The Medical Cognition program in the Day Cognition Lab studies how people find, understand, remember, and use medical information. The basic approach has the following characteristics.

Who
Anyone who deals with medical information, especially:

Health Care Professionals --physicians --physicians associates --nurses --nurse practitioners --pharmacists

Consumers --patients --caregivers

Others --industry --regulators --legal system

Medical Information

General types of medical information include:

--drugs (prescription, over-the-counter) --medical devices --other medical treatments --health information

Specific content includes:
	--side effects ("adverse events") --drug interactions --pictograms --medical terminology	--instructions for use --alternative treatments --medication schedules --health diaries

General issues include:
	--cognition in both providers in patients --patient safety --risks (assessment, perception, management) --"fair balance" of benefits vs. risks --medical error --health outcomes --doctor/patient communication --informed consent --electronic medical records (pros and cons)

Cognitive Accessibility
A key concept in this work is "cognitive accessibility" (Day, 2000), the ease with which people can find, understand, remember, and use medical information in a safe and effective way.

Information Sources
A wide range of existing medical information sources is examined, developed for use by both health care professionals and consumers, including:

	--	FDA-approved "product labeling" for drugs (also Physicians Desk Reference)
	--	medical device labeling and manuals
	--	patient package inserts (PPI's)
	--	pharmacy leaflets
	--	internet product websites
	--	print and TV ads
	--	informed consent forms

Methodological Approaches
Basic methodological approaches include:

1)	Information Analysis
		Evaluate the cognitive accessibility of information in existing information sources. Develop quantitative methods (e.g., for assessing "fair balance" of benefits vs. risks).
2)	Document Design
		Design/redesign materials to enhance their cognitive accessibility.
3)	Laboratory Experiments
		Test the effects of alternative displays of medical information on cognition and behavior using carefully-controlled laboratory methods.
4)	Real-World Experiments
		Test the effects of alternative medical displays on cognition, behavior, and health outcomes in everyday settings (including hospitals, clinics, and self care).

Goals

1)	To understand why medical information can be hard to understand, remember, and use
2)	To enhance the cognitive accessibility of medical information
3)	To enable people to use medical information in a safe and effective manner
4)	To reduce medical error (by both professionals and patients)
5)	To understand how cognitive processes operate in real-world situations
6)	To re-evaluate cognitive theories generated in the laboratory, based on findings from everyday cognition research in medical settings

--Usability Testing of Model Medical Device Patient Labeling. U.S. Food and   Drug Administration, Center for Devices and Radiological Health, 1999. --Optimizing Patient Comprehension through Medicine Information Leaflets.   U.S. Pharmacopeia, Inc. 1998 (Subcontractor with Pharmacy School, University of North Carolina) --Comprehension of Drug Information in the Elderly. National Institutes on   Aging, 1988.

Consulting for many types of "stakeholders" in the pharmaceutical, medical device, and related medical domains, including industry, the U.S. Food and Drug Administration (FDA), the U.S. Pharmacopeia (USP), information vendors, hospital clinics and physician practices.

--Migraine management. Glaxo, Inc. (Note: resulted in patient-physician   brochure, Charting Your Route to Relief: A Personal Migraine Management Program, in use from 1994 to present.) --Gastric distress syndrome. Glaxo, Inc. --Multiple medication schedules for patient education. Individual physicians. --Auto-injectors for drug delivery. Dey, Inc. (Note: redesigned Patient Package   Insert for EpiPen® for severe allergic reactions, now packaged with the product) --Electronic medical records -- design/development/testing for cognitive   accessibility. Duke University Medical Center. --Effects of labeling on cognitive accessibility: Rx and OTC drugs. FDA and   industry. --Comprehension of drug information pictograms. FDA, Center for Biologics. --Memory for drug information in television ads. FDA, Center for Drug   Evaluation and Research. --Physician labeling of prescription drugs. FDA, Center for Drug Evaluation   and Research. --Risk assessment/perception/management and patient safety. FDA, Center for   Drug Evaluation and Research.

Day, R. S. Alternative representations. In G.H. Bower (Ed.), The Psychology of
	Learning and Motivation. New York: Academic Press, 1988, 22, 261-305. (Note: includes research on alternative displays for multiple medication schedules.)

Day, R. S. Cognition experiments: Optimizing patient comprehension through
	medicine information leaflets. In A.G. Hartzema, S. Tolleson-Rinehart, B.L. Sleath, and R.S. Day, Optimizing patient comprehension through medicine information leaflets. Rockville, MD: U.S. Pharmacopeia, 1999, 60-176.

Day, R. S. Ways to Know It, Ways to Show It: Effects on Memory,
	Comprehension, and Problem Solving. In preparation.

Day, R. S. and Wagner, G. Cognitive analysis of provider tasks in a cardiology
	clinic before and after launching an electronic medical record. In preparation.

Day, R. S. Reducing medication mistakes in the elderly. Cognitive Aging
	Conference, 1990.

Day, R. S. Alternative displays: Effects on memory and problem solving for drug
	information. Glaxo, Inc, 1994.

Day, R. S. Deadly drugs vs. medical miracles: Understanding prescription
	medications. North Carolina Cognition Conference, 1994.

Day, R. S. Cognitive analysis of Zantac information: Text and pictorial problems.
	Glaxo, Inc., 1995.

Day, R. S. Understanding, remembering and using drug interaction information.
	Psychonomic Society, 1995.

Day, R. S. Memory and problem solving in pharmacy. Pharmacy School,
	University of North Carolina, 1996.

Day, R. S. Understanding drug information: Recent studies. Thailand Pharmacy
	Delegation, 1996.

Day, R. S. Cognitive problems in everyday pharmacy practice. Senior Pharmacy
	Administration Staff, Duke University Medical Center, 1996.

Day, R. S. Drug information pictograms: If a picture is worth 1,000 words, which
	words are they? North Carolina Cognition Conference, 1999.

Day, R. S. Useful patient information. National Drug Information Stakeholders
	Meeting, 1999.

Day, R. S. Cognitive aspects of drug information: Implications for patients and
	professionals. Micromedex, Inc., 1999.

Day, R. S. Medical misadventures: Comprehension of drug and device
	information. Humanities in Medicine Lecture Series, Duke University Medical Center, 2000.

Day, R. S. Medical errors: Cognitive bases and solutions. Psychology
	Department, Duke University, 2000.

Day, R. S. Cognitive accessibility of drug information: Implications for patients
	and professionals. U.S. Food and Drug Administration, Center for Drug Evaluation and Research, 2000.

Day. R. S. Drug information pictograms: A comprehensive approach. Human
	Factors and Ergonomics Society, 2000.

Day, R. S. Cognitive tasks for medical device evaluation. Human Factors and
	Ergonomics Society, 2000.

Day, R. S. How are medication risks and benefits understood by consumers and
	healthcare professionals? International Pharmaceutical Federation, Vienna, Austria, 2000.

Day, R. S. "BrandName.Com" - Cognitive accessibility of internet drug
	information? Drug Information Agency, 2000.

Day, R. S. Electronic medical records: Effects on cognition and behavior.
	Mission St. Joseph Research Institute.