A work domain analysis framework for modelling intensive care unit patients

Work domain analysis (WDA) has been applied to a range of complex work domains, but few WDAs have been undertaken in medical contexts. One pioneering effort suggested that clinical abstraction is not based on means-ends relations, whereas another effort downplayed the role of bio-regulatory mechanisms. In this paper it is argued that bio-regulatory mechanisms that govern physiological behaviour must be part of WDA models of patients as the systems at the core of intensive care units. Furthermore it is argued that because the inner functioning of patients is not completely known, clinical abstraction is based on hypothetico-deductive abstract reasoning. This paper presents an alternative modelling framework that conforms to the broader aspirations of WDA. A modified version of the viable systems model is used to represent the patient system as a nested dissipative structure while aspects of the recognition primed decision model are used to represent the information resources available to clinicians in ways that support lsquoif...thenrsquo conceptual relations. These two frameworks come together to form the recursive diagnostic framework, which may provide a more appropriate foundation for information display design in the intensive care unit.

Reasoning about timeouts

In real-time programming a timeout mechanism allows exceptional behaviour, such as a lack of response, to be handled effectively, while not overly affecting the programming for the normal case. For. example, in a pump controller if the water level has gone below the minimum level and the pump is on and hence pumping in more water, then the water level should rise above the minimum level within a specified time. If not, there is a fault in the system and it should be shut down and an alarm raised. Such a situation can be handled by normal case code that determines when the level has risen above the minimum, plus a timeout case handling the situation when the specified time to reach the minimum has passed. In this paper we introduce a timeout mechanism, give it a formal definition in terms of more basic real-time commands, develop a refinement law for introducing a timeout clause to implement a specification, and give an example of using the law to introduce a timeout. The framework used is a machine-independent real-time programming language, which makes use of a deadline command to represent timing constraints in a machine-independent fashion. This allows a more abstract approach to handling timeouts.