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Frankenthal H, Ben Shlomo I, Kurzweil Segev Y, K A, Orkin D, Kobo Greenhut A. Perceived Reliability of Medical Device Alarms - A Major Determinant of Medical Errors Driven by Frozen Medical Thinking. Int J Qual Health Care 2022; 34:6528686. [PMID: 35166351 DOI: 10.1093/intqhc/mzac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
This concept paper introduces the phenomenon of self-assigning a "perceived reliability" value to medical device readings as a potential source of cognitive bias in medical decision making. Medical errors can result from clinical decisions based on partial clinical data despite medical device readings providing data to the contrary. At times this results from clinician distrust of medical device output. Consequentially, clinicians engage in a form of "frozen thinking," a fixation on a particular thought process despite data to the contrary. Many medical devices, such as ICU monitors and alarms, lack validated statistics of device output reliability and validity. In its absence, clinicians assign a self-perceived reliability value to device output data and base clinical decisions therefrom. When the perceived reliability value is low, clinicians distrust the device and ignore device readings especially when other clinical data is contrary. We explore the cognitive and theoretical underpinnings of this "perceived reliability" phenomenon. The mental assignment of a perceived reliability value stems from principles of "script theory" of medical decision making. In this conceptual framework, clinicians make decisions by comparing current situations to mental 'scripts' of prior clinical decisions and their outcomes. As such, the clinician utilizes scripts of prior experiences to create the perceived reliability value. Self-assigned perceived reliability is subject to multiple dangers of reliability and cognitive biases. Some of these biases are presented. Among these is the danger of dismissing device readings as "noise." This is particularly true of ICU alarms that can emit frequent false alarms and contribute to clinician sensory overload. The cognitive dangers of this "noise dismissal" are elaborated via its similarity to the phenomenon of "spatial disorientation" among aviation pilots. We conclude with suggestions for reducing the potential bias of "perceived reliability". First presented are regulatory/legislative and industry-based interventions for increasing the study of, and end-user access to, validated device output reliability statistics. Subsequently, we propose strategies for overcoming and preventing this phenomenon. We close with suggestions for future research and development of this "perceived reliability" phenomenon.
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Affiliation(s)
- Hilel Frankenthal
- Department of Pediatric Critical Care, Rebecca Seiff Medical Center, Safed, Israel.,Emergency Medicine Program, Zefat Academic College, Safed, Israel
| | - Izhar Ben Shlomo
- Emergency Medicine Program, Zefat Academic College, Safed, Israel
| | | | | | - Dina Orkin
- Department of Anesthesia, Sheba Medical Center, Ramat Gan, Israel
| | - Ayala Kobo Greenhut
- Department of Pediatric Critical Care, Rebecca Seiff Medical Center, Safed, Israel
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Ross JM, Hamm JP. Cortical Microcircuit Mechanisms of Mismatch Negativity and Its Underlying Subcomponents. Front Neural Circuits 2020; 14:13. [PMID: 32296311 PMCID: PMC7137737 DOI: 10.3389/fncir.2020.00013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/17/2020] [Indexed: 12/11/2022] Open
Abstract
In the neocortex, neuronal processing of sensory events is significantly influenced by context. For instance, responses in sensory cortices are suppressed to repetitive or redundant stimuli, a phenomenon termed “stimulus-specific adaptation” (SSA). However, in a context in which that same stimulus is novel, or deviates from expectations, neuronal responses are augmented. This augmentation is termed “deviance detection” (DD). This contextual modulation of neural responses is fundamental for how the brain efficiently processes the sensory world to guide immediate and future behaviors. Notably, context modulation is deficient in some neuropsychiatric disorders such as schizophrenia (SZ), as quantified by reduced “mismatch negativity” (MMN), an electroencephalography waveform reflecting a combination of SSA and DD in sensory cortex. Although the role of NMDA-receptor function and other neuromodulatory systems on MMN is established, the precise microcircuit mechanisms of MMN and its underlying components, SSA and DD, remain unknown. When coupled with animal models, the development of powerful precision neurotechnologies over the past decade carries significant promise for making new progress into understanding the neurobiology of MMN with previously unreachable spatial resolution. Currently, rodent models represent the best tool for mechanistic study due to the vast genetic tools available. While quantifying human-like MMN waveforms in rodents is not straightforward, the “oddball” paradigms used to study it in humans and its underlying subcomponents (SSA/DD) are highly translatable across species. Here we summarize efforts published so far, with a focus on cortically measured SSA and DD in animals to maintain relevance to the classically measured MMN, which has cortical origins. While mechanistic studies that measure and contrast both components are sparse, we synthesize a potential set of microcircuit mechanisms from the existing rodent, primate, and human literature. While MMN and its subcomponents likely reflect several mechanisms across multiple brain regions, understanding fundamental microcircuit mechanisms is an important step to understand MMN as a whole. We hypothesize that SSA reflects adaptations occurring at synapses along the sensory-thalamocortical pathways, while DD depends on both SSA inherited from afferent inputs and resulting disinhibition of non-adapted neurons arising from the distinct physiology and wiring properties of local interneuronal subpopulations and NMDA-receptor function.
