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PubMed2004

Knowledge management in pediatric pain: mapping on-line expert discussions to medical literature.

Clinical decision-making can be vastly improved with the availability of the right medical knowledge at the right time. This concept paper presents a knowledge management re-search program to (a) identify, capture and organize the tacit knowledge inherent within on-line problem-solving discussions between pediatric pain practitioners; (b) establish linkages between topic-specific pediatric pain discussions and corresponding published medical literature on children's pain available at PubMed--i.e. linking tacit expert knowledge to explicit medical literature; and (c) make these knowledge re-sources available to pediatric pain practitioners via the WWW for timely access to various modalities of clinical knowledge.

Artificial Intelligence↗
PubMed1989

Knowledge management as a decision support method: a diagnostic workup strategy application.

We have explored the potential of a computer-based approach called "knowledge management" to aid in clinical problem solving and education. The major features of the approach are its ability to support flexible and immediate access by a user to relevant knowledge and annotation and organization of the knowledge for personal use and subsequent retrieval. We illustrate this approach with its application to diagnostic workup strategy problems. In this application, knowledge may be in the form of static narrative text, diagrams, pictures, graphs, tables, flow charts, or bibliographic citations. Other more dynamic forms of knowledge may be the result of simulations, "what if" analyses or modeling, quantitative mathematical or statistical calculation, or heuristic inference. User assessment has demonstrated the system's ease of use and user perception of its desirability, but underscores the need for a "critical mass" of knowledge before such an approach will be widely utilized.

Decision Support Techniques↗
PubMed2005

Using key performance indicators as knowledge-management tools at a regional health-care authority level.

The advantages of the introduction of information and communication technologies in the complex health-care sector are already well-known and well-stated in the past. It is, nevertheless, paradoxical that although the medical community has embraced with satisfaction most of the technological discoveries allowing the improvement in patient care, this has not happened when talking about health-care informatics. Taking the above issue of concern, our work proposes an information model for knowledge management (KM) based upon the use of key performance indicators (KPIs) in health-care systems. Based upon the use of the balanced scorecard (BSC) framework (Kaplan/Norton) and quality assurance techniques in health care (Donabedian), this paper is proposing a patient journey centered approach that drives information flow at all levels of the day-to-day process of delivering effective and managed care, toward information assessment and knowledge discovery. In order to persuade health-care decision-makers to assess the added value of KM tools, those should be used to propose new performance measurement and performance management techniques at all levels of a health-care system. The proposed KPIs are forming a complete set of metrics that enable the performance management of a regional health-care system. In addition, the performance framework established is technically applied by the use of state-of-the-art KM tools such as data warehouses and business intelligence information systems. In that sense, the proposed infrastructure is, technologically speaking, an important KM tool that enables knowledge sharing amongst various health-care stakeholders and between different health-care groups. The use of BSC is an enabling framework toward a KM strategy in health care.

Greece↗
PubMed2001

Knowledge management of the neuroscientific literature: the data model and underlying strategy of the NeuroScholar system.

This paper describes the underlying strategy and system's design of a knowledge management system for the neuroscientific literature called 'NeuroScholar'. The problem that the system is designed to address is to delineate fully the neural circuitry involved in a specific behaviour. The use of this system provides experimental neuroscientists with a new method of building computational models ('knowledge models') of the contents of the published literature. These models may provide input for analysis (conceptual or computational), or be used as constraint sets for conventional neural modelling work. The underlying problems inherent in this approach, the general framework for the proposed solution, the practical issues concerning usage of the system and a detailed, technical account of the system are described. The author uses a widely used software specification language (the Universal Modelling Language) to describe the design of the system and present examples from published work concerned with classical eyeblink conditioning in the rabbit.

Animals↗
PubMed2004

From SARS to systems: developing advanced knowledge management for public health.

Historically, public health has been at the forefront of data processing applications but it is lagging behind other areas of health care in the application of advanced interconnected and mobile information technologies. Ready to use technologies are lacking not only for the management of emerging infections or bio-terrorism but also for the coordination of prevention and chronic care initiatives. Advanced information and knowledge management for community health should expedite the transfer of research evidence to practice and provide essential logistical support for action. We need to find ways to integrate new scientific knowledge into our environment in order to expedite the translation of research to practice.

Decision Support Techniques↗
PubMed2004

Personal and professional pain experiences and pain management knowledge among Greek nurses.

The purpose of this exploratory study was to describe Greek registered nurses' personal and professional pain experiences and to examine the relationship with their pain management knowledge. Forty-six Greek nurses provided written responses to open-ended questions about their personal and professional experiences with pain and beliefs about suffering. Reporting a personal pain experience was associated with describing a positive professional pain experience, Phi=0.44, p < 0.03. The nurses vividly described their personal and professional pain experiences. One nurse wrote " em leader I begged to lose consciousness, in order not to feel". These compelling accounts might motivate nurses to strengthen their understanding of pain management.

Adaptation, Psychological↗
PubMed2006

Synergy between Competitive Intelligence (CI), Knowledge Management (KM) and Technological Foresight (TF) as a strategic model of prospecting--the use of biotechnology in the development of drugs against breast cancer.

The aim of this paper is to demonstrate the synergy between Competitive Intelligence, Knowledge Management and Technological Foresight, and to emphasize the proposal of a strategic model of data prospecting as a mechanism to support decision-making in regard to three approaches for sustainable development and innovation: technological, social and economic. The use of biotechnology in the development of drugs against breast cancer is the case study. The article shows the results of data and text mining in specialized medical and patent databases, identifying the most frequently cited drugs, as well as the authors of research, and the inventors of new technology at the beginning of the 21st century. In addition, the study includes reference to Brazilian competence in breast cancer area, the international trends in drugs for treatment of this cancer, leading international institutions and Brazilian competencies. A framework is presented, which could serve as a guide and support for the decision-making process.

Biotechnology↗
PubMed2004

Computerized knowledge management in diabetes care.

INTRODUCTION: Many scientific achievements become part of usual diabetes care only after long delays. The purpose of this article is to identify the impact of automated information interventions on diabetes care and patient outcomes and to enable this knowledge to be incorporated into diabetes care practice. METHODS: We conducted systematic electronic and manual searches and identified reports of randomized clinical trials of computer-assisted interventions in diabetes care. Studies were grouped into 3 categories: computerized prompting of diabetes care, utilization of home glucose records in computer-assisted insulin dose adjustment, and computer-assisted diabetes patient education. RESULTS: Among 40 eligible studies, glycated hemoglobin and blood glucose levels were significantly improved in 7 and 6 trials, respectively. Significantly improved guideline compliance was reported in 6 of 8 computerized prompting studies. Three of 4 pocket-sized insulin dosage computers reduced hypoglycemic events and insulin doses. Metaanalysis of studies using home glucose records in insulin dose adjustment documented a mean decrease in glycated hemoglobin of.14 mmol/L (95% confidence interval [CI], 0.11-0.16) and a decrease in blood glucose of.33 mmol/L (95% CI, 0.28-0.39). Several computerized educational programs improved diet and metabolic indicators. DISCUSSION: Computerized knowledge management is becoming a vital component of quality diabetes care. Prompting follow-up procedures, computerized insulin therapy adjustment using home glucose records, remote feedback, and counseling have documented benefits in improving diabetes-related outcomes.

Blood Glucose Self-Monitoring↗
PubMed2003

Knowledge management system for benchmarking performance indicators using statistical process control (SPC) and Virtual Instrumentation (VI).

Healthcare is ever changing environment and with the Joint Commission for the Accreditation of Hospital Organization (JCAHO) emphasis on quality improvement during the past several years, and the cost-focused healthcare reforms of the 1990s, benchmarking with peer comparison, and more recently benchmarking against competitors, has taken on a new emphasis. All acute healthcare organizations accredited by JCAHO now require participation in a program titled ORYX, which is designed to use comparisons with other organizations and promote national benchmarks. The knowledge management system designed assists clinical engineering department to convert vast amounts of available data into information, which is ultimately transformed into knowledge to enable better decision-making. The systems assist in using the data as a comparison tool, to compare the performance internally and also compare performance with peer organizations using the same measures within the same measurement system. Collectively, these applications support better, faster data-driven decisions. This tool provides fast and easy access to financial and quality metrics to clinical engineering department managers, which increases their ability to perform sophisticated analysis to develop accurate models and forecasts, and make timely, data driven decisions. The project also provides a platform by means of which clinical engineering departmental procedures, data, and methods can be assessed and shared among institutions.

Artificial Intelligence↗
PubMed2003

Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system.

Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.

Artificial Intelligence↗
PubMed2003

Designing a knowledge management system for distributed activities: a human centered approach.

In this study we use the principles of distributed cognition and the methodology of human-centered distributed information design to analyze a complex distributed human-computer system, identify its problems, and generate design requirements and implementation specifications of a replacement prototype for effective organizational memory and knowledge management. We argue that a distributed human-computer information system has unique properties, structures and processes that are best described in the language of distributed cognition. Distributed cognition provides researchers a richer theoretical understanding of human-computer interactions and enables re-searchers to capture the phenomenon that emerges in social interactions as well as the interactions between people and structures in their environment.

Artificial Intelligence↗
PubMedDate not supplied

The role of Web agents in medical knowledge management.

The intelligent agent approach offers the promise of remaking a traditional enterprise into a learning organization, one that uses progressive information technology and information strategies to study its outcomes prospectively, to avoid repetition of past errors, and to improve its effectiveness continuously. This paper explores whether agent technology can fulfill this promise in health care, both in a general sense and in terms of knowledge management and performance support. A case study is presented to illustrate some lessons learned and the pitfalls that need to be avoided as the development of agents proceeds.

Artificial Intelligence↗
PubMed2005

Advances in knowledge management for pharmaceutical research and development.

There are two assumptions that are taken for granted in the pharmaceutical industry today. Firstly, that we can generate an unprecedented amount of drug-related information along the research and development (R&D) pipeline, and secondly, that researchers are more connected to each other than they have ever been, owing to the internet revolution of the past 15 years or so. Both of these aspects of the modern pharmaceutical company have brought many benefits to the business. However, the pharmaceutical industry is currently under fire due to allegations of decreased productivity despite significant investments in R&D, which if left to continue at the present pace, will reach almost US 60 billion dollars by 2006. This article explores the role of knowledge in the industry and reviews recent developments and emerging opportunities in the field of knowledge management (KM) as it applies to pharmaceutical R&D. It is argued that systematic KM will be increasingly necessary to optimize the value of preceding advances in high-throughput approaches to R&D, and to fully realize the anticipated increase in productivity. The application of KM principles and practices to the business can highