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PubMedDate not supplied

Strategies for transforming fine scale knowledge to management usability.

Simulation tools used for management purposes should fulfill several conditions by being computationally fast, user-friendly, realistic, generic and reliable. These traits are often counteracting since they simultaneously demand for model complexity as well as simplicity. Here we develop a strategy to overcome this general problem of environmental modelling for management use. Major ingredients are model analysis and reduction as new core components of the modelling process. In detail, a set of combined methods is proposed. Within a large class of models the set allows for automatically exploring model behaviour and for aggregating fine scale process knowledge together with spatio temporal resolution. Applications to a huge aquatic European regional seas ecosystem model (ERSEM), a complex photosynthesis model (PGEN) as well as a simple diagenetic model are presented. The analysis and aggregation methods provide first steps towards a new generation of decision support tools able to cope with an increase in scientific knowledge as well as management demands.

Decision Support Techniques↗
PubMed2003

'Best practice' development and transfer in the NHS: the importance of process as well as product knowledge.

A core prescription from the knowledge management movement is that the successful management of organizational knowledge will prevent firms from 'reinventing the wheel', in particular through the transfer of 'best practices'. Our findings challenge this logic. They suggest instead that knowledge is emergent and enacted in practice, and that normally those involved in a given practice have only a partial understanding of the overall practice. Generating knowledge about current practice is therefore a precursor to changing that practice. In this sense, knowledge transfer does not occur independently of or in sequence to knowledge generation, but instead the process of knowledge generation and its transfer are inexorably intertwined. Thus, rather than transferring 'product' knowledge about the new 'best practice' per se, our analysis suggests that it is more useful to transfer 'process' knowledge about effective ways to generate the knowledge of existing practice, which is the essential starting point for attempts to change that practice.

Benchmarking↗
PubMed2005

[The contribution of a scientific journal to nursing integration and the foundation of professional actions].

This study analyzes how the Latin American Journal of Nursing contributed to the integration of nurses in Brazil and Latin America and provided foundations for their professional actions. The research methodology is based on the knowledge management model called "Knowledge Capitals", developed by the CRIE (Business Intelligence Reference Center), which focuses on subscriber Relationship Capital. Data were collected from the Journal's subscriber database and by means of an electronic questionnaire sent to subscribers ranked as "private persons" and those with an electronic address. It was evidenced that the Journal's role is inexpressive in Latin America, with a merely satisfactory penetration in Brazil. The respondents confirmed the Journal's contribution to the foundation of professional nursing actions.

Attitude of Health Personnel↗
PubMed2000

Knowledge acquisition, management and representation for the diagnostic support in human inborn errors of metabolism.

The very complex and specific knowledge about inborn errors of metabolism increases rapidly and is spread worldwide. Therefore an Internet platform for the acquisition of statistical knowledge (PATDB) and for the collection of the experience of experts (Metabolic diseases database) has been established. The success of diagnostic support highly depends on the way of knowledge representation. An information retrieval system for physicians will offer first insights about useful user interfaces and handling properties. Furthermore information fusion of biomedical systems to a Biomedical Workbench for the simulation of biochemical reactions is described.

Artificial Intelligence↗
PubMedDate not supplied

SARS: current knowledge and management.

Severe acute respiratory syndrome (SARS) was identified as a new infectious disease in Asia early in 2003. Since then an unprecedented global public health response has been mounted. This article describes current knowledge of the infection and outlines the management of SARS in the UK.

Case Management↗
PubMed2003

Decision support at the point of care: challenges in knowledge representation, management, and patient-specific access.

Many applications in a clinical information system can benefit from the incorporation of medical knowledge to provide patient-specific, point-of-care decision support. These include computer-based provider order entry, referral, clinical result interpretation, consultation, adverse event monitoring, scheduling, shared patient-doctor decision-making, and generation of alerts and reminders, among others. To be executable, knowledge must be represented in the form of rules, constraints, calculations, guidelines, and other logical/algorithmic formats. The main difficulty is that the integration of such knowledge into clinical applications, when it occurs, tends to be very system- and application-specific, often encoded in a programming language, or even in the formating specifications of a user interaction display. Also, the data references and services invoked are highly dependent on the system/platform and electronic medical record implementation. This makes it difficult and time-consuming to encode authoritative evidence-based knowledge, severely limits the ability to disseminate and share successes, and hampers efforts to review and update the logic as medical knowledge changes. Solutions to this problem involve the development of standards-based representations for medical knowledge, and tools for authoring/editing, dissemination, adaptation to local environments, and execution. Numerous approaches are being pursued, all of which will be described in this presentation.

Decision Support Systems, Clinical↗
PubMed2004

Farmers' perceptions, knowledge, and management of coffee pests and diseases and their natural enemies in Chiapas, Mexico.

Small farmers' perceptions of coffee Coffea arabica L. herbivores and their natural enemies, how those perceptions relate to field infestation levels, and pest management practices being implemented by members from two organic and nonorganic coffee grower organizations in the Soconusco region, southeastern Mexico, were analyzed through an interview survey, diagnostic workshops, and field sampling. The terms pest, disease, and damage were commonly used as synonyms. The major phytophagous species, as perceived by the interviewees, were Hypothenemus hampei (Ferrari), and to a lesser extent the fungi Corticium koleroga Cooke (Höhnel) and Hemileia vastatrix Berkeley & Broome. Among the nonorganic farmers, other nonpest-related constraints were regarded as more important. Awareness of the existence of natural enemies was low, despite more organic farmers have used the ectoparasitoid bethylid Cephalonomia stephanoderis Betrem against H. hampei. Labor supplied by household members was most frequent for pest control; only organic farmers exchanged labor for this purpose. The levels of infestation by H. hampei, Leucoptera coffeella Guérin-Méneville, and C. koleroga were lower within the organic coffee stands. However, a low effectiveness for pest control was commonly perceived, probably due to a feeling, among the organic farmers, of a low impact of their pest management extension service, whereas a lack of motivation was prevalent among the nonorganic farmers, shown by a concern with their low coffee yields and the emigration of youth. The importance of understanding farmers' perceptions and knowledge of pests and their natural enemies and the need for participatory pest management approaches, are discussed.

Agriculture↗
PubMed1997

Massachusetts Risk Management Survey (MaRMS) of teaching hospital physicians.

OBJECTIVE: To assess and compare the risk management knowledge of physicians from Massachusetts teaching hospitals. DESIGN: A survey. SETTING: Participating Massachusetts teaching hospitals. PARTICIPANTS: 639 of some 2,000 staff physicians of participant hospitals who were sent surveys. An additional 174 postgraduate year 1 (PGY1) and PGY3 house officers also completed the survey. MAIN OUTCOME MEASURES: Percent of questions answered correctly, and comparisons between staff physicians and house officers. RESULTS: Staff physicians scored higher (87%) than PGY1s and PGY3s combined (81%), P<0.001. Scores among staff physicians did not differ according to field of medicine, age, proportion of time spent in clinical practice, or years in practice. PGY3s did not score significantly higher than PGY1s (82% vs. 80%). Some 40% of physicians said they ordered more tests than necessary because of malpractice worries; they indicated 72% of their colleagues do so as well. Physicians in obstetrics-gynecology and emergency medicine were more likely to respond yes to this question than physicians in other fields of medicine (P<0.001), as were physicians who had been defendants in a malpractice suit (88 P=0.013). CONCLUSIONS: Surveyed staff physicians have an adequate risk management knowledge. Training directors should encourage house officers to attend risk management programs to improve their knowledge. Physicians might overestimate the amount spent on defense medicine based on their perceptions of other physicians.

Adult↗
PubMedDate not supplied

Knowledge and management of diarrhea among underserved minority parents/caregivers.

OBJECTIVE: Dehydration resulting from diarrhea continues to be a cause of morbidity, mortality, and increased health care costs in the United States. This study assesses parental knowledge of the causes and signs of diarrhea and dehydration. It also examines parental-care practices during an episode of diarrhea. METHODS: A survey was given to 219 parents/caregivers of children less than 5 years of age who presented to a pediatric continuity clinic. A bilingual interviewer was used to administer the surveys to participants for assessing knowledge of causes, signs, and treatment of diarrhea; signs of dehydration; and care practices during an episode of diarrhea. RESULTS: A wide variation in the level of awareness of signs, causes, and treatment of diarrhea was detected. General knowledge of diarrhea was related positively to accessibility of health information, level of education, ethnicity, and experience with dehydration. General knowledge of diarrhea, adjusted for level of education, was higher in African Americans than in Hispanics. CONCLUSIONS: In children, dehydration from diarrhea may be prevented by increasing parents'/caregivers' general knowledge of diarrhea and dehydration and the appropriate usage of oral rehydration solutions. Intervention programs designed to increase parents'/caregivers' knowledge must be culturally sensitive and appropriate for diverse educational backgrounds and must assist in improving access to health-related information.

Adolescent↗
PubMedDate not supplied

Dollar$ & $en$e. Part V: What is your added value?

In Part I of this series, I introduced the concept of memes (1). Memes are ideas or concepts--the information world equivalent of genes. The goal of this series of articles is to infect you with memes, so that you will assimilate, translate, and express them. No matter what our area of expertise or "-ology," we all are in the information business. Our goal is to be in the wisdom business. In the previous papers in this series, I showed that when we convert raw data into wisdom we are moving along a value chain. Each step in the chain adds a different amount of value to the final product: timely, relevant, accurate, and precise knowledge that can be applied to create the ultimate product in the value chain: wisdom. In Part II of this series, I introduced a set of memes for measuring the cost of adding value (2). In Part III of this series, I presented a new set of memes for measuring the added value of knowledge, i.e., intellectual capital (3). In Part IV of this series, I discussed practical knowledge management tools for measuring the value of people, structural, and customer capital (4). In Part V of this series, I will apply intellectual capital and knowledge management concepts at the individual level, to help answer a fundamental question: What is my added value?

Cost-Benefit Analysis↗
PubMedDate not supplied

Knowledge and management of scabies in general practitioners and dermatologists.

Scabies is an infectious skin disease with an increasing incidence during the past decade. A survey was conducted among general practitioners (GPs) and dermatologists in the region of Ghent, Belgium, to explore their knowledge on scabies. Information on the treatment advice given and the frequency of reporting scabies to the Health Inspection was also collected. The scores on the knowledge test were of an acceptable level in both GPs and dermatologists (median score 59% and 79% respectively). We found that profession (dermatologist versus GP), the number of years of experience and the estimated number of scabies patients per year had a significant effect on this score. Permethrin cream, currently regarded as the standard treatment, is prescribed as the only treatment for scabies by half of the GPs and dermatologists. Almost 50% of the GPs and dermatologists indicated they rarely or never report scabies to the Health Inspection. As a result the correct incidence of scabies in Belgium, as in many other countries, is not known.

Adult↗
PubMed2006

Quality of care in patients with asthma and rhinitis treated by respiratory specialists and primary care physicians: a 3-year randomized and prospective follow-up study.

BACKGROUND: Previous studies evaluating asthma care provided by primary care providers and respiratory specialists (RSs) are limited by short observation periods and nonrandomized designs. OBJECTIVE: To evaluate long-term outcomes in patients with asthma and rhinitis randomly selected to be cared for by RSs or primary care specialists. METHODS: In a randomized, 3-year, longitudinal study, 472 patients with asthma and allergic rhinitis were cared for by RSs or primary care physicians. Outcome measures, including disease severity, lung function, medication use, compliance, and self-management knowledge, were compared between groups. RESULTS: Compared with patients followed up by primary care providers, those in the RS group had reduced asthma severity (P = .046), significantly fewer days with asthma symptoms (P < .01), and improved asthma self-management knowledge (P < .01). At baseline, most patients were undertreated. This value was significantly reduced from 74% to 37% in the RS group and from 71% to 57% in the primary care physician group. We found odds ratios of 8.5 (95% confidence interval, 2-43; P < .01) for worsening of asthma and 0.3 (95% confidence interval, 0.1-0.9; P = .04) for asthma improvement when followed up by primary care physicians, which indicates that primary care follow-up increases the risk of worsening of asthma and decreases the chance of improving. Similar results were observed in patients with allergic rhinitis, although the findings were less pronounced. CONCLUSION: Treatment and follow-up by an RS ensured better quality of care in patients with asthma and rhinitis.

Adolescent↗
PubMed2003

From gene networks to brain networks.

The brain's structural organization is so complex that 2,500 years of analysis leaves pervasive uncertainty about (i) the identity of its basic parts (regions with their neuronal cell types and pathways interconnecting them), (ii) nomenclature, (iii) systematic classification of the parts with respect to topographic relationships and functional systems and (iv) the reliability of the connectional data itself. Here we present a prototype knowledge management system (http://brancusi.usc.edu/bkms/) for analyzing the architecture of brain networks in a systematic, interactive and extendable way. It supports alternative interpretations and models, is based on fully referenced and annotated data and can interact with genomic and functional knowledge management systems through web services protocols.

Animals↗
PubMed2005

Promoting a biopsychosocial orientation in family practice: effect of two teaching programs on the knowledge and attitudes of practising primary care physicians.

The bio-psychosocial (BPS) approach to patient care has gained acceptance in medical education. However, reported teaching programs rarely describe the efficacy of alternative approaches to continuing medical education aimed at promoting a BPS approach. The objective was to describe and evaluate the effect of two teaching programs on learners' BPS knowledge, management intentions, patient-centered attitudes, professional self-esteem, burnout, work related strain and mental workload. The learners were Israeli general practitioners. The first ("didactic") program consisted of problem-based reading assignments, lectures and discussions. The second ("interactive") program consisted of reading assignments, lectures and discussions, in addition to role-playing exercises, Balint groups and one-to-one counseling by a facilitator. One month before and six months after the teaching interventions, we used structured questionnaires to test for knowledge, management intentions (responses to questions, such as "what would you tell a patient with ...") and attitudes. Both programs led to measurable improvement in knowledge, intentions, patient-centered attitudes and self-esteem. The interactive teaching approach improved significantly more the learners' professional self-esteem and intentions than the didactic approach. Self-reported burnout significantly increased after the program. It is concluded that teaching intervention enhanced a BPS orientation and led to changes in knowledge, intentions, self-esteem and attitudes. An interactive method of instruction was more effective in achieving some of these objectives than a didactic one. The observed increase in burnout was unexpected and requires further study and confirmation.

Burnout, Professional↗
PubMed1985

Knowledge and management strategies in incest cases: a survey of physicians, psychologists and family counselors.

A questionnaire was mailed to all 255 psychologists, psychiatrists, pediatricians, and family counselors listed in the 1983 telephone directory. Of the 108 private practitioners who responded, over one-half had treated a child or adult incest victim in the past year; 86% requested more training in this area. Practitioners had a high level of general knowledge about intrafamilial child sexual abuse. Nevertheless, one-third stated they would not refer to protective services a child who had first made, but then retracted, an incest allegation. While most pediatricians would recommend physical examination of a child who had retracted, only half of other professionals would do so. Women practitioners were more realistic about the high frequency of actual father-daughter incest and were more likely to report the hypothetical case of the retracted allegation.

Attitude of Health Personnel↗