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Affiliation(s)
- Jordan M Ross
- Neuroscience Institute, Georgia State University, Atlanta, GA, United States.,Center for Behavioral Neuroscience, Georgia State University, Atlanta, GA, United States
| | - Jordan P Hamm
- Neuroscience Institute, Georgia State University, Atlanta, GA, United States.,Center for Behavioral Neuroscience, Georgia State University, Atlanta, GA, United States.,Center for Neuroinflammation and Cardiometabolic Diseases, Georgia State University, Atlanta, GA, United States
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3
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Towards building a more complex view of the lateral geniculate nucleus: Recent advances in understanding its role. Prog Neurobiol 2017. [DOI: 10.1016/j.pneurobio.2017.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Strauss DJ, Francis AL. Toward a taxonomic model of attention in effortful listening. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2017; 17:809-825. [PMID: 28567568 PMCID: PMC5548861 DOI: 10.3758/s13415-017-0513-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In recent years, there has been increasing interest in studying listening effort. Research on listening effort intersects with the development of active theories of speech perception and contributes to the broader endeavor of understanding speech perception within the context of neuroscientific theories of perception, attention, and effort. Due to the multidisciplinary nature of the problem, researchers vary widely in their precise conceptualization of the catch-all term listening effort. Very recent consensus work stresses the relationship between listening effort and the allocation of cognitive resources, providing a conceptual link to current cognitive neuropsychological theories associating effort with the allocation of selective attention. By linking listening effort to attentional effort, we enable the application of a taxonomy of external and internal attention to the characterization of effortful listening. More specifically, we use a vectorial model to decompose the demand causing listening effort into its mutually orthogonal external and internal components and map the relationship between demanded and exerted effort by means of a resource-limiting term that can represent the influence of motivation as well as vigilance and arousal. Due to its quantitative nature and easy graphical interpretation, this model can be applied to a broad range of problems dealing with listening effort. As such, we conclude that the model provides a good starting point for further research on effortful listening within a more differentiated neuropsychological framework.
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Affiliation(s)
- Daniel J Strauss
- Systems Neuroscience and Neurotechnology Unit, Neurocenter, Faculty of Medicine, Saarland University & School of Engineering, Building 90.5, 66421, htw saar, Homburg/Saar, Germany.
- Leibniz-Institute for New Materials, Saarbruecken, Germany.
- Key Numerics GmbH - Neurocognitive Technologies, Saarbruecken, Germany.
| | - Alexander L Francis
- Speech Perception and Cognitive Effort Laboratory Department of Speech, Language & Hearing Sciences, Purdue University, West Lafayette, IN, USA
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Rogala J, Waleszczyk WJ, Łęski S, Wróbel A, Wójcik DK. Reciprocal inhibition and slow calcium decay in perigeniculate interneurons explain changes of spontaneous firing of thalamic cells caused by cortical inactivation. J Comput Neurosci 2012; 34:461-76. [PMID: 23150147 PMCID: PMC3650241 DOI: 10.1007/s10827-012-0430-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 10/05/2012] [Accepted: 10/09/2012] [Indexed: 11/27/2022]
Abstract
The role of cortical feedback in the thalamocortical processing loop has been extensively investigated over the last decades. With an exception of several cases, these searches focused on the cortical feedback exerted onto thalamo-cortical relay (TC) cells of the dorsal lateral geniculate nucleus (LGN). In a previous, physiological study, we showed in the cat visual system that cessation of cortical input, despite decrease of spontaneous activity of TC cells, increased spontaneous firing of their recurrent inhibitory interneurons located in the perigeniculate nucleus (PGN). To identify mechanisms underlying such functional changes we conducted a modeling study in NEURON on several networks of point neurons with varied model parameters, such as membrane properties, synaptic weights and axonal delays. We considered six network topologies of the retino-geniculo-cortical system. All models were robust against changes of axonal delays except for the delay between the LGN feed-forward interneuron and the TC cell. The best representation of physiological results was obtained with models containing reciprocally connected PGN cells driven by the cortex and with relatively slow decay of intracellular calcium. This strongly indicates that the thalamic reticular nucleus plays an essential role in the cortical influence over thalamo-cortical relay cells while the thalamic feed-forward interneurons are not essential in this process. Further, we suggest that the dependence of the activity of PGN cells on the rate of calcium removal can be one of the key factors determining individual cell response to elimination of cortical input.
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Affiliation(s)
- Jacek Rogala
- Department of Neurophysiology, Nencki Institute of Experimental Biology, 3 Pasteur St, 02-093 Warsaw, Poland
| | - Wioletta J. Waleszczyk
- Department of Neurophysiology, Nencki Institute of Experimental Biology, 3 Pasteur St, 02-093 Warsaw, Poland
| | - Szymon Łęski
- Department of Neurophysiology, Nencki Institute of Experimental Biology, 3 Pasteur St, 02-093 Warsaw, Poland
| | - Andrzej Wróbel
- Department of Neurophysiology, Nencki Institute of Experimental Biology, 3 Pasteur St, 02-093 Warsaw, Poland
| | - Daniel K. Wójcik
- Department of Neurophysiology, Nencki Institute of Experimental Biology, 3 Pasteur St, 02-093 Warsaw, Poland
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McCarthy PT, Rao MP, Otto KJ. Simultaneous recording of rat auditory cortex and thalamus via a titanium-based, microfabricated, microelectrode device. J Neural Eng 2011; 8:046007. [PMID: 21628772 PMCID: PMC3158991 DOI: 10.1088/1741-2560/8/4/046007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Direct recording from sequential processing stations within the brain has provided opportunity for enhancing understanding of important neural circuits, such as the corticothalamic loops underlying auditory, visual, and somatosensory processing. However, the common reliance upon microwire-based electrodes to perform such recordings often necessitates complex surgeries and increases trauma to neural tissues. This paper reports the development of titanium-based, microfabricated, microelectrode devices designed to address these limitations by allowing acute recording from the thalamic nuclei and associated cortical sites simultaneously in a minimally invasive manner. In particular, devices were designed to simultaneously probe rat auditory cortex and auditory thalamus, with the intent of recording auditory response latencies and isolated action potentials within the separate anatomical sites. Details regarding the design, fabrication, and characterization of these devices are presented, as are preliminary results from acute in vivo recording.
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Affiliation(s)
- P T McCarthy
- Department of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA
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The effect of orientation adaptation on responses of lateral geniculate nucleus neurons with high orientation bias in cats. Neuroscience 2009; 164:760-9. [PMID: 19682557 DOI: 10.1016/j.neuroscience.2009.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 08/05/2009] [Accepted: 08/06/2009] [Indexed: 11/20/2022]
Abstract
Adaptation to stimulus orientation is assumed to have a cortical basis, but few studies have addressed whether it affects the activity of subcortical neurons. Using single-unit recording, we studied the effects of orientation adaptation on the responses of lateral geniculate nucleus (LGN) neurons with high orientation bias (OB) in anesthetized and paralyzed cats. Following adaptation to one stimulus orientation, the response at the adapting orientation was decreased, and the preferred orientation was shifted away from the adapting orientation. This phenomenon was similar to the effects observed for orientation adaptation in the primary visual cortex (V1), and was obvious when the adapting orientation was at an appropriate location relative to the original preferred orientation. Moreover, when the V1 was inactivated, the response at the adapting orientation was also decreased but the preferred orientation did not show a systematic shift after orientation adaptation in LGN. This result indicates that cortical feedback contributes to the effect of orientation adaptation on LGN neurons, which have a high OB. These data provide an example of how the corticothalamic loop modulates the processing of visual information, and suggest that the LGN is not only a simply passive relay but also a modulator of visual information.
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Li L, Ebner FF. Cortical modulation of spatial and angular tuning maps in the rat thalamus. J Neurosci 2007; 27:167-79. [PMID: 17202484 PMCID: PMC6672283 DOI: 10.1523/jneurosci.4165-06.2007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 11/20/2006] [Accepted: 11/28/2006] [Indexed: 11/21/2022] Open
Abstract
The massive feedback projections from cortex to the thalamus modulate sensory information transmission in many ways. We investigated the role of corticothalamic feedback projections on the directional selectivity (angular tuning) of neurons in the rat ventral posterior medial (VPM) nucleus to stimulation of their principal whisker. The angular tuning properties of single VPM neurons were compared before and after epochs of electrical stimulation of layer VI feedback neurons in the ipsilateral cortex under urethane anesthesia. Microstimulation of layer VI in "matched" (homologous) barrel columns sharpens the angular tuning curves of single VPM neurons that are tuned to the same direction as the stimulation site in the cortex. Further, microstimulation rotates the angular preference of VPM neurons initially tuned to a different direction toward the direction that cortical neurons prefer. Stimulation in "mismatched" (nonhomologous) barrel columns suppresses responses without consistent effects on angular tuning. We conclude that the primary sensory cortex exerts a significant influence on both spatial and angular tuning maps in the relay nuclei that project to it. The results suggest that the tuning properties of VPM cells in the behaving animal are continually modified to optimize perception of the most salient incoming messages.
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Affiliation(s)
- Lu Li
- Department of Psychology, Vanderbilt University, Nashville, Tennessee 37203
| | - Ford F. Ebner
- Department of Psychology, Vanderbilt University, Nashville, Tennessee 37203
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