Cognitive Aids Research Articles

ABCDE Approach for Massive Hemoptysis: A Novel Cognitive Aid.

Massive hemoptysis is a high-risk, low-frequency clinical scenario, and teaching the management of this emergency should extend beyond reliance on clinical exposure. Massive hemoptysis requires emergent intervention to avoid asphyxiation and death. Practitioners need both cognitive and procedural skills to intervene in a high-stress situation. Cognitive aids have demonstrated benefits in other emergency settings, but no such tool exists for massive hemoptysis. Using expert recommendations, we developed the ABCDE Approach for Massive Hemoptysis, a cognitively accessible, prioritized toolbox of interventions designed to assist learners in organizing an approach to these high-risk and time-sensitive patient cases. Herein we present the elements and use of the ABCDE approach. Providing a cognitive approach to massive hemoptysis is an important first step in improving education for this potentially fatal clinical scenario.

An Initial Psychometric Analysis of the Brain Gauge Tactile-Based Test Battery and Its Potential for Clinical Use Assessing Patients With Acute Mild Traumatic Brain Injury.

A new brief computerized test battery that uses tactile stimulation, Brain Gauge (BG), has been proposed as a cognitive assessment aid and its developers have reported an almost perfect ability to distinguish acute mild traumatic brain injury (mTBI) patients from healthy controls. This investigation attempted to replicate those results and serve as an initial psychometrically and clinically focused analysis of BG. BG scores from 73 military service members (SM) assessed within 7 days after having a clinically diagnosed mTBI were compared to 100 healthy SMs. Mean scores were compared, score distributions were examined, and univariate and multivariate base rate analyses of low scores were performed. SMs with mTBI had statistically significantly worse performance on both BG Reaction Time (RT) tests and the Sequential Amplitude Discrimination test as reflected by higher mean RT and RT variability and higher minimum detectable amplitude difference. SMs with mTBI also had a significantly lower whole-battery composite (i.e., Cortical Metric Symptom Score). Larger proportions of SMs with mTBI had lower overall performance than controls. However, at most only 26.9% of those with mTBI performed at potentially clinically meaningful cutoffs that were defined as various numbers of low scores that were prevalent in no more than 10% of the control group, which is equivalent to specificity ≥90% and sensitivity ≤26.9% for mTBI. Our analysis did not replicate the high level of classification accuracy reported by BG's developers. Pending further psychometric development, BG may have limited clinical utility for assessing mTBI patients.

A Checklist to Address Implicit Bias in Healthcare Settings During the COVID-19 Pandemic: The PLACE Strategy.

A Checklist to Address Implicit Bias in Healthcare Settings During the COVID-19 Pandemic: The PLACE Strategy.

Impact of Intrinsic Cognitive Skills and Metacognitive Beliefs on Tool Use Performance

Abstract Cognitive tools (e.g., calculators) provide all users with the same potential. Yet when people use such cognitive tools, interindividual variations are observed. Previous findings have indicated that 2 main factors could explain these variations: intrinsic cognitive skills (i.e., the “non–tool use” cognitive skills associated with the task targeted) and metacognitive beliefs about one's performance with tool use. In this study we sought to reproduce these findings and to investigate in more detail the nature of the relationships (i.e., linear vs. exponential) between tool use performance and intrinsic cognitive skills. In Experiment 1, 200 participants completed 2 cognitive tasks (calculation and geography) in 2 conditions (non–tool use vs. tool use). In Experiment 2, 70 participants performed a geography task in 2 conditions (non–tool use vs. tool use) and estimated their performance in each condition before completing the task. Results indicated that intrinsic cognitive skills and, to a lesser extent, metacognitive beliefs improved tool use performance: The higher the intrinsic cognitive skills and the higher participants estimated their tool use performance, the higher this tool use performance was. The nature of the relationship between tool use performance and intrinsic cognitive skills appeared to be linear rather than exponential. These findings extend previous research showing a strong impact of intrinsic cognitive skills on the performance associated with the use of cognitive tools or external aids.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

