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Background: In the SPOTLIGHT trial (Spot Sign Selection of Intracerebral Hemorrhage to Guide Hemostatic Therapy), patients with a computed tomography (CT) angiography spot-sign positive acute intracerebral hemorrhage were randomized to rFVIIa (recombinant activated factor VIIa; 80 μg/kg) or placebo within 6 hours of onset, aiming to limit hematoma expansion. Administration of rFVIIa did not significantly reduce hematoma expansion. In this prespecified analysis, we aimed to investigate the impact of delays from baseline imaging to study drug administration on hematoma expansion. Methods: Hematoma volumes were measured on the baseline CT, early post-dose CT, and 24 hours CT scans. Total hematoma volume (intracerebral hemorrhage+intraventricular hemorrhage) change between the 3 scans was calculated as an estimate of how much hematoma expansion occurred before and after studying drug administration. Results: Of the 50 patients included in the trial, 44 had an early post-dose CT scan. Median time (interquartile range) from onset to baseline CT was 1.4 hours (1.2–2.6). Median time from baseline CT to study drug was 62.5 (55–80) minutes, and from study drug to early post-dose CT was 19 (14.5–30) minutes. Median (interquartile range) total hematoma volume increased from baseline CT to early post-dose CT by 10.0 mL (−0.7 to 18.5) in the rFVIIa arm and 5.4 mL (1.8–8.3) in the placebo arm ( P =0.96). Median volume change between the early post-dose CT and follow-up scan was 0.6 mL (−2.6 to 8.3) in the rFVIIa arm and 0.7 mL (−1.6 to 2.1) in the placebo arm ( P =0.98). Total hematoma volume decreased between the early post-dose CT and 24-hour scan in 44.2% of cases (rFVIIa 38.9% and placebo 48%). The adjusted hematoma growth in volume immediately post dose for FVIIa was 0.998 times that of placebo ([95% CI, 0.71–1.43]; P =0.99). The hourly growth in FFVIIa was 0.998 times that for placebo ([95% CI, 0.994–1.003]; P =0.50; Table 3). Conclusions: In the SPOTLIGHT trial, the adjusted hematoma volume growth was not associated with Factor VIIa treatment. Most hematoma expansion occurred between the baseline CT and the early post-dose CT, limiting any potential treatment effect of hemostatic therapy. Future hemostatic trials must treat intracerebral hemorrhage patients earlier from onset, with minimal delay between baseline CT and drug administration. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01359202.

PurposeAn enterprise system (ES) implementation proceeds as a multi-team system (MTS), with multiple project teams spanning time and business functions to meet organization-wide goals. Thus, the focus shifts from the output of a single project team to the outcomes of all ES project teams as part of the larger MTS. This study extends concepts of shared mental models (SMMs) in aspects of goals and plans in both MTS level and project team level and further examines SMMs' interactive impact on the MTS-based project performance.Design/methodology/approachThis study tests the model with survey data from 140 MTS-based ES implementations in China. Partial Least Squares Structural Equation Modeling (PLS SEM) served to test the hypothesized relationships.FindingsSMMs of project team-level goals and plans contribute to the cooperation and coordination in the ES implementation and thereby improve final implementation efficiency either directly or in combination. However, SMMs of MTS-level goal and plans contribute integration only when considered with achievements at the project level.Originality/valuePrior literature suggests a critical role of integration among ES project teams but finds challenges in achieving such integration. By leveraging shared mental model theory, the authors' results show that both common goal and plan understandings in the integration team critically influence integration in ES implementation and, thus, the final ES implementation efficiency, though not in a strictly linear relationship.

In recent years, there has been growing recognition of the active role of patients in healthcare, highlighting the need to support patient work by designing systems, processes, and communications that are patient-centered. Patients are called upon to make consequential decisions based on complex cognitive and perceptual cues. Some patients may even possess deep knowledge about their condition and its management. However, there is little research applying naturalistic decision making (NDM) to study patient cognition and decision making. This application may have the potential to help understand and support patients to more effectively manage their health, wellness, and safety. In this panel, we address the relevance and applicability of NDM in terms of theory, terminology, and methods to the design of patient-centered solutions.

