Evaluating the effects of cognitive support on psychiatric clinical comprehension.
Evaluating the effects of cognitive support on psychiatric clinical comprehension.
复制标题
DOI：
10.1016/j.artmed.2014.08.002
复制
发表时间：
2014-10
影响因子：
7.5
通讯作者：
Cohen, Trevor.
中科院分区：
文献类型：
--
作者：
Dalai, Venkata V.;Khalid, Sana;Gottipati, Dinesh;Kannampallil, Thomas;John, Vineeth;Blatter, Brett;Patel, Vimla L.;Cohen, Trevor.
关键词：
临床医生的注意力是一种宝贵的资源，在当前的医疗实践中，由于复杂的患者状况、信息过载、时间压力以及对聚集和综合来自不同来源的信息的需求而产生的认知需求消耗了临床医生的注意力。以便于生成有效诊断解决方案的方式组织信息的能力是专家医师的显著特征，这表明以类似方式组织临床信息的自动化系统可以增强医师的决策能力。在本文中，我们描述了一个理论驱动的认知支持系统（CSS），协助精神科医生在他们的解释临床病例的设计和评估。该系统突出显示并提供导航到根据一组诊断和治疗上有意义的更高级别概念组织的文本的方法。为了评估界面，16名精神病学住院医师解释了两个临床病例场景，有和没有CSS。在他们解释的情况下，大声思考协议捕获转录和定性分析。此外，还评估了案件口头摘要中与关键高级概念有关的内容的频率和相对位置。此外，从两组的成绩单进行了比较，专家得出的参考标准，使用潜在语义分析（LSA）。定性分析表明，该系统的用户更好地参加了这两种情况下，这些突出的系统，并揭示了系统介导的假设生成和评价的方式，具体的临床重要方面。对汇总数据的分析显示，有无该系统的重点存在差异。LSA分析表明，该系统的用户在他们的重点更“专家”，认知支持在更复杂的情况下更有效。认知支持影响临床理解。这似乎很有帮助，但也可能导致忽视系统没有突出显示的信息（如心理社会史）。研究结果对临床叙述的CSS设计有一定的影响，包括信息组织和文本修饰的作用，以更有效地进行临床病例介绍和理解。
Clinicians’ attention is a precious resource, which in the current healthcare practice is consumed by the cognitive demands arising from complex patient conditions, information overload, time pressure, and the need to aggregate and synthesize information from disparate sources. The ability to organize information in ways that facilitate the generation of effective diagnostic solutions is a distinguishing characteristic of expert physicians, suggesting that automated systems that organize clinical information in a similar manner may augment physicians’ decision-making capabilities. In this paper, we describe the design and evaluation of a theoretically driven cognitive support system (CSS) that assists psychiatrists in their interpretation of clinical cases. The system highlights, and provides the means to navigate to, text that is organized in accordance with a set of diagnostically and therapeutically meaningful higher-level concepts. To evaluate the interface, 16 psychiatry residents interpreted two clinical case scenarios, with and without the CSS. Think-aloud protocols captured during their interpretation of the cases were transcribed and analyzed qualitatively. In addition, the frequency and relative position of content related to key higher-level concepts in a verbal summary of the case were evaluated. In addition the transcripts from both groups were compared to an expert derived reference standard using latent semantic analysis (LSA). Qualitative analysis showed that users of the system better attended to specific clinically important aspects of both cases when these were highlighted by the system, and revealed ways in which the system mediates hypotheses generation and evaluation. Analysis of the summary data showed differences in emphasis with and without the system. The LSA analysis suggested users of the system were more “expert-like” in their emphasis, and that cognitive support was more effective in the more complex case. Cognitive support impacts upon clinical comprehension. This appears to be largely helpful, but may also lead to neglect of information (such as the psychosocial history) that the system does not highlight. The results have implications for the design of CSSs for clinical narratives including the role of information organization and textual embellishments for more efficient clinical case presentation and comprehension.
登录
查看更多内容
影响因子：
4.5
作者：
Cohen T;Widdows D
通讯作者：
Widdows D
影响因子：
4.5
作者：
Cohen, Trevor;Blatter, Brett;Patel, Vimla
通讯作者：
Patel, Vimla
影响因子：
--
作者：
NORMAN, GR;ROSENTHAL, D;MUZZIN, LJ
通讯作者：
MUZZIN, LJ
影响因子：
4.5
作者：
Kannampallil, Thomas G.;Schauer, Guido F.;Patel, Vimla L.
通讯作者：
Patel, Vimla L.
影响因子：
5.4
作者：
KINTSCH, W;GREENO, JG
通讯作者：
GREENO, JG