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Depicting cognitive fixation over time

I'm looking for some help with my study of cognitive fixation during acute medical emergencies in the operating room. My question is how to depict the elements of this cognitive fixation. The goal of the graphic is to highlight how attention (represented by diagnoses, treatments, symptoms noticed) widens, narrows, persists or ceases over time. (E.g fewer symptoms noticed = narrowing of attention). If anyone has examples of how this sort of thing has been handled well by others, can improve on my ideas, or suggest good software for doing a better job than I'm proposing below, I'd be very grateful. The data are diagnoses considered, treatments pursued, symptoms noticed, and a leading vital sign (oxygen saturation.) My current idea is to depict diagnoses in columns (with x's or dots), time in rows, with diagnoses treated appearing in a different color than diagnoses not treated. I would capture the clinical signs considered with a color scale behind the diagnosis x's (darker could equal more clinical signs considered.) Thanks for your help!

-- Jenny Rudolph (email)

Take a look at the writings on flying, where fixation on a particular instrument and the failure to scan by the pilot are issues.

-- Edward Tufte

As you are going to be working with data presented over time, you may find some insights into presenting your findings in Dr. Tufte's piece on Project Management. It's here on this site at .

The project management methodology will allow you to present data for several individuals working simultaneously on the same case, each with specific skills (surgeon, anaethesiologist, nurse, resident, intern, paramedic, even patient, etc.) and perhaps medical biases. To keep with Dr. Tufte's analogy to fixation in flight, each person becomes an "instrument" with a wider or narrower field of expertise and experience.

-- Steve Sprague (email)

Not a direct answer to your interesting question, but I'd suggest you take a look at the book 'Sources of Power: How People Make Decisions' by Gary Klein. (MIT Press, 2001) Klein's put in years of fieldword observing decision-making under difficult and nonroutine situations. Some of his conclusions about the cognitive strategies used in situations with similarities to yours might be useful to you. Surprising and interesting.

-- Matthew Dunn (email)

This may or may not be of benefit to you.

Neuroscience may offer an alternate view of fixation. Research results by Alan Shore, et. al., demonstrate the effect trauma (emotional, physical) and shock have on short-term memory processing. This also includes observational processing.

When the human organism experiences high emotional affect the Amygdala, hippocampus and other limbic system functions override the "normal" state of observation and memory by chemical release.

-- Mike Levine (email)

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