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PubMed2004

The use of concept mapping to enlighten the knowledge networks of diabetic children: a pilot study.

OBJECTIVE: The value of concept mapping in enlightening nature and organization of knowledge was shown with adult diabetic or obese patients. Our objectives were to ascertain the relevance and feasability of concept mapping in diabetic children during an educational program. METHOD: This qualitative research was performed in 5 children from 8 to 13 years. Concept maps were drawn at the beginning (Phase 1) and at the end (Phase 2) of an educational program. During the interview each child was invited to express himself starting from the central concept: "diabetes", and to express his/her knowledge, representations, and life experience. RESULTS: The ten maps analysis shows: an increase of knowledge between phase 1 and phase 2 (+34%), towards a deepening of initial knowledge and an addition of new knowledge (43% and 41% of the added knowledge); a decrease of inaccurate knowledge in phase 2; an enrichment of the knowledge networks (+16 cross links); an increase of knowledge related to the ways to behave knowledge (+42%). CONCLUSION: This preliminary report demonstrated that concept maps were feasible, useful and relevant in therapeutic education of children. This method allowed us to show how every child connected his knowledge and how it was modified by an educational intervention. Concept maps therefore contributed to individual educational diagnosis and assessment of new knowledge integration.

Adolescent↗

PubMed2000

The biomedical disciplines and the structure of biomedical and clinical knowledge.

The relation between biomedical knowledge and clinical knowledge is discussed by comparing their respective structures. The knowledge of a disease as a biological phenomenon is constructed by the interaction of facts and theories from the main biomedical disciplines: epidemiology, diagnostics, clinical trial, therapy development and pathogenesis. Although these facts and theories are based on probabilities and extrapolations, the interaction provides a reliable and coherent structure, comparable to a Kuhnian paradigma. In the structure of clinical knowledge, i.e. knowledge of the patient with the disease, not only biomedical knowledge contributes to the structure but also economic and social relations, ethics and personal experience. However, the interaction between each of the participating "knowledges" in clinical knowledge is not based on mutual dependency and accumulation of different arguments from each, as in biomedical knowledge, but on competition and partial exclusion. Therefore, the structure of biomedical knowledge is different from that of clinical knowledge. This difference is used as the basis for a discussion in which the place of technology, evidence-based medicine and the gap between scientific and clinical knowledge are evaluated.

Biometry↗

PubMed1997

Knowledge of oral radiology among Swedish dentists.

OBJECTIVES: To develop a method of measuring Swedish dentists' knowledge of oral radiology and to relate the knowledge measure to a number of characteristics including risk attitude and use of low dose techniques. METHODS: A questionnaire was mailed to 2000 randomly selected dentists listed in the register of the Swedish Dental Society, with a response rate of 69.2%. An index for measuring knowledge was constructed, based on the answers to the questions. The measure was cross-tabulated with a number of demographic variables. RESULTS: Dentists with 5-25 years in practice had a higher level of knowledge than those with either fewer or more years in practice. Dentists working in the Public Dental Health Service had a higher level of knowledge compared with those in private practice. Specialists had a significantly higher level of knowledge compared with dentists who were not. Forty-two per cent of the dentists had not attended any course in oral radiology since graduation. Seventy-nine per cent of the dentists using a 'low' dose technique had a 'high' level of knowledge. The difference between dentists using a 'low-dose' and a 'high-dose' technique was statistically significant (P = 0.000). Dentists' attitude to risk is related to their knowledge. Seventy-one per cent of the dentists in counties with a specialist in oral radiology had a 'high level of knowledge' compared with 57% in those without. CONCLUSIONS: It is possible to study the relationship between knowledge and demographic variables by a survey. Work experience and extended education affect dentists' knowledge. There is an association between knowledge, use of low-dose techniques and risk attitude.

Adult↗

PubMed2001

Israeli nurses' knowledge of health care reforms.

