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PubMed2002

An intelligent biological information management system.

MOTIVATION: As biomedical researchers are amassing a plethora of information in a variety of forms resulting from the advancements in biomedical research, there is a critical need for innovative information management and knowledge discovery tools to sift through these vast volumes of heterogeneous data and analysis tools. In this paper we present a general model for an information management system that is adaptable and scalable, followed by a detailed design and implementation of one component of the model. The prototype, called BioSifter, was applied to problems in the bioinformatics area. RESULTS: BioSifter was tested using 500 documents obtained from PubMed database on two biological problems related to genetic polymorphism and extracorporal shockwave lithotripsy. The results indicate that BioSifter is a powerful tool for biological researchers to automatically retrieve relevant text documents from biological literature based on their interest profile. The results also indicate that the first stage of information management process, i.e. data to information transformation, significantly reduces the size of the information space. The filtered data obtained through BioSifter is relevant as well as much smaller in dimension compared to all the retrieved data. This would in turn significantly reduce the complexity associated with the next level transformation, i.e. information to knowledge.

Abstracting and Indexing↗

PubMed1995

Physician knowledge and attitudes about cancer pain management: a survey from the Minnesota cancer pain project.

The purposes of the study were to determine the knowledge and attitudes about cancer pain management (CPM) among practicing physicians in six Minnesota communities and to determine the physician-related barriers to optimal CPM. Eligible community physicians were surveyed by telephone. The study analyzed responses of 145 physicians (response rate, 87%). The majority of the physicians were primary care specialists (73%). Significant knowledge deficits were identified in nine of 14 CPM principles, but inappropriate attitudes were found in only two of nine CPM concepts. Medical specialty had the strongest influence on knowledge and attitudes, with primary care physicians having significantly better outcomes than surgeons or medical subspecialists. Effective education strategies must address knowledge deficits, attitudes, and motivations of the relevant peer group influencing physicians, as well as those of individual physicians. The Minnesota Cancer Pain Project is testing strategies to enhance CPM by physicians and improve patient outcomes.

Clinical Competence↗

PubMed2002

Predictive microbiology: providing a knowledge-based framework for change management.

This contribution considers predictive microbiology in the context of the Food Micro 2002 theme, "Microbial adaptation to changing environments". To provide a reference point, the state of food microbiology knowledge in the mid-1970s is selected and from that time, the impact of social and demographic changes on microbial food safety is traced. A short chronology of the history of predictive microbiology provides context to discuss its relation to and interactions with hazard analysis critical control point (HACCP) and risk assessment. The need to take account of the implications of microbial adaptability and variable population responses is couched in terms of the dichotomy between classical versus quantal microbiology introduced by Bridson and Gould [Lett. Appl. Microbiol. 30 (2000) 95]. The role of population response patterns and models as guides to underlying physiological processes draws attention to the value of predictive models in development of novel methods of food preservation. It also draws attention to the paradox facing today's food industry that is required to balance the "clean, green" aspirations of consumers with the risk, to safety or shelf life, of removing traditional barriers to microbial development. This part of the discussion is dominated by consideration of models and responses that lead to stasis and inactivation of microbial populations. This highlights the consequence of change on predictive modelling where the need is now to develop interface and non-thermal death models to deal with pathogens that have low infective doses for general and/or susceptible populations in the context of minimal preservation treatments. The challenge is to demonstrate the validity of such models and to develop applications of benefit to the food industry and consumers as was achieved with growth models to predict shelf life and the hygienic equivalence of food processing operations.

Bacteria↗

PubMed2002

Does prior training and staff occupation influence knowledge acquisition from an aggression management training program?

Aggression management training has become mandatory for mental health staff in New South Wales, Australia. This study explores the differential effects of knowledge acquisition following a 2-day intensive training program for 103 mental health staff comprising three groups: (i) nurses, (ii) allied and medical staff, and (iii) ancillary staff. All occupations had significant knowledge gains following training, although knowledge acquisition was less for staff with prior training than for those without. Results suggest previously trained staff would be better suited to shorter, more frequent, on ward skills-based refresher training.

Aggression↗

PubMedDate not supplied

Utilization management and healthcare reform.

The reform movement in healthcare is occurring in response to financial pressures on American business. The trend toward managed care with competition-based discounting and capitation contracts is likely to continue even if Congress does not enact healthcare reform legislation. Efficient management of resources with acceptable outcomes and customer satisfaction is becoming increasingly crucial. As cost-shifting options are reduced, accurate knowledge and management of resource consumption costs become critical to enable hospitals to assume the financial risks associated with competing in any future capitation area. Hospitals must consider altering their approach to utilization management and business as usual to survive these changes.

Cost Control↗

PubMed1994

ISWAC: proposed system for the integrated assembly of chromosomes.

