***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective .We tested the hypothesis that a monitoring display proposed by Blike et al. improves the performance of  anesthesiologists .  We measured the performance of anesthesiologists using the new display and compared it to their performance with at raditional display . We studied three different displays on how they affected recognition and differentiation of five etiologies ofshock – anaphylaxis , bradycardia , hypovolemia , ischemia and pulmonary embolus . Methods .The participants monitored heartrate , systemic arterial and pulmonary blood pressure , central venous pressure , and cardiac output during five shock states and five non-shock states . The result ing 10 data sets made up ten decision screens , which we presented r and omly on a computer monitor to the subjects in one of three different formats ( a Single Sensor Single Indicator (SSSI)Numericdisplay ; anObjectdisplay ; and an Object Minus Shapesdisplay ) . Subjects used soft-buttons on a computer touch-screen monitor to : a ) advance to the next display ; b ) differentiate a non-shock state from a shock state ; and , c ) select the etiology of shock state represented by the display ( Figure 4 ) . The internal clock and memory of the computer made the collection of data automatic . Results .The subjects recognized a problem more rapidly with the help of a graphical “ pointer on a referencescale ” in both Objectdisplays , but their accuracy had not improved in comparison to the SSSI Numericdisplay . The shape of the Objectdisplay improved performance of etiology determination compared to the Object Minus Shapesdisplay and SSSI Numericdisplay . Testing ( 10 trials ) was completed in less than 45 minutes . Conclusions .The new display with“emergent features ” can improve the diagnostic performance of clinicians The aim of this study was to quantify the impact of ProCCESs AWARE , Ambient Clinical Analytics , Rochester , MN , a novel acute care electronic medical record interface , on a range of care process and patient health outcome metrics in intensive care units ( ICUs ) . ProCCESs AWARE is a novel acute care EMR interface that contains built-in tools for error prevention , practice surveillance , decision support and reporting . We compared outcomes before and after AWARE implementation using a prospect i ve cohort and a historical control . The study population included all critically ill adult patients ( over 18 years old ) admitted to four ICUs at Mayo Clinic , Rochester , MN , who stayed in hospital at least 24 h. The pre-AWARE cohort included 983 patients from 2010 , and the post-AWARE cohort included 856 patients from 2014 . We analyzed patient health outcomes , care process quality , and hospital charges . After adjusting for patient acuity and baseline demographics , overall in-hospital and ICU mortality odds ratios associated with AWARE intervention were 0.45 ( 95 % confidence interval 0.30 to 0.70 ) and 0.38 ( 0.22 , 0.66 ) . ICU length of stay decreased by about 50 % , hospital length of stay by 37 % , and total charges for hospital stay by 30 % in post AWARE cohort ( by $ 43,745 after adjusting for patient acuity and demographics ) . Better organization of information in the ICU with systems like AWARE has the potential to improve important patient outcomes , such as mortality and length of stay , result ing in reductions in costs of care Family-centered care is becoming the new st and ard for Neonatal Intensive Care Unit ( NICU ) patients . In support of this , we developed the Physician PArent Decision Support System ( PPADS ) , which provides clinical up date s and predictions of clinical outcomes for infants in the NICU to the neonatologists , and provides an aid to parents for making difficult decisions on the direction of care of their infant with the health care team . The tool may lead to earlier intervention , better allocation of re sources , and reduction of the negative outcomes . The tool underwent a usability study with 8 parents whose infant survived the NICU stay and 5 neonatologists . Both parents and physicians thought the tool was easy to use , useful , and would help improve team communication . The next usability study will be with parents whose infant died while in the NICU , and then conduct a r and omized prospect i ve study with parents who have a sick infant admitted to the NICU BACKGROUND A novel monitoring system ( integrated monitor of anaesthesia , IMA ) which integrates three components of general anaesthesia on one single display was developed . The focus of this study was to evaluate the performance and user-friendliness of four different display design s. METHODS Four interface displays of the IMA were developed , including one numerical , one numerical and graphical ( mixed numerical-graphical ) , one only graphical , and one an advanced two-dimensional graphical display . Each of the four displays was evaluated in a r and om order by 10 staff anaesthetists