A Multimodal Approach to Training Coronavirus Disease (COVID‐19) Processes Across Four Intensive Care Units

BackgroundCoronavirus disease (COVID-19) required innovative training strategies for emergent aerosol generating procedures in intensive care units. This manuscript summarizes institutional operationalization of COVID-specific training, standardized across four intensive care units. Methods & ResultsAn interdisciplinary team collaborated with the Simulator Program and OpenPediatrics refining logistics using process maps, walkthroughs and simulation. A multimodal approach to information dissemination, high-volume team training in modified resuscitation practices and technical skill acquisition included instructional videos, training superusers, small-group simulation using a flipped classroom approach with rapid cycle deliberate practice, interactive webinars, and cognitive aids. Institutional data on application of this model are presented. ConclusionSuccess was founded in interdisciplinary collaboration, resource availability and institutional buy in.

THYRAID: a cognitive aid for the management of neck haematoma following thyroid surgery.

THYRAID: a cognitive aid for the management of neck haematoma following thyroid surgery.

Arsenic: a Culpable Element and a Possible Menace for HIV/AIDS Patients.

Arsenic contamination has long been recognized as one of the most harmful environmental pollutants resulting from anthropogenic activity. Apart from being an environmental toxicant or pollutant, this culpable heavy metal also has detrimental effects on human health. People throughout the world are exposed to arsenic (As) mostly through polluted drinking water. Acute inorganic arsenic (iAs) poisoning causes nausea, vomiting, stomach discomfort, and severe diarrhea. As on long-term exposure is a potent carcinogen, characterized by IARC (International Agency for Research on Cancer). As levels are high mainly in Gangetic regions due to which the people living around are suffering the consequences. The carcinogenicity of As is well established but the immunotoxicity caused by it is still unknown. Some animal model supports the toxicity of As in the immune system as well, but in humans, mainly suffering from human immunodeficiency virus (HIV), it is not well established. iAs suppresses the immune system by acting on different targets and exacerbating infections. Although animal studies have demonstrated that arsenic trioxide (As2O3) reduces viral rebound and restores CD4 + count in vivo when coupled with antiretroviral medications, elemental AS may have devastating effects on the immune system of HIV patients, making them more prone to opportunistic infections (OIs). It is well known that in later stages of HIV infection, neurological problems also complicate the conditions such as cognitive impairment and AIDS dementia complex (ADC). Along with immunotoxicity, As has the potential to damage HIV patients' brains. This article addresses theimmunotoxicity of arsenic and exacerbations caused by it, along with the neurotoxicity, particularly in HIV patients residing near the Gangetic belt.

Tactics for hemorrhagic shock: A virtual course and visual aid for improved resuscitation.

Our trauma performance improvement initiative recognized missed treatment opportunities for patients undergoing massive transfusion. To improve patient care, we developed a novel cognitive aid in the form of a poster entitled "TACTICS for Hemorrhagic Shock." We hypothesized that this reference and corresponding course would improve the performance of trauma leaders caring for simulated patients requiring massive transfusion. First, residents and physician assistants participated in a one-on-one, socially distanced, screen-based virtual patient simulation. Next, they watched a short presentation introducing the TACTICS visual aid. They then underwent a similar second virtual simulation during which they had access to the reference. In both simulations, the participants were assessed using a scoring system developed to measure their ability to provide appropriate predetermined interventions while leading a trauma resuscitation (score range, 0-100%). Preintervention and postintervention scores were compared using a one-group pre-post within-subject design. Participants' feedback was obtained anonymously. Thirty-two participants (21 residents and 11 physician assistants) completed the course. The median score for the first simulation without the use of the visual aid was 43.8% (interquartile range, 33.3.8-61.5%). Commonly missed treatments included giving tranexamic acid (success rate, 37.5%), treating hypothermia (31.3%), and reversing known anticoagulation (28.1%). All participants' performance improved using the visual aid, and the median score of the second simulation was 89.6% (interquartile range, 79.2-94.8%; p < 0.001). Ninety-two percent of survey respondents "strongly agreed" that the TACTICS visual aid would be a helpful reference during real-life trauma resuscitations. The TACTICS visual aid is a useful tool for improving the performance of the trauma leader and is now displayed in our emergency department resuscitation rooms. This performance improvement course, the associated simulations, and visual aid are easily and virtually accessible to interested trauma programs. Therapeutic/Care Management; Level IV.

