The cognitive processes of doctors and nurses in the interpretation of physiological monitoring data in the neonate
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Journal Article↗
Biomedical subjects
R Logie
Publications and source records attributed to R Logie.
Computerisation and decision making in neonatal intensive care: a cognitive engineering investigation.
This paper reports results from a cognitive engineering study that looked at the role of computerised monitoring in neonatal intensive care. A range of methodologies was used: interviews with neonatal staff, ward observations, and experimental techniques. The purpose was to investigate the sources of information used by clinicians when making decisions in the neonatal ICU. It was found that, although it was welcomed by staff, computerised monitoring played a secondary role in the clinicians' decision making (especially for junior and nursing staff) and that staff used the computer less often than indicated by self-reports. Factors that seemed to affect staff use of the computer were the lack (or shortage) of training on the system, the specific clinical conditions involved, and the availability of alternative sources of information. These findings have relevant repercussions for the design of computerised decision support in intensive care and suggest ways in which computerised monitoring can be enhanced, namely: by systematic staff training, by making available online certain types of clinical information, by adapting the user interface, and by developing intelligent algorithms.
Attitude to Computers↗
INFORM: European survey of computers in intensive care units.
The aims of this study were (a) to survey and evaluate the impact of information technology applications in High Dependency Environments (HDEs) on organizational, psychological and cost-effectiveness factors, (b) to contribute information and design requirements to the other workpackages in the INFORM Project, and (c) to develop useful evaluation methodologies. The evaluation methodologies used were: questionnaires, case studies, objective findings (keystroke) and literature search and review. Six questionnaires were devised covering organizational impact, cost-benefit impact and perceived advantages and disadvantages of computerized systems in HDE (psychological impact). The general conclusion was that while existing systems have been generally well received, they are not yet designed in such a developed and integrated way as to yield their full potential. Greater user involvement in design and implementation and more emphasis on training emerged as strong requirements. Lack of reliability leading to parallel charting was a major problem with the existing systems. It proved difficult to assess cost effectiveness due to a lack of detailed accounting costs; however, it appeared that in the short term, computerisation in HDEs tended to increase costs. It is felt that through a better stock control and better decision making, costs may be reduced in the longer run and effectiveness increased; more detailed longitudinal studies appear to be needed on this subject.
Case-Control Studies↗
Human factors and computerisation in intensive care units: a review.
Current literature on the computerisation of Intensive Care Units indicates that many human factor considerations are relevant to the design and introduction of computer systems and to the evaluation of such systems within this environment. This paper aims to review and summarise essential points from the literature.
Attitude to Computers↗
Users' perceptions of a computerised information system in intensive care (ABICUS) on introduction and after 2 months use.
The aim of the present study was to assess the perceived utility of a computerised information system in an intensive care unit (ICU). Questionnaires were devised in which ICU staff indicated the ease or difficulty of obtaining and recording information (a) under the previous manual system, (b) soon after the introduction of the computerised system and (c) two months after computerisation. Results indicated the system was well received immediately and this favourable attitude persisted unchanged after two months experience. The questionnaire method also served to pinpoint some particular interface problems which are to be remedied in future versions of the system.
Attitude of Health Personnel↗
The decline of working memory in Alzheimer's disease. A longitudinal study.
A previous study (Baddeley et al., 1986) explored the hypothesis that patients suffering from dementia of the Alzheimer type (AD) are particularly impaired in the functioning of the central executive component of working memory. It showed that, when patients are required to perform 2 concurrent tasks simultaneously, the AD patients are particularly impaired, even when level of performance on the individual tasks is equated with that of age-matched controls. Although the results were clear, interpretation was still complicated by 2 issues: first, the question of comparability of performance on the separate tests between AD and control patients; secondly, the question of whether our results could be interpreted simply in terms of a limited general processing capacity being more taxed by more difficult dual tasks than by the individual tasks performed alone. The present study followed up the AD and control patients after 6 and 12 mths. We were able to allow for the problem of comparability of performance by using patients as their own control. Under these conditions, there is a very clear tendency for dual task performance to deteriorate while single task performance is maintained. A second experiment varied difficulty within a single task in which patients and controls were required to categorize words as belonging to 1, 2 or 4 semantic categories. There was a clear effect of number of categories on performance and a systematic decline in performance over time. There was, however, no interaction between task difficulty as measured by number of alternatives and rate of deterioration, suggesting that the progressive deterioration in performance shown by AD patients is a function of whether single or dual task performance is required, and is not dependent on simple level of task difficulty. Implications for the analysis of the central executive component of working memory are discussed.
Aged↗