Agency affects adults', but not children's, guessing preferences in a game of chance.

Adults and children have recently been shown to prefer guessing the outcome of a die roll after the die has been rolled (but remained out of sight) rather than before it has been rolled. This result is contrary to the predictions of the competence hypothesis (Heath & Tversky, 1991 ), which proposes that people are sensitive to the degree of their relative ignorance and therefore prefer to guess about an outcome it is impossible to know, rather than one that they could know, but do not. We investigated the potential role of agency in guessing preferences about a novel game of chance. When the experimenter controlled the outcome, we replicated the finding that adults and 5- to 6-year-old children preferred to make their guess after the outcome had been determined. For adults only, this preference reversed when they exerted control over the outcome about which they were guessing. The adult data appear best explained by a modified version of the competence hypothesis that highlights the notion of control or responsibility. It is proposed that potential attributions of blame are related to the guesser's role in determining the outcome. The child data were consistent with an imagination-based account of guessing preferences.

Imagining what might be: why children underestimate uncertainty.

Children's well-documented tendency to behave as if they know more than they do about uncertain events is reduced under two conditions: when the outcome of a chance event has yet to be determined and when one unknown outcome has occurred but is difficult to imagine. In Experiment 1, in line with published findings, 5- and 6-year-olds (N=61) preferred to guess the unknown location of a known object when the object was in place rather than before its location had been determined. There was no such preference when the object's identity was unknown. In Experiment 2, 29 5- and 6-year-olds were more likely to correctly mark both possible locations when an already hidden object's identity was unknown rather than known. We conclude that children's vivid imaginations can lead them to underestimate uncertainty in a similar way to imagination inflation or fluency effects in adults.

Scales for assessing self-efficacy of nurses and assistants for preventing falls.

AIM: This paper is a report of the development and testing of the Self-Efficacy for Preventing Falls Nurse and Assistant scales. BACKGROUND: Patient falls and fall-related injuries are traumatic ordeals for patients, family members and providers, and carry a toll for hospitals. Self-efficacy is an important factor in determining actions persons take and levels of performance they achieve. Performance of individual caregivers is linked to the overall performance of hospitals. Scales to assess nurses and certified nursing assistants' self-efficacy to prevent patients from falling would allow for targeting resources to increase SE, resulting in improved individual performance and ultimately decreased numbers of patient falls. METHOD: Four phases of instrument development were carried out to (1) generate individual items from eight focus groups (four each nurse and assistant conducted in October 2007), (2) develop prototype scales, (3) determine content validity during a second series of four nurse and assistant focus groups (January 2008) and (4) conduct item analysis, paired t-tests, Student's t-tests and internal consistency reliability to refine and confirm the scales. Data were collected during February-December, 2008. RESULTS: The 11-item Self-Efficacy for Preventing Falls Nurse had an alpha of 0·89 with all items in the range criterion of 0·3-0·7 for item total correlation. The 8-item Self-Efficacy for Preventing Falls Assistant had an alpha of 0·74 and all items had item total correlations in the 0·3-0·7 range. CONCLUSIONS: The Self-Efficacy for Preventing Falls Nurse and Self-Efficacy for Preventing Falls Assistant scales demonstrated psychometric adequacy and are recommended to measure bedside staff's self-efficacy beliefs in preventing patient falls.

Complementary methods of system usability evaluation: surveys and observations during software design and development cycles.

Poor usability of clinical information systems delays their adoption by clinicians and limits potential improvements to the efficiency and safety of care. Recurring usability evaluations are therefore, integral to the system design process. We compared four methods employed during the development of outpatient clinical documentation software: clinician email response, online survey, observations and interviews. Results suggest that no single method identifies all or most problems. Rather, each approach is optimal for evaluations at a different stage of design and characterizes different usability aspect. Email responses elicited from clinicians and surveys report mostly technical, biomedical, terminology and control problems and are most effective when a working prototype has been completed. Observations of clinical work and interviews inform conceptual and workflow-related problems and are best performed early in the cycle. Appropriate use of these methods consistently during development may significantly improve system usability and contribute to higher adoption rates among clinicians and to improved quality of care.

Effects of documentation-based decision support on chronic disease management.

OBJECTIVE: To evaluate whether a new documentation-based clinical decision support system (CDSS) is effective in addressing deficiencies in the care of patients with coronary artery disease (CAD) and diabetes mellitus (DM). STUDY DESIGN: Controlled trial randomized by physician. METHODS: We assigned primary care physicians (PCPs) in 10 ambulatory practices to usual care or the CAD/DM Smart Form for 9 months. The primary outcome was the proportion of deficiencies in care that were addressed within 30 days after a patient visit. RESULTS: The Smart Form was used for 5.6% of eligible patients. In the intention-to-treat analysis, patients of intervention PCPs had a greater proportion of deficiencies addressed within 30 days of a visit compared with controls (11.4% vs 10.1%, adjusted and clustered odds ratio =1.14; 95% confidence interval, 1.02-1.28; P = .02). Differences were more pronounced in the "on-treatment" analysis: 17.0% of deficiencies were addressed after visits in which the Smart Form was used compared with 10.6% of deficiencies after visits in which it was not used (P <.001). Measures that improved included documentation of smoking status and prescription of antiplatelet agents when appropriate. CONCLUSIONS: Overall use of the CAD/DM Smart Form was low, and improvements in management were modest. When used, documentation-based decision support shows promise, and future studies should focus on refining such tools, integrating them into current electronic health record platforms, and promoting their use, perhaps through organizational changes to primary care practices.

Improving management of chronic diseases with documentation-based clinical decision support: results of a pilot study.

Clinical Decision Support Systems (CDSS) have the potential to improve patient care. We developed the Coronary Artery Disease and Diabetes Mellitus (CAD/DM) Smart Form as a documentation-based application that provides decision support for the management of chronic diseases. Results of a pilot study suggest that the CAD/DM Smart Form has the potential to improve patient care.

Searching and planning: young children's reasoning about past and future event sequences.

Six experiments examined children's ability to make inferences using temporal order information. Children completed versions of a task involving a toy zoo; one version required reasoning about past events (search task) and the other required reasoning about future events (planning task). Children younger than 5 years failed both the search and the planning tasks, whereas 5-year-olds passed both (Experiments 1 and 2). However, when the number of events in the sequence was reduced (Experiment 3), 4-year-olds were successful on the search task but not the planning task. Planning difficulties persisted even when relevant cues were provided (Experiments 4 and 5). Experiment 6 showed that improved performance on the search task found in Experiment 3 was not due to the removal of response ambiguity.