OBJECTIVES: This study examines health care reforms' implementation processes from the perspective of nurses' knowledge regarding the reforms. The research has been carried out in the Israeli context, where health care reforms were initiated in 1995. Three specific research questions were formulated: (a) What is the level of nurses' knowledge regarding the recommendations of the Netanyahu committee? (b) What is the level of nurses' knowledge concerning the basic principals of the National Insurance Law? and (c) Are there knowledge differences relating to employment setting (hospital, community, and educational settings), nurses' roles (managerial vs. staff nurses), years of experience, and level and type of education? METHOD: The stratified nonproportional random sample consisted of a total of 468 nurses. Of these nurses, 206 were employed in community settings (136 in curative care, and 70 in preventive care), 137 were employed in hospital settings, and 125 worked in schools and departments of nursing. Research tools, developed for the purpose of this study, included the nurses' knowledge questionnaire comprised of five subscales, and the knowledge relevancy questionnaire. RESULTS: Overall, data demonstrated a low to moderate level of knowledge on all knowledge scales. Knowledge level on the criteria questions was particularly low. Contrary to the low level of knowledge, nurses regarded health care reforms' knowledge as highly relevant to their work life. Curative setting, an extensive work experience, managerial position, and non-nursing academic degree were all positively related to higher levels of reforms' knowledge. CONCLUSION: These findings should encourage both policy makers and managers in various health care organizations to develop programs for informing health care providers on central aspects of health care reforms considered most relevant to the practice setting.

Adult↗

PubMed2000

Education for the practice of occupational medicine: knowledge, competence, and professionalism.

The multistep process of education is delineated by the sequential phases: (1) Knowledge Transfer, (2) Competence Development, and (3) Professional Inculcation. The realities of practice modes and curricular time constraints are important determinants of the breadth and depth of the information provided in the Knowledge Transfer process. Accordingly, it is proposed that Phase 1, the Knowledge Acquisition Process, be organized into two components: (1) Core Knowledge, requiring both significant breadth and depth; and (2) Augmentive Knowledge, providing wide breadth and appropriate but variable depth. This curricular organizing proposition recognizes that: (1) the wide breadth of multiple stores of knowledge inherent in the practice of PM and EOM considerably exceeds many other medical specialities; (2) the duration of training is inherently shorter; and (3) its practitioners generally operate as members of teams consisting of other professionals (e.g., attorneys, engineers, business administrators, industrial hygienists, sociologists, psychologists). Obviously, it is unreasonable to expect the members of such teams to each have comparable depth and breadth of knowledge. A broad knowledge base, implicit in Augmentive Knowledge, provides the capacity for recognition, understanding, and application of capabilities brought by other professionals. Facilitating communications between team members, each possessing a broad knowledge base, enhances the effectiveness of the knowledge, competence, and professionalism of collaborative efforts. Phase 2, Competency, consists of the coherent integration of multiple stores of information applicable to the management of a clearly defined task with a clearly measurable outcome. The accomplishment of true competency is not based on the simple possession of multiple stores of knowledge; rather it depends on the facility and effectiveness with which information bases are marshaled, integrated, and communicated. Clearly, the effectiveness of this process increases with its interaction; it is unreasonable to expect a significant degree of competence immediately upon graduation from a training program. Phase 3, Professionalism, and its basic ethos provides the governing context for the sound application of competencies. Although it is difficult to teach, only with its accomplishment can the educational process be considered whole, albeit never complete.

Clinical Competence↗

PubMed2000

Stroke knowledge among stroke support group members.

BACKGROUND AND PURPOSE: Community stroke education is needed to improve early stroke recognition and reduce delays in the referral of stroke patients. In some regions, stroke support groups are important promoters of regional stroke education. However, there are no data about the level of stroke knowledge among support group members that support this promotional role. METHODS: We performed a cross-sectional questionnaire survey among 11 German stroke support groups. The questionnaire asked for stroke knowledge and sociodemographic and medical data. Stroke knowledge was excellent if a participant knew (1) at least 2 stroke symptoms (good symptom knowledge) and (2) at least 2 stroke risk factors (good risk factor knowledge), as well as knowing (3) that immediate hospital admission or an emergency call is necessary in case of stroke (good action knowledge). RESULTS: A total of 133 members (96.2%) of 11 stroke support groups took part in the study. Mean age was 65.3 years (SD 11.2 years). Fifty-four percent of subjects were female, 72.8% were retired, and 69.8% were stroke patients. Of the participants, 80.3% had good symptom knowledge, 64.7% had good risk factor knowledge, and 79.7% had good action knowledge. Stroke knowledge was excellent in 44.0% of subjects. Logistic regression analysis showed that age <70 years and not having had a stroke were significant predictors for excellent stroke knowledge. CONCLUSIONS: Overall, members of stroke support groups are well informed about all aspects of modern stroke care. Because of their knowledge and personal experience, support groups should be viewed as important partners in community stroke education.