Physicians' perceptions of two ways of algorithm presentation: graphic versus text-based approach

Acute bleeding during surgery or after trauma harms patients, and challenges involved physicians. Protocols and cognitive aids can help in such situations. This dual-centre study investigated physicians' opinions regarding two ways to present cognitive aids, graphic ‘Haemostasis Traffic Light’ and text-based, using the example of a coagulation management algorithm to identify the strengths and limitations of both presentation modalities. Using qualitative research methods, we identified recurring answer patterns and derived major topics and subthemes through inductive coding. Eighty-four physicians participated. We assigned each half randomly to one of the cognitive aids (graphic/text-based) and determined 447 usable statements. We qualitatively deduced the importance of having a cognitive aid for physicians. Furthermore, it is noticeable that the graphic group made more positive comments (154 of 242 (64%) statements), while the text-based participants made more negative annotations (126 of 205 (61%) statements), suggesting a generally stronger approval of this cognitive aid. Practitioner summary: This qualitative study provides an overview of physicians` positive and negative perceptions regarding two presentation ways for a coagulation management algorithm. Participants perceived the graphic method created according to user-centred design principles more positively. The analysis reveals components that an ideal algorithm should have to help streamline the decision-making process.

A Systematic Review of Smartphone and Tablet Use by Older Adults With and Without Cognitive Impairment.

Background and ObjectivesA systematic review was conducted to explore the use of smartphones and tablet computers as cognitive and memory aids by older adults with and without cognitive impairment, specifically the effects of smartphone and tablet use on participants’ cognition and memory, and the barriers and facilitators to smartphone and tablet use for cognitive and memory support.Research Design and MethodsA systematic search of 6 key databases found 11,895 citations published between 2010 and 2021. Studies were included if they involved community-dwelling older adults with or without cognitive impairment arising from acquired brain injury, mild cognitive impairment, or dementia, and if they evaluated everyday smartphone or tablet device use for cognition, memory, or activities of daily living.ResultsA total of 28 papers were included in the narrative synthesis. There was some evidence that the use of smartphones and tablets could aid cognitive function in older adults without cognitive impairment, particularly executive function and processing speed. There was modest evidence that smartphone and tablet use could support memory in both older adults without cognitive impairment and those with acquired brain injury and dementia.Discussion and ImplicationsSmartphones and tablets were seen by users as acceptable, enjoyable, and nonstigmatizing alternatives to conventional assistive technology devices; however, current use of smartphone and tablet devices is hindered by the digital literacy of older adults, a lack of accommodation for older adult users’ motor and sensory impairments, and a lack of input from clinicians and researchers. Much of the evidence presented in this review derives from case studies and small-scale trials of smartphone and tablet training interventions. Further research is needed into older adults’ use of smartphones and tablets for cognitive support before and after the onset of cognitive impairment in order to develop effective evidence-based smart technology cognition and memory aids.

Novel Technologies and Techniques for Prehospital Airway Management: An NAEMSP Position Statement and Resource Document