PurposeDiscover how organizations effectively integrate the temporary program outputs into the permanent organization.Design/methodology/approachA grounded theory approach deriving knowledge from interviews, field observations and documentary evidence.FindingsA network of actors integrates the multiteam program system into the overall organization, generating alternate political and implementation impetus.Research limitations/implicationsThe paper significantly contributes to the literature of IT-enabled programs by surfacing processes, mechanisms and structures that simultaneously address extant concerns in the program management literature.Practical implicationsThe directives of current research and program standards of professional societies identify an individual responsible for integrating the program output into the organization. The study indicates greater autonomy on the responsible actor requiring adjusting to changing stakeholder groups.Originality/valueThe authors add a missing link in understanding how programs can institute effective work structures to address emerging program conflicts and issues, suggesting strategies to foster interaction between temporary and permanent organizations.

Background The relationship between duration of transient neurological events and presence of diffusion‐weighted lesions by symptom type is unclear. Methods and Results This was a substudy of SpecTRA (Spectrometry for Transient Ischemic Attack Rapid Assessment), a multicenter prospective cohort of patients with minor ischemic cerebrovascular events or stroke mimics at academic emergency departments in Canada. For this study we included patients with resolved symptoms and determined the presence of diffusion‐weighted imaging (DWI) lesion on magnetic resonance imaging within 7 days. Using logistic regression, we evaluated the association between symptom duration and DWI lesion, assessing for interaction with symptom type (focal only versus nonfocal/mixed), and adjusting for age, sex, education, comorbidities, and systolic blood pressure. Of 658 patients included, a DWI lesion was present in 232 (35.1%). There was a significant interaction between symptom duration and symptom type. For those with focal‐only symptoms, there was a continuous increase in DWI probability up to 24 hours in duration (ranging from ≈40% to 80% probability). In stratified analyses, the increase in probability of DWI lesion with increased duration of focal symptoms was seen in women but not men. For those with nonfocal or mixed symptoms, predicted probability of DWI lesion was ≈35% and was greater in men, but did not increase with longer duration. Conclusions Increased duration of neurological deficits is associated with greater probability of DWI lesion in those with focal symptoms only. For individuals with nonfocal or mixed symptoms, about one‐third had DWI lesions, but the probability did not increase with duration. These results may be important to improve risk stratification of transient neurological events.

How people make decisions, size up situations, spot anomalies, and anticipate problems in real-world settings. Gary Klein, author of the bestselling Sources of Power, is the cognitive psychologist who discovered how people actually make decisions, particularly under time pressure and uncertainty. In Snapshots of the Mind, he offers a set of short essays—“snapshots” of different aspects of cognitive functioning in real-world settings that will help us learn to recognize the cognitive processes that underlie and drive performance. In these essays Klein provides practical tools for escaping fixation on initial hunches and learning to detect the ways that people make decisions, size up situations, spot anomalies, and anticipate problems. Snapshots of the Mind grows out of the Naturalistic Decision Making movement, which studies how decision makers handle uncertainty and complexity in high-stakes situations. In the essays, Klein examines how people make tough choices and assessments in the real-world, discussing such topics as training, information technology, teamwork, expertise, and insights. Debunking the idea that artificial intelligence will soon take over human decision making, he argues instead for machines that make us smarter and expand our expertise. He describes his Recognition-Primed Decision (RPD) model, which has been incorporated into Army doctrine and was one of the inspirations for Malcolm Gladwell's Blink. Snapshots of the Mind offers fresh takes on such topics as confirmation bias, anomaly detection, intuition, anticipatory thinking and perspective-taking. Readers come away attuned to the primary aspects of expert cognition: the mindsets, mental models, and perceptual sensitivity.