and 10 residents/fellows using a set of five scenarios . Scenarios involved one or more abnormal variables that participants had to verbally phrase . For each interface test , reaction time , response accuracy , and NASA-Task Load Index were measured and compared . RESULTS The numerical , graphical , and advanced-graphical interfaces yielded similar median reaction times , respectively , 7.99 s ( 5.15 - 10.79 ) , 8.21 s ( 6.20 - 11.88 ) , and 9.43 s ( 6.19 - 13.3 ) . Reaction times were significantly shorter ( P<0.006 ) with the mixed numerical-graphical interface : 6.26 s ( 4.52 - 8.32 ) . The correct response rate was significantly lower in the graphical interface . The three others presented no statistical difference when compared among each other . The mixed numerical-graphical interface yielded a significantly lower NASA-TLX than the numerical and the advanced-graphical interfaces ( 19/100 vs 34/100 , P<0.003 ) . CONCLUSIONS A mixed numerical-graphical display design appears to present the best results in terms of user reaction times , response accuracy , and performance index when detecting abnormal critical events BACKGROUND Nurses ' ability to rapidly detect decreases in cerebral perfusion pressure ( CPP ) , which may contribute to secondary brain injury , may be limited by poor visibility of CPP displays . OBJECTIVE To evaluate the impact of a highly visible CPP display on the functional outcome in individuals with cerebral aneurysms . METHODS Patients with cerebral aneurysms ( n = 100 ) who underwent continuous CPP monitoring  were enrolled and r and omized to beds with or without the additional CPP display .  Six-month outcome was assessed . RESULTS Functional outcome was not significantly different between control and intervention groups after controlling for initial neurologic condition ( odds ratio .904 , 95 % confidence interval 0.317 to 2.573 ) . However , greater time below CPP thresholds ( 55 to 70 mm Hg ) was significantly associated with poorer outcome ( P = .005 to .010 ) . CONCLUSIONS Although the enhanced CPP display was not associated with significantly better outcome , longer periods of CPP below set levels were associated with poorer outcome This research evaluated physicians ' agreement about patients ' diagnoses and nurses ' ability to detect  patient change  using traditional charts ( TC ) and a work domain analysis -based paper prototype ( PP ) and also sought to determine whether differences persisted when the PP was represented as an electronic prototype ( EP ) .  Nurses ' change detection improved using the PP and EP compared to TC ( PP vs TC , t((df=6))=1.94 , p<0.03 ; EP vs TC , t((df=6))=3.14 , p<0.01 ) and detection was better using the EP compared with the PP ( t((df=6))=5.96 , p<0.001 ) . Physicians were more likely to agree about failed physiological systems using the EP compared with the PP ( t((df=10))=3.14 , p<0.01 ) , but agreement about patient diagnoses was higher using the PP compared with the EP ( t((df=10))=2.23 ; p<0.02 ) . These results are attributed to information grouping around physiological functions and the direct association of cause- and -effect relations in clinical information design BACKGROUND Goal -directed therapy has a secure place in perioperative care . Algorithms are based on Starling 's law of the heart , notwithst and ing that this does not numerically define volume or heart performance variables . These have been developed based on a Guytonian view of the circulation and are implemented in a computerized decision support system ( Navigator ™ ) . We studied the feasibility and performance of the graphical display of the system in an intervention and a control group of patients undergoing major abdominal surgery . METHODS Patients were r and omized to either graphically ( intervention ) or numerically ( control ) guided administration of therapy . Goals were set and treatments and concordance with guidance noted , where applicable . Anaesthesia was provided by one of three experienced anaesthetists well acquainted with Navigator ™ . The primary objective was to determine whether the use of graphical display decision support more efficiently enables the achievement of oxygen delivery targets . This was quantitated as percentage time in the target zone and averaged st and ardized distance from the target centre . RESULTS The mean percentage time in the target zone was 36.7 % for control and 36.5 % for intervention . The averaged st and ardized difference was 1.5 in control and 1.6 in intervention . There was no significant difference in fluid balances . There was a high level of concordance between decision support recommendation and anaesthetist action ( 84.3 % ) . CONCLUSIONS In experienced h and s , the addition of a graphical display for haemodynamic guidance result ed in a similar time in target and averaged st and ardized difference . The haemodynamic guidance system should be explored in a comparative study to anaesthesia management without guidance Objective .Comprehensive monitoring of the patient state and subsequent decision making is an essential part of the task of ananaesthetist . The physicians ' decision making process is based upon aconcept of partly abstract physiologic parameters such as depth of anaesthesiaor contractility . This concept is derived from the measured parameters givenon todays ' trend displays in addition to context information availablefor the anaesthetist . We investigated two alternative approaches of display design for hemodynamic monitoring : 1 ) integrated displays based on ecologicalinterface design , and 2 ) profilogram displays based on intelligent alarms . Method .To evaluate differences in decision making , the two displays and a trend display were compared in an experimental set-up with computersimulated vital parameter curves . From a start state with r and om parameterdeviations from the ideal state , subjects had to achieve the ideal circulatoryperformance as fast as possible by manipulating vasomotor tone , heart rate , blood volume and contractility . To analyse subjects ' decision makingprocess , eye-tracking , event-logging , and the method of think aloud protocol swere used . Twenty anaesthesiologists performed 113 experiments ( approximately2 with each display ) . Results .The anaesthetists failed to achieve thetask in 37 % using the trend display , in 19 % using the profilogram display , and in 13 % using the ecological interface . Hence , a safer task solution waspossible with the ecological interface and the profilogram display but at theexpense of various performance parameters such as higher trial time , moreinteractions with the simulated system , and more frequent eye movements . Incontrast to the trend display and the profilogram display , where anaesthetistswere mainly focussed on controlling the left atrial pressure , such anbehaviour was less observed with the ecological interface . Conclusion .Our results have shown that subjects came to more effective solutions withthe traditional trend display . The main reason for this result may be theiryears of experience with this kind of display type . Regarding safe and goal -intended decision finding , the results are encouraging for furtherexperiments with re design ed ecological displays . But these displays ought tohave smoother changes with respect to the traditional trend displays . Furthermore , new experiments have to be performed under real or fairly real(e.g . together with an anaesthesia simulator ) conditions to underline thepositive results for ecological interfaces OBJECTIVES AWARE ( Ambient Warning and Response Evaluation ) is a novel electronic medical record ( EMR ) dashboard design ed by clinicians to support bedside clinical information management in the ICU . AWARE sits on top of pre-existing , comprehensive EMR systems . The purpose of the study was to test the acceptance and impact of AWARE on data management in live clinical ICU setting s. The primary outcome measure was observed efficiency of data utilization as determined by time spent in data gathering before morning rounds . DESIGN Step wedge cluster r and omization trial . SETTING Four ICUs ( surgical , medical , and mixed ) at an academic referral center . SUBJECTS All members of the critical care team participating in morning ICU rounds . INTERVENTION Pilot implementation of a novel EMR interface with direct observation and survey . MEASUREMENTS AND MAIN RESULTS The study took place between April and July 2012 . A total of 80 and 63 direct observations were made in the pre- and post-implementation study periods respectively . The time spent on pre-round data gathering per patient decreased from 12 ( 10 - 15 ) to 9 ( 7.3 - 11 ) min for pre- and post-implementation phases respectively ( p=0.03 ) . Compared to the existing  EMR , information management ( data presentation format , efficiency of data access ) was reported to be better after AWARE implementation . AWARE made the task of gathering data for rounds significantly less difficult and mentally dem and ing . CONCLUSIONS The introduction of a novel , patient-centered EMR viewer for the ICU was associated with improved efficiency and ease of clinical data management compared to the st and ard EMR Anaesthesia involves processing large amounts of information over time . One task of the anaesthetist is to detect substantive changes in physiological variables promptly and reliably . It has been previously demonstrated that a graphical trend display of historical data leads to more rapid detection of such changes . We examined the effect of a graphical indication of the magnitude of Trigg 's Tracking Variable , a simple 
    Output:
    
Implementing user-centered design ( UCD ) processes , especially iterative evaluation and re design , result ed in positive impact in outcomes such as accuracy and efficiency .
Improved information presentation can facilitate faster information interpretation and more accurate diagnoses and treatment .