The generation of a physical map as an integral part of sequence project management is a problem that present computer systems do not address. Primarily, the analysis performed is based solely on the information available from a single knowledge level. Management systems that are currently available do not adequately model the multi-layer top down strategy that is most often utilized to manage large scale sequencing projects. Single layered approaches reflect an algorithmic inadequacy since interacting data sets are required to provide a good solution. The analysis tool that is currently under development termed ISWAC, the Integrated System for Wholistic Assembly of Chromosomes, overcomes these limitations by integrating information available from five layers of knowledge. These knowledge layers utilize information from the linkage map, physical map, restriction map, clone strategy map and the DNA sequence itself. The approach we are implementing, reviews current project status and continually refines the experimental strategy necessary to efficiently complete the sequencing task. To facilitate project completion the system is designed to interactively recommend strategies based on partial information. The utility of this tool is enhanced by implementing knowledge representation techniques that allow reasoning with approximate concepts characteristic of these data-sets. In addition, the raw physical data is maintained within an integrated map database to ease data verification. This paper presents the first discussion of the design specifications for a computer system to assimilate the various forms of data that are being generated as part of the human genome project. It was specifically written to stimulate discussion regarding data standardization, translation, analysis and most important, an understandable user-interphase for the molecular biologist. We would hope that interested readers would respond by assisting in the definition of a set of universal data standards and adopting them in their laboratories.

Algorithms↗

PubMed1989

An approach to occupational health risk management for a diversified international corporation.

A risk management program is presented which is effective in handling occupational health risks in a diversified multinational corporation. The three-step program of plant reviews involves initial assessment visits designed to determine the compliance status and degree of sophistication of the occupational health program. These assessments are followed by more formal assurance reviews which include consultation, training, and program support. Finally, formal surveillance reviews are conducted to verify compliance with respect to company and regulatory agency requirements. Each type of review requires planning and adherence to a standardized process to allow comparability of the information generated. Critical elements of this approach include senior management support, knowledge of applicable regulations, and communication of results. Reporting is done on several levels and is designed to communicate relevant information to management from line supervisors to the board of directors. Corrective action, where indicated, is planned by local managers with assistance from other groups as required. Corrective action plan implementation is tracked in conjunction with other mechanisms of occupational health and medical services to assure effective management of these risks.

Environmental Monitoring↗

PubMed1989

Cleft lip and palate and related disorders: issues for future research of high priority.

On October 14 to 17, 1987, a meeting entitled "State of the Art Conference: Multidisciplinary Management of Cleft Lip and Palate" was held in Iowa City. The major purpose of the conference was to review the available knowledge concerning management of unilateral cleft lip and palate from the perspectives of surgery, speech-language pathology, and orthodontics. The closing feature of the conference was the identification of issues for future research. Participants identified issues of high priority that were then discussed by the entire conference faculty. This paper reports the summary of that discussion and the recommendations of the Conference.

Cleft Lip↗

PubMed2002

Why study pain? A qualitative analysis of medical and nursing faculty and students' knowledge of and attitudes to cancer pain management.

Although effective means for pain management have long been available, cancer pain remains widely undertreated. Surveys of medical personnel have revealed knowledge deficits and attitudinal barriers to pain management, but have not determined why such attitudes persist and how they may be addressed in medical and nursing curricula. This paper presents findings from a qualitative study of the beliefs and attitudes toward pain and cancer pain management held by medical and nursing students and faculty who participated in the Cancer Education Module for the Management of Pain (CEMMP) project. Analysis centered on informants' prioritization and knowledge of pain and cancer pain management and on the meanings informants assigned to pain in a clinical context. Themes in prioritization included the importance of learning about pain versus cancer pain and the responsibility of primary care providers versus specialists for pain and cancer pain management. Themes in informants' knowledge of pain included knowledge deficits about medications and adjunct therapies and the presence of pain management in the curriculum, and the role of knowledgeable faculty members and mentors in the dissemination of information about pain management. Themes in the meanings informants' assigned to pain included opioidphobia, and the (inter-)subjectivity of pain. The discussion focuses in particular on tensions within the prioritization, knowledge and meanings of pain that must be resolved before students can be appropriately educated for optimal pain management.

Attitude of Health Personnel↗

PubMed2006

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management.

Heart failure remains a common diagnosis, especially in older individuals. It continues to be associated with significant morbidity and mortality, but major advances in both diagnosis and management have occurred and will continue to improve symptoms and other outcomes in patients. The Canadian Cardiovascular Society published its first consensus conference recommendations on the diagnosis and management of heart failure in 1994, followed by two brief updates, and reconvened this consensus conference to provide a comprehensive review of current knowledge and management strategies. New clinical trial evidence and meta-analyses were critically reviewed by a multidisciplinary primary panel who developed both recommendations and practical tips, which were reviewed by a secondary panel. The resulting document is intended to provide practical advice for specialists, family physicians, nurses, pharmacists and others who are involved in the care of heart failure patients. Management of heart failure begins with an accurate diagnosis, and requires rational combination drug therapy, individualization of care for each patient (based on their symptoms, clinical presentation and disease severity), appropriate mechanical interventions including revascularization and devices, collaborative efforts among health care professionals, and education and cooperation of the patient and their immediate caregivers. The goal is to translate best evidence-based therapies into clinical practice with a measureable impact on the health of heart failure patients in Canada.