Aged↗

PubMed2006

Using a conceptual framework during learning attenuates the loss of expert-type knowledge structure.

BACKGROUND: During evolution from novice to expert, knowledge structure develops into an abridged network organized around pathophysiological concepts. The objectives of this study were to examine the change in knowledge structure in medical students in one year and to investigate the association between the use of a conceptual framework (diagnostic scheme) and long-term knowledge structure. METHODS: Medical students' knowledge structure of metabolic alkalosis was studied after instruction and one year later using concept-sorting. Knowledge structure was labeled 'expert-type' if students shared >or= 2 concepts with experts and 'novice-type' if they shared < 2 concepts. Conditional logistic regression was used to study the association between short-term knowledge structure, the use of a diagnostic scheme and long-term knowledge structure. RESULTS: Thirty-four medical students completed the concept-sorting task on both occasions. Twenty-four used a diagnostic scheme for metabolic alkalosis. Short-term knowledge structure was not a correlate of long-term knowledge structure, whereas use of a diagnostic scheme was associated with increased odds of expert-type long-term knowledge structure (odds ratio 12.6 [1.4, 116.0], p = 0.02). There was an interaction between short-term knowledge structure and the use of a diagnostic scheme. In the group who did not use a diagnostic scheme the number of students changing from expert-type to novice-type was greater than vice versa (p = 0.046). There was no significant change in the group that used the diagnostic scheme (p = 0.6). CONCLUSION: The use of a diagnostic scheme by students may attenuate the loss of expert-type knowledge structure.

Adult↗

PubMed2003

Correlates of knowledge of prevention of sexually transmitted diseases among primary school pupils in Tanzania.

In this paper we attempt to identify factors that determine knowledge on prevention of sexually transmitted diseases (STDs) among primary school pupils in Tanzania using data extracted from the Family Life Education KAP Survey conducted in 1999. The data used consist of a sample of 18,564 pupils (about 50% males and 50% females) from all the 20 regions of Tanzania mainland. There were significant differences between boys and girls as regards knowledge of family life education in general. Boys tended to be more knowledgeable than girls about many aspects of family life education. The findings show that only 40.1% of the respondents were able to identify all the three STDs given in the questionnaire namely gonorrhoea, syphilis and AIDS. As regards modes of HIV transmission only 37.5% had full knowledge of these, while 48.8% knew condom use and abstinence as methods of STD prevention. The bivariate analysis showed significant relationships between knowledge of condom use and abstinence as methods of STD prevention with knowledge of STDs, HIV transmission, education level of the respondents, residence and parents' education for both boys and girls. However, knowledge of STDs, HIV transmission and residence came out clearly in the logistic regression as predictors of knowledge of condom use as a method of STD prevention for both sexes. For males, mother's education was also a significant predictor of knowledge of condom use as a method of STD prevention. Furthermore, a significant predictor of knowledge of condom use for female respondents was found to be the respondent's educational level. On the other hand, predictors of knowledge of abstinence as a method of STD prevention were knowledge of STDs and HIV transmission.

Adolescent↗

PubMedDate not supplied

Adults' knowledge and behaviors related to human papillomavirus infection.

BACKGROUND: Our objective was to assess adults' knowledge, risk behaviors, and preference for information about human papillomavirus (HPV). METHODS: A cross-sectional study using a self-administered questionnaire given in 3 locations (a university health service and 2 community family practice offices); 289 people completed the questionnaire. The primary outcome measure was a knowledge score calculated from the responses on specific items in the questionnaire. This knowledge score was developed by other investigators and has acceptable psychometric properties. RESULTS: Knowledge about HPV was low, with an average knowledge score of 5.50 (possible scores ranged from 0 to 14) and a mode of 0. Knowledge scores were significantly higher in women (P =.001) and married adults (P =.001). Knowledge scores were inversely related to age (P =.004) and positively correlated with years of education (P =.001) and self-assessment of knowledge (P <.001). Knowledge scores were positively correlated with condom use (P =.05) but not significantly associated with other risk behaviors. The most frequently desired time to receive information about HPV was before becoming sexually active. CONCLUSIONS: Adults seen in a typical family physician's office have limited knowledge of HPV. One tool family physicians can use to identify those with the least amount of knowledge is to ask patients how informed they are about HPV. The preferred time to receive information about HPV was before a patient became sexually active. However, it remains unclear whether educational intervention or knowledge changes risky behaviors.