Novel technologies and techniques can influence airway management execution as well as procedural and clinical outcomes. While conventional wisdom underscores the need for rigorous scientific data as a foundation before implementation, high-quality supporting evidence is frequently not available for the prehospital setting. Therefore, implementation decisions are often based upon preliminary or evolving data, or pragmatic information from clinical use. When considering novel technologies and techniques. NAEMSP recommends: Prior to implementing a novel technology or technique, a thorough assessment using the best available scientific data should be conducted on the technical details of the novel approach, as well as the potential effects on operations and outcomes. The decision and degree of effort to adopt, implement, and monitor a novel technology or technique in the prehospital setting will vary by the quality of the best available scientific and clinical information: • Routine use – Technologies and techniques with ample observational but limited or no interventional clinical trial data, or with strong supporting in-hospital data. These techniques may be reasonably adopted in the prehospital setting. This includes video laryngoscopy and bougie-assisted intubation. • Limited use – Technologies and techniques with ample pragmatic clinical use information but limited supporting scientific data. These techniques may be considered in the prehospital setting. This includes suction-assisted laryngoscopy and airway decontamination and cognitive aids. • Rare use – Technologies and techniques with minimal clinical use information. Use of these techniques should be limited in the prehospital setting until evidence exists from more stable clinical environments. This includes intubation boxes. The use of novel technologies and techniques must be accompanied by systematic collection and assessment of data for the purposes of quality improvement, including linkages to patient clinical outcomes. EMS leaders should clearly identify the pathways needed to generate high-quality supporting scientific evidence for novel technologies and techniques.

Hyperinsulinemia Associated Depression.

Hyperinsulinemia promotes fat accumulation, causing obesity. Being an inflammatory state, obesity can induce further inflammation and is a risk factor for HPA (hypothalamic pituitary axis) dysregulation through hypercortisolism-related hyperglycemia. In another hypothesis, the sympathetic nervous system (SNS) plays a significant role in the regulation of hormone secretion from the pancreas such as an increase in catecholamines and glucagon as well as a decrease in plasma insulin levels, a disruption on SNS activity increases insulin levels, and induces glycogenolysis in the liver and lipolysis in adipose tissue during hypoglycemia. Hyperglycemia-hyperinsulinemia exacerbates inflammation and increases the oxidative stress along with regulating the levels of norepinephrine in the brain sympathetic system. Increased inflammatory cytokines have also been shown to disrupt neurotransmitter metabolism and synaptic plasticity which play a role in the development of depression via inhibiting serotonin, dopamine, melatonin, and glutamate signaling. An increased level of plasma insulin over time in the absence of exercising causes accumulation of lipid droplets in hepatocytes and striated muscles thus preventing the movement of glucose transporters shown to result in an increase in insulin resistance due to obesity and further culminates into depression. Further hyperinsulinemia-hyperglycemia condition arising due to exogenous insulin supplementation for diabetes management may also lead to physiological hyperinsulinemia associated depression. Triple therapy with SSRI, bupropion, and cognitive behavioral therapy aids in improving glycemic control, lowering fasting blood glucose, decreasing the chances of relapse, as well as decreasing cortisol levels to improve cognition and the underlying depression. Restoring the gut microbiota has also been shown to restore insulin sensitivity and reduce anxiety and depression symptoms in patients.

A Coding Framework for Usability Evaluation of Digital Health Technologies.

Several studies have reported low adherence and high resistance from clinicians to adopt digital health technologies into clinical practice, particularly the use of computer-based clinical decision support systems. Poor usability and lack of integration with the clinical workflow have been identified as primary issues. Few guidelines exist on how to analyze the collected data associated with the usability of digital health technologies. In this study, we aimed to develop a coding framework for the systematic evaluation of users' feedback generated during focus groups and interview sessions with clinicians, underpinned by fundamental usability principles and design components. This codebook also included a coding category to capture the user's clinical role associated with each specific piece of feedback, providing a better understanding of role-specific challenges and perspectives, as well as the level of shared understanding across the multiple clinical roles. Furthermore, a voting system was created to quantitatively inform modifications of the digital system based on usability data. As a use case, we applied this method to an electronic cognitive aid designed to improve coordination and communication in the cardiac operating room, showing that this framework is feasible and useful not only to better understand suboptimal usability aspects, but also to recommend relevant modifications in the design and development of the system from different perspectives, including clinical, technical, and usability teams. The framework described herein may be applied in other highly complex clinical settings, in which digital health systems may play an important role in improving patient care and enhancing patient safety.

Guiding Attention via a Cognitive Aid During a Simulated In-Hospital Cardiac Arrest Scenario: A Salience Effort Expectancy Value Model Analysis.