Canada↗

PubMed1989

The librarian as consultant and educator for personal file management software.

Librarians are encouraged to extend their information managing skills to include familiarity with personal file management software. Knowledge of automated solutions to overgrown manual reprint files can be valuable to the institution that a librarian serves. The capabilities of REFERENCE MANAGER, PRO-CITE, ASKSAM, and SCI-MATE are compared in a series of classes given for faculty and staff by the Medical College of Wisconsin Libraries reference staff.

Consultants↗

PubMed2006

Impact of an education campaign on management in pregnancy of women infected with a blood-borne virus.

OBJECTIVE: To assess obstetricians' antenatal screening practice for blood-borne viruses (HIV, hepatitis B and C viruses [HBV and HCV]) and knowledge about management during labour and risk of transmission via breastfeeding for infected women after an educational intervention, Australia. DESIGN: Cohort study, with surveys before and after an educational intervention. SETTING AND PARTICIPANTS: Survey 1 was mailed in 2002-2003 to all 767 Fellows registered with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and Survey 2 was mailed in 2004 to the 743 of these Fellows who were still practising. INTERVENTION: Multifaceted intervention with mail-out of survey results and a summary of recommended management, publication of two review articles in the RANZCOG journal, and an oral presentation at the RANZCOG annual scientific meeting. MAIN OUTCOME MEASURES: Self-reported frequency of antenatal screening for blood-borne viruses, change in practice based on a woman's infection status, and advice given about risk of virus transmission via breastfeeding in Survey 2, compared with Survey 1. RESULTS: Survey 2 (response rate, 68%) found increases from the previous survey in the proportion of respondents reporting they always offered antenatal screening for HIV, from 51% to 59%, and for HCV, from 60% to 69% (P = 0.001 for both). For women with HIV infection, the proportion of respondents always recommending elective caesarean section increased from 37% to 49% (P = 0.001) and always avoiding rupture of membranes increased from 33% to 49% (P < 0.001). The proportion who reported advising (incorrectly) that breastfeeding is associated with increased risk of transmission to the infant decreased from 34% to 25% for HBV (P = 0.01) and from 47% to 39% for HCV (P = 0.03). CONCLUSION: The frequency of antenatal testing for HIV and HCV is increasing in Australia. Knowledge about interventions to reduce mother-to-child transmission of HIV and knowledge of the risk of HBV and HCV transmission via breastfeeding improved after a relatively simple educational intervention.

Australia↗

PubMed2004

Readiness to implement Hazard Analysis and Critical Control Point (HACCP) systems in Iowa schools.

OBJECTIVE: To evaluate current food-handling practices, food safety prerequisite programs, and employee knowledge and food safety attitudes and provide baseline data for implementing Hazard Analysis and Critical Control Point (HACCP) systems in school foodservice. DESIGN: One member of the research team visited each school to observe food-handling practices and assess prerequisite programs using a structured observation form. A questionnaire was used to determine employees' attitudes, knowledge, and demographic information. SUBJECTS/SETTING: A convenience sample of 40 Iowa schools was recruited with input from the Iowa Department of Education. STATISTICAL ANALYSES: Descriptive statistics were used to summarize data. One-way analysis of variance was used to assess differences in attitudes and food safety knowledge among managers, cooks, and other foodservice employees. Multiple linear regression assessed the relationship between manager and school district demographics and the food safety practice score. RESULTS: Proper food-handling practices were not being followed in many schools and prerequisite food safety programs for HACCP were found to be inadequate for many school foodservice operations. School foodservice employees were found to have a significant amount of food safety knowledge (15.9+/-2.4 out of 20 possible points). School districts with managers (P=.019) and employees (P=.030) who had a food handler certificate were found to have higher food safety practice scores. APPLICATIONS/CONCLUSIONS: Emphasis on implementing prerequisite programs in preparation for HACCP is needed in school foodservice. Training programs, both basic food safety such as ServSafe and HACCP, will support improvement of food-handling practices and implementation of prerequisite programs and HACCP.

Adolescent↗

PubMed2005

Oral Hygiene and dental student's knowledge, attitude and behaviour in managing HIV/AIDS patients.

The human immunodeficiency virus (AIDS) and the acquired immunodeficiency syndrome (AIDS) have profoundly affected every aspect of the public health sector. The possibility of HIV transmission in the oral health care setting is very rare. Nonetheless, the oral health care environment has become a helpful setting for early detection, as most lesions of HIV infection present orally during the first stages of the disease. Willingness to treat patients with HIV/AIDS appears to be related to knowledge of the disease process, its oral manifestations and modes of transmission, thus influencing health workers' attitudes and behaviour towards management of HIV/AIDS patients. This study assessed the level of management of HIV/AIDS patients amongst dental and oral hygiene students at the University of the Western Cape Dental faculty. Student's knowledge of HIV/AIDS, their behaviour and attitude in treating HIV/AIDS patients, the precautionary measures practiced and their perceptions of curriculum preparation on HIV/AIDS were assessed. Data were collected by means of a self- administered questionnaire. The results indicated that students' knowledge on HIV/AIDS generally increased as they progressed throughout their curriculum but their utilization of all barrier techniques for infection control and clinical protocol, lacked consistency and compliance. Given the fact that the possibility of transmission of HIV/AIDS does exist within the dental setting, it is important that supervisors reinforce universal precautions. Clinical application of these precautions has a direct impact on the spread of the disease.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Home healthcare nursing in the managed care environment. Part I. Managed care: and overview.

Dramatic changes in the provision of healthcare from fee-for-service to managed care have had a definitive impact on consumers as well as providers. As providers and recipients of healthcare, home care nurses must be knowledgeable about managed care and Health Maintenance Organizations (HMOs): This article, part 1 of a two-part series, discusses the tenets of managed care and the different types of HMOs. Part 2, in next month's issue, discusses the historic background of home care and home care nurses perceptions of the impact that managed care has on clients and the practice of home care nursing.

Community Health Nursing↗

PubMed1987

Attitudes and knowledge of nursing staff in relation to management of postoperative pain.

The effectiveness of pain control following surgery is notoriously difficult to assess, but objective assessment by nursing staff has been found to correlate reasonably well with subjective patient assessment. A study was designed to investigate the attitudes and knowledge of 86 qualified nursing staff in relation to postoperative pain management. Overall knowledge was sound to a point, but there were some obvious deficiencies in practical application; for example, 25% of staff would wait until a patient was in severe pain before using a prescribed (charted) analgesic. Additionally, almost three-quarters of staff felt that, in general, postoperative patients received adequate pain relief, while the great majority felt that prescription writing could be improved, mainly by improved legibility and clarity of actual instructions. The results suggest that the aim of postoperative pain management--that is, the provision of adequate analgesia--may need to be more strongly defined in nursing education.

Analgesics, Opioid↗

PubMed1994

General practitioners' knowledge of and attitudes to the management of hypertension in elderly patients.

BACKGROUND: It is not known whether the results from randomized controlled trials influence general practitioners' knowledge of and attitudes to clinical practice. AIM: This study set out to assess general practitioners' knowledge of and attitudes to the management of hypertension in patients aged 65 years and over after the publication of three randomized controlled trials. METHOD: A cross-sectional survey of principals in general practice was undertaken using a self-administrated questionnaire. The study was confined to 35 randomly selected general practices whose patient catchment area lay within the boundary of Northamptonshire Family Health Services Authority. A total of 92 general practitioners from 27 practices responded. The main outcome measures were: the reported use of a protocol to manage elderly patients with hypertension; method and frequency of blood pressure measurement; influence of patients' age on diagnosing and initiating treatment of hypertension; and use of non-pharmacological and pharmacological therapies. RESULTS: Eighty four per cent of the general practitioners reported starting treatment only after measuring blood pressure on three separate occasions; 99% measured blood pressure with the patient seated while 29% also measured blood pressure while the patient was standing. Half of the respondents reported treating patients with isolated systolic hypertension once systolic blood pressure exceeded 179 mmHg. All the general practitioners reported recommending non-pharmacological treatment prior to drug therapy; 83% would use a diuretic as their drug of first choice. CONCLUSION: It appears that despite the publication of several sets of guidelines for the management of hypertension in elderly people, based on randomized controlled trials, there is still considerable variation in the knowledge and attitudes of general practitioners. However, compared with a previous survey in Leicestershire in 1991, the general practitioners in this study reported a lower blood pressure threshold for initiating treatment of elevated blood pressure in elderly patients, including those with isolated systolic hypertension, which may in part be attributed to the introduction of the guidelines.

Aged↗

PubMed1988

Surgical management of tracheal strictures.

Tracheal strictures are complications of prolonged endotracheal intubation or tracheostomy. Successful management requires knowledge of tracheal anatomy, principles of anesthesia, and principles of tracheal surgery. Strictures involving up to one half of the adult trachea can be successfully managed by resection and primary anastomosis in over 90 per cent of the patients.

Anesthesia↗