Adult↗

PubMed1989

Knowledge and the child's developing theory of the world.

In this article, I have presented a brief history of research directed toward examining the developing ability of children to comprehend and produce metaphor that occurs with increasing age. I argued that the child's ability in this area does not rest upon developing an ability specific to metaphor, but, instead, metaphor comprehension and production, not unlike other forms of cognition, rests upon a developing theory of the world founded upon an expanding knowledge base. Given that knowledge is central to the child's cognitive development, I turned to an examination of the nature of knowledge. The discussion of knowledge drawn from philosophers who have attempted to propose theories of knowledge in answer to the question, "What is knowledge?" Traditional justificationalist theories of knowledge and subsequently developed nonjustificationalist theories were considered. The discussion was focused upon a number of issues which have divided philosophers with respect to their treatment of knowledge in order to highlight the problematic nature of knowledge. Cognitive and developmental psychologists may wish to consider some of these issues and the implications they hold for their theories as they study knowledge and/or invoke knowledge as a part of their theory construction. Some of the implications of the issues were illustrated in a discussion of the relation of knowledge to the developing child's comprehension and production of metaphor.

Child↗

PubMed2002

Growth of medical knowledge.

BACKGROUND: Knowledge is an essential component of medical competence and a major objective of medical education. Thus, the degree of acquisition of knowledge by students is one of the measures of the effectiveness of a medical curriculum. We studied the growth in student knowledge over the course of Maastricht Medical School's 6-year problem-based curriculum. METHODS: We analysed 60 491 progress test (PT) scores of 3226 undergraduate students at Maastricht Medical School. During the 6-year curriculum a student sits 24 PTs (i.e. four PTs in each year), intended to assess knowledge at graduation level. On each test occasion all students are given the same PT, which means that in year 1 a student is expected to score considerably lower than in year 6. The PT is therefore a longitudinal, objective assessment instrument. Mean scores for overall knowledge and for clinical, basic, and behavioural/social sciences knowledge were calculated and used to estimate growth curves. FINDINGS: Overall medical knowledge and clinical sciences knowledge demonstrated a steady upward growth curve. However, the curves for behavioural/social sciences and basic sciences started to level off in years 4 and 5, respectively. The increase in knowledge was greatest for clinical sciences (43%), whereas it was 32% and 25% for basic and behavioural/social sciences, respectively. INTERPRETATION: Maastricht Medical School claims to offer a problem-based, student-centred, horizontally and vertically integrated curriculum in the first 4 years, followed by clerkships in years 5 and 6. Students learn by analysing patient problems and exploring pathophysiological explanations. Originally, it was intended that students' knowledge of behavioural/social sciences would continue to increase during their clerkships. However, the results for years 5 and 6 show diminishing growth in basic and behavioural/social sciences knowledge compared to overall and clinical sciences knowledge, which appears to suggest there are discrepancies between the actual and the planned curricula. Further research is needed to explain this.

Clinical Competence↗

PubMed2003

The role of domain knowledge in automating medical text report classification.

OBJECTIVE: To analyze the effect of expert knowledge on the inductive learning process in creating classifiers for medical text reports. DESIGN: The authors converted medical text reports to a structured form through natural language processing. They then inductively created classifiers for medical text reports using varying degrees and types of expert knowledge and different inductive learning algorithms. The authors measured performance of the different classifiers as well as the costs to induce classifiers and acquire expert knowledge. MEASUREMENTS: The measurements used were classifier performance, training-set size efficiency, and classifier creation cost. RESULTS: Expert knowledge was shown to be the most significant factor affecting inductive learning performance, outweighing differences in learning algorithms. The use of expert knowledge can affect comparisons between learning algorithms. This expert knowledge may be obtained and represented separately as knowledge about the clinical task or about the data representation used. The benefit of the expert knowledge is more than that of inductive learning itself, with less cost to obtain. CONCLUSION: For medical text report classification, expert knowledge acquisition is more significant to performance and more cost-effective to obtain than knowledge discovery. Building classifiers should therefore focus more on acquiring knowledge from experts than trying to learn this knowledge inductively.

Algorithms↗

PubMed1996

Differential influences on asthma self-management knowledge and self-management behavior in acute severe asthma.

AIM: While asthma education increases knowledge, it is less clear whether education influences actual patient behavior. To determine whether there are differences between asthma self-management knowledge and the actual behavior of patients during an acute severe asthma attack and to determine which clinical and psychosocial factors are associated with knowledge and behavior. METHODS: Validated hypothetical scenarios describing the development of life-threatening asthma and patients' reported actual behavior were scored (out of 25) using a system based on Thoracic Society of Australia and New Zealand and British Thoracic Society criteria. RESULTS: In 137 patients admitted to the hospital with severe asthma, the pattern of the index attack was slow onset (> or = 6 h) in 96%. The score for the hypothetical attack (knowledge) was 13.8 +/- 4.6, while that for the timeline (behavior) was 10.2 +/- 3.9 (p < 0.001) with 56% and 84%, respectively, having a score of less than 15 (regarded as inadequate). Certain components showed marked discrepancy (eg, appropriately seeking medical help 82% vs 52% (p < 0.001) and calling ambulance 61% vs 23% (p < 0.001). Factors such as physician-patient relationship, previous asthma morbidity, availability of peak flowmeter, action plan, and oral steroids correlated positively with both measures. Knowledge was negatively associated with being non-European, with anxiety, pessimism, and stigmatization. Behavior (but not knowledge) was negatively associated with lack of knowledge of what to do in the index attack, previous emotional counseling, and business failure. Those factors associated with the difference between knowledge and behavior scores (knowledge-behavior gap) were being non-European, anxiety, pessimism, and stigmatization, concerns about medical costs, and the only income for the household being a Social Security benefit. CONCLUSION: There are marked differences between patients' self-management knowledge and their actual behavior, particularly in terms of potentially life-saving actions. Psychological, health-care, and socioeconomic factors have a powerful and differential influence on knowledge and behavior. Improved understanding of the discrepancies between knowledge and behavior and which factors influence them may lead to more effective asthma educational interventions.

Acute Disease↗

PubMed1990

Knowledge bases in medicine: a review.

Efforts to represent knowledge effectively have been central to progress in various aspects of medical informatics. These efforts range from relatively simple "electronic textbooks" to fairly sophisticated knowledge-based systems, which function as well as, or even better than, human experts faced with similar problems. Knowledge bases have been developed in many fields, but the relatively limited domains and structured language of medicine, as well as the importance of information in the provision of good medical care, have made research in medical knowledge representation an area of intense activity. This paper reviews representative knowledge bases and knowledge-based systems in medicine: electronic textbooks such as PDQ and the Hepatitis Knowledge Base (HKB), rule-based systems such as MYCIN, causal models (e.g., CASNET), and hypothesis- or frame-based systems, exemplified by PIP and INTERNIST-1. The paper describes the relationships among divergent approaches and provides a sense of current and future trends. It examines problems in knowledge-based systems, particularly in knowledge representation and acquisition, and the responses to these challenges. The latter include the use of domain-independent software shells for constructing knowledge bases, the adaptation and use of previously existing knowledge bases, and multiple uses of the same knowledge base for different purposes.

Artificial Intelligence↗

PubMed1990

A method for the acquisition of formalized knowledge in pathology.

A tool is introduced for the acquisition of pathology knowledge in a formalized form, directly by the expert. Formalization of the knowledge is intended to make descriptive pathology knowledge more suitable for computerized diagnostic support since a formal representation of knowledge allows more extensive indexing, hence more flexible access. The knowledge acquisition (KA) tool also provides a useful research instrument to investigate to what extent pathology knowledge can be made explicit, to what degree ambiguity is present, in what way experts differ when formalizing knowledge, and whether it is feasible to incrementally acquire decision criteria on the basis of the formalized descriptive knowledge. Crucial in the design of the KA tool is the incorporated meta-knowledge, which is reflected by the knowledge-base structure and is used to elicit knowledge from the expert. Knowledge is acquired from the expert via a menu-driven user interface, which follows the general steps of the pathologist when describing a case. The paper discusses the considerations underlying the design, the implementation of the KA tool, and the research goals.

Diagnosis, Computer-Assisted↗

PubMed1985

Assessment of medical student fund of knowledge in surgery.

A medical student's fund of knowledge can be assessed by either his demonstrated fund of knowledge on a clinical service or an examination at the completion of the clerkship. During the past 2 years we have evaluated each student's fund of knowledge in two ways: clinical assessment by faculty and residents and performance on the National Board of Medical Examiners Part II Special Surgical Examination given at the end of the surgical clerkship. This study compares the clinical assessment of surgical knowledge for all 100 members of the class of 1984 at the University of Utah with other subjective evaluations such as attitudes and college grade point average and objective measures of performance such as premed MCAT score, Part I National Boards score, and the National Boards Special Surgical Examination. The correlation between clinical assessment of knowledge and the Surgical Examination was 0.23, with a range on individual services from -0.42 to 0.45. There was a higher correlation for the total group of 0.56 between fund of knowledge and attitudes, with a range on individual services of -0.04 to 0.72. The correlations between clinical assessment of knowledge and Part I National Boards, college grade point average, and chemistry MCAT score were 0.23, 0.09, and 0.15, respectively. These results indicate that the clinical assessment of fund of knowledge is not a good predictor of performance on the surgical section of the National Boards. Clinical assessment of fund of knowledge appears to be linked more closely to faculty and resident assessment of student attitudes. There are a couple possible explanations for these results: clinicians are measuring different aspects of knowledge than are National Boards or clinicians do not accurately assess knowledge and confuse attitudes such as interest and enthusiasm with fund of knowledge.

Clinical Clerkship↗

PubMed1997

Dimensions of AIDS knowledge and risky sexual practices: a study of northern Thai males.

The relation between AIDS-related knowledge and sexual risk-taking for a sample of young men living in northern Thailand was examined. Data were collected during the fall of 1991. The sample of 1472 men includes university students, soldiers, store clerks, and laborers. Recent commercial sex patronage was variable among the subgroups, and consistent condom use among these recent patrons was far from universal. Several important misunderstandings among our respondents regarding the AIDS virus were identified. These misconceptions were most common among men of relatively low socioeconomic status (laborers and soldiers). Factor analysis identified four distinct domains of AIDS knowledge among the student and soldier groups: knowledge about the mechanics of contagion, knowledge about the consequences of infection, knowledge about appropriate strategies for avoiding the virus, and knowledge regarding inappropriate strategies for avoiding the virus. In multivariate logistic regression, knowledge about inappropriate strategies and knowledge about contagion were the only two domains predictive of recent commercial sex patronage: Men with a relatively good understanding regarding the inefficacy of inappropriate strategies and the mechanics of contagion had lower odds of recent commercial sex patronage compared with men who had a relatively poor understanding of these domains of AIDS knowledge. In the condom use analysis, knowledge about both appropriate and inappropriate strategies was predictive of consistent condom use among recent commercial sex patrons. Thus programs should attempt to improve knowledge about strategies for avoiding the virus and the mechanics of contagion. Special efforts should be made to debunk existing myths about the perceived effectiveness of inappropriate strategies.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Power and knowledge in psychiatry and the troubling case of Dr Osheroff.

OBJECTIVE: To consider the state of knowledge in psychiatry with reference to the 'Osheroff debate' about the treatment of depression. METHOD: A review of the key philosophical issues regarding the nature of knowledge applied to the Osheroff case. RESULTS: There is an apparent dichotomy between knowledge derived from a reductionist scientific method, as manifest in evidence-based medicine, and that of a narrative form of knowledge derived from clinical experience. The Focauldian notion of knowledge/power and knowledge as discourse suggests that scientific knowledge dominates over narrative knowledge in psychiatry. The implication of this applied to the Osheroff case is the potential annihilation of all forms of knowledge other than science. CONCLUSIONS: Knowledge in psychiatry is a pluralist, rather than singularly scientific enterprise. In the Osheroff case, the potential for scientific knowledge to abolish other forms of knowledge posed a serious threat of weakening the profession. In the light of the current debate about best practice, there is a need for reconsideration of the implications of Osheroff.

Antidepressive Agents, Tricyclic↗