To investigate the effect of a cognitive aid on the visual attention distribution of the operator using the Salience Effort Expectancy Value (SEEV) model. Cognitive aids aim to support an operator during the execution of a task. The effect of cognitive aids on performance is frequently evaluated but whether a cognitive aid improved, for example, attention distribution has not been considered. We built the Expectancy Value (EV) model version which can be considered to indicate optimal attention distribution for a given event. We analyzed the eye tracking data of emergency physicians while using a cognitive aid application versus no application during a simulated in-hospital cardiac arrest scenario. The EV model could fit the attention distribution in such a simulated emergency situation. Partially supporting our hypothesis, the cognitive aid application group showed a significantly better EV model fit than the no application group in the first phases of the event, but a worse fit in the last phase. We demonstrated that a cognitive aid affected attention distribution and that the SEEV model provides the means of capturing these effects. We suggest that the aid supported and improved visual attention distribution in the stressful first phases of a cardiopulmonary resuscitation but may have focused attention on objects that are relevant for lower priority goals in the last phase. The SEEV model can provide insights into expected and unexpected effects of cognitive aids on visual attention distribution and may help to design better artifacts.

118 Simulation for Novice Anaesthetists: Addressing Training Gaps Created by a Global Pandemic

It is well documented that the COVID-19 pandemic is having a huge impact on doctors in training. Much of novice anaesthetists’ training is delivered during high turnover, elective theatre lists of low-risk patients The aim of the study was to create a trust-wide high-fidelity simulation course for novice anaesthetists, focussing on confidence building and preparation for on-calls, together with clinical and non-technical management of specific anaesthetic complications.A pre-course questionnaire aided a learning needs analysis and informed the learning objectives. Poor confidence due to lack of training was a common theme. Issues identified included limited case numbers, exposure to common emergencies and difficulty progressing to more distant supervision. Using a standardized scenario authoring platform (IRIS) we collaborated with a multi-professional faculty group to design a 1-day simulation course. To ensure an authentic learner experience, scenarios were designed for delivery in a high-fidelity simulation suite using Laerdal SimMan3G with LEAP software. Familiar clinical equipment, such as a Datex Ohmeda anaesthetic machine, was used and access to typical cognitive aids provided to mirror a real theatre environment.Initially, participants prepared for an anaesthetic induction following standard operating procedures, including performing the World Health Organisation Surgical Safety Checklist. They then carried out this uncomplicated induction with the assistance of a trained Operating Department Practitioner. This aided in embedding good clinical practice and promoted patient safety. A second scenario followed, during which an emergency unfolded. The group observed each scenario through a video link and contributed to a consultant-led debrief. To assess course impact participants completed post-course questionnaires. Confidence universally improved after the course. Every attendee found the course useful and was highly likely to recommend it to a colleague. For several participants, this provided their first experience carrying out an emergency anaesthetic induction without direct supervision. In this setting, simulation has been used as a valuable tool to supplement clinical exposure where there were significant barriers to traditional training methods. We intend to further develop this course to become an integral part of novice anaesthetic training within our trust.

Development of the DREAM System: Digital Reminders for Everyday Activity Memory

Prospective memory, the ability to remember to execute an intention in the future, is crucial for the performance of many everyday tasks important for independent living. Prospective memory abilities decline with age, and older adults living with mild cognitive impairment (MCI), cognitive impairment due to traumatic brain injury (TBI), and cognitive impairment due to stroke are especially susceptible to prospective memory failures. The goal of the Digital Reminders for Everyday Activity Memory (DREAM) project is first to establish proof of concept for an adaptive cognitive aid to support the prospective memory of older adults with various cognitive impairments, and then establish proof of product in studies examining the use of a working prototype within the lab and within participants’ homes. Data will be presented from initial work verifying product requirements through engagement with stakeholders, including subject matter experts, older adults with cognitive impairments, and their care partners.

ENHANCE: The Center for Enhancing Neurocognitive Health, Abilities, Networks, &amp; Community Engagement

Approximately 9 % of those aged 65 and over have a cognitive impairment due to a variety of causes including Alzheimer’s disease and other forms of dementia, Mild Cognitive Impairment (MCI), Parkinson’s disease, traumatic brain injury (TBI), and stroke. Few technology solutions have been directed towards supporting older adults with cognitive impairments and the literature regarding the efficacy of these solutions is sparse. In this symposium, we describe our new Center called ENHANCE (Enhancing Neurocognitive Health, Abilities, Networks, and Community Engagement), which is focused on developing technology support for aging adults with a cognitive impairment due to MCI, TBI, and Stroke. Sara Czaja will provide an overview of the conceptual framework, goals, and structure of ENHANCE, and describe the STRUMM project, that focuses on the design and evaluation of an innovative intelligent adaptive software package aimed at providing cognitive and social support to aging adults with cognitive impairments. Wendy Rogers will discuss the ENACT project, a longitudinal needs assessment focusing on understanding the needs, challenges, and support preferences of our target population and informal caregivers. Neil Charness will describe the AUGMENT development project, which is concerned with developing an instructional support tool for mobility activities, such as wayfinding, locating, and using transportation services. Finally, Walter Boot will discuss the DREAM development project, which is focused on developing a technology-based cognitive aid to support prospective memory activities. Michelle Bourgeois will serve as the discussant for the symposium and highlight the unique opportunities and challenges associated with ENHANCE.

Impact of a Digital Cognitive Aid on the Performance of Military Healthcare Teams During Critical Care Management in a Warfront Injury Situation: A Simulation Randomized Controlled Study.

Initial healthcare delivery after warfront injury is unpredictably challenging for military forces. As preparatory training, healthcare providers use simulation to improve their performance in stressful critical situations. This study investigated whether a digital CA held by the team leader improved performance in simulated combat casualty care. This randomized controlled trial was performed during a combat casualty training course for military physicians and nurses in France. Each pair of care providers completed 2 scenarios randomized to be undertaken either with or without a digital CA. The primary end point was the technical performance evaluated from a video recording by 2 independent raters using a pre-established score grid (up to 100%) according to military protocols. The secondary end point was the nontechnical performance (TEAM scale, maximum: 54 points). Thirty-six pairs of participants were included. Use of the digital CA improved both technical (74% vs 53%, P < 0.001) and nontechnical (42 vs 32, P < 0.001) performance. The digital CA improved technical and nontechnical performance during training of medical care for military combat casualties. Use of a dedicated digital CA might improve care in a combat environment. This study is a randomized controlled trial.

Improving physical distancing among healthcare workers in a pediatric intensive care unit.

Healthcare workers (HCWs) not adhering to physical distancing recommendations is a risk factor for acquisition of severe acute respiratory coronavirus virus 2 (SARS-CoV-2). The study objective was to assess the impact of interventions to improve HCW physical distancing on actual distance between HCWs in a real-life setting. HCWs voluntarily wore proximity beacons to measure the number and intensity of physical distancing interactions between each other in a pediatric intensive care unit. We compared interactions before and after implementing a bundle of interventions including changes to the layout of workstations, cognitive aids, and individual feedback from wearable proximity beacons. Overall, we recorded 10,788 interactions within 6 feet (∼2 m) and lasting >5 seconds. The number of HCWs wearing beacons fluctuated daily and increased over the study period. On average, 13 beacons were worn daily (32% of possible staff; range, 2-32 per day). We recorded 3,218 interactions before the interventions and 7,570 interactions after the interventions began. Using regression analysis accounting for the maximum number of potential interactions if all staff had worn beacons on a given day, there was a 1% decline in the number of interactions per possible interactions in the postintervention period (incident rate ratio, 0.99; 95% confidence interval, 0.98-1.00; P = .02) with fewer interactions occurring at nursing stations, in workrooms and during morning rounds. Using quantitative data from wearable proximity beacons, we found an overall small decline in interactions within 6 feet between HCWs in a busy intensive care unit after a multifaceted bundle of interventions was implemented to improve physical distancing.