Search

BackgroundObtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. ObjectiveThis study aimed to (1) identify the information about elderly patients’ recent acute care visits needed to coordinate their care, (2) use this information to assess discharge summaries, and (3) provide recommendations to help improve the quality of electronic health record (EHR)–generated discharge summaries, thereby increasing patient safety. MethodsA literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently discharged elderly patients. Based upon those data, 2 guidelines for creating useful discharge summaries were created. The new guidelines, along with 17 previously developed medical documentation usability heuristics, were applied to assess 4 simulated elderly patient discharge summaries. ResultsThe initial research effort yielded a list of 29 items that should always be included in elderly patient discharge summaries and a list of 7 “helpful, but not always necessary” items. Evaluation of 4 deidentified elderly patient discharge summaries revealed that none of the documents contained all 36 necessary items; between 14 and 18 were missing. The documents each had several other issues, and they differed significantly in organization, layout, and formatting. ConclusionsVariations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care transition–related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization.

New and radically reformative thinking about the enactive and embodied basis of cognition holds out the promise of moving forward age-old debates about whether we learn and how we learn. The radical enactive, embodied view of cognition (REC) poses a direct, and unmitigated, challenge to the trademark assumptions of traditional cognitivist theories of mind— those that characterize cognition as always and everywhere grounded in the manipulation of contentful representations of some kind. REC has had some success in understanding how sports skills and expertise are acquired. But, REC approaches appear to encounter a natural obstacle when it comes to understanding skill acquisition in knowledge-rich, conceptually based domains like the hard sciences and mathematics. This paper offers a proof of concept that REC’s reach can be usefully extended into the domain of science, technology, engineering, and mathematics (STEM) learning, especially when it comes to understanding the deep roots of such learning. In making this case, this paper has five main parts. The section “Ancient Intellectualism and the REC Challenge” briefly introduces REC and situates it with respect to rival views about the cognitive basis of learning. The “Learning REConceived: from Sports to STEM?” section outlines the substantive contribution REC makes to understanding skill acquisition in the domain of sports and identifies reasons for doubting that it will be possible to apply the same approach to knowledge-rich STEM domains. The “Mathematics as Embodied Practice” section gives the general layout for how to understand mathematics as an embodied practice. The section “The Importance of Attentional Anchors” introduces the concept “attentional anchor” and establishes why attentional anchors are important to educational design in STEM domains like mathematics. Finally, drawing on some exciting new empirical studies, the section “Seeing Attentional Anchors” demonstrates how REC can contribute to understanding the roots of STEM learning and inform its learning design, focusing on the case of mathematics.

Context • A central motivation behind various embodied, extended, and enactive (4E) approaches to cognition is to ground our understanding of minds and cognition within the biological structures that give rise to life. Because of this, their advocates often claim a natural kinship with dynamical and developmental systems theories. However, these accounts also explicitly or implicitly privilege individual organisms in ways that contrast with many of the insights of systems and developmental systems approaches to biology. > Problem • The prioritization of individual organisms within 4E approaches to cognition contrasts with the default entangled structure of biological systems associated with cognitive agency. We provide means for 4E cognitive science to move beyond an individual-centred view of cognitive agency. > Method • We first identify and problematize individual-centredness within various predominant 4E approaches by comparison with biological research and developmental systems theory. Subsequently, we offer conceptual resources from the field of ecological research for understanding cognitive agency beyond the predominant focus on individual organisms. > Results • Cognitive agency may be understood without privileging individual organisms by reading nonequilibrium maintenance in terms of a dynamic differentiation instead of individual organismic autonomy. This form of organizational structure corresponds to the notion of sympoiesis from ecological research. > Implications • Approaching cognitive agency without privileging individual organisms should be invaluable to advocates of 4E cognition seeking to ground notions of cognition and mind within contemporary biological research. > Constructivist content • We seek to expand upon existing constructivist perspectives on the organizing principles of cognitive agency, such as sensorimotor embodiment and autopoiesis, arguing that meta-organismic cognitive agents (including humans) embody distributed relations beyond the privileging of individual organisms. [ABSTRACT FROM AUTHOR]

We delineate the distinctness of sympoiesis from adaptive notions of autopoiesis and explain why we see it as helpful to the exploration and explanation of agentive and adaptive cognitive systems. [ABSTRACT FROM AUTHOR]