its effects on dyadic communication. The primary hypothesis is that simulation-based communication skills training of PACU personnel will significantly improve the quality of handoffs. Clinicians' performance is being compared before and after their training on four dimensions of handoff effectiveness: information transfer; use of best evidence handoff strategies; interpersonal skills; and team behaviors. Clinicians also rate their own handoffs. Lessons learned and results to date will be presented.
Workload is a construct used to describe the extent to which an operator has engaged the cognitive and physical resources required for task performance. As task difficulty increases, operators ...allocate more resources to maintain acceptable performance. The purpose of the present study is to develop a technique to measure workload continuously, with high-resolution in real-time, and in a way that accounts for the contribution of multiple individual task components of the job of administering anesthesia. Workload associated with 51 clinical tasks performed by anesthesiologists was assessed using a written survey instrument, developed for this study. Participants were 241 anesthesia providers. Interval scale values were computed for each of the tasks using direct estimatation procedures. These values were then used to produce workload density maps for actual anesthesia cases by weighting the tasks performed during the case by their workload scale values. Moment-by-moment data on the specific tasks performed by anesthesiologists were obtained in real-time by trained observers during actual anesthetic cases. This type of analysis can be used to evaluate the costs associated with technical anesthesia procedures, increase our understanding of the anesthesiologist's job, and guide rational optimization of procedures, equipment, scheduling, and training.
Panel: The Role of Human Factors in Healthcare – 2020 Alvarado, Carla J.; Cao, Caroline; Klein, Gary ...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting,
09/2004, Volume:
48, Issue:
15
Book Review, Journal Article
Peer reviewed
What role will human factors professionals play in healthcare 2020? Health systems throughout the world face a number of common pressures, related to demography, epidemiology, science and technology ...developments, and medical demand. In particular, while developments in technology do not just provide health care with new possibilities for human factors engineering, medical interventions and therapies. They also produce changes the in our understanding of sickness and health, the possibilities and needs for managing the systems, for innovation, for standardization, and the political and economic relationships. The health care providers not only have to cope with these technological developments but assure their successful implementation and acceptance. The uncertainties and expectations linked to these innovations face major issues within the research and health care system, such as policies for managing scarcity of resources and changes in the relative frequency of diseases because of factors like ageing, and mobile global population and the like. A panel of both healthcare and human factors experts will discuss the role that human factors will play in healthcare in 2020.
Monitors that show intravenous (IV) drug concentrations currently do not exist. However, using real-time displays of intravenous anesthetic concentrations and effects could significantly enhance ...intraoperative clinical decision-making. Pharmacokinetic models are available to estimate past, present and future drug concentrations in the brain, and pharmacodynamic models are available to predict the drug's associated physiological effects. An interdisciplinary research team developed a new graphic display incorporating these models to show the predicted concentrations and effects of anesthetic drugs in real-time. To evaluate the effectiveness of the display on the management of anesthesia, 15 anesthesiologists participated in a computer-based simulation study. Anesthesiologists maintained drug concentrations closer to an optimal target level when they used the prototype anesthesia drug display. Participants also reported lower levels of workload with the display and rated the display as a useful addition to anesthesia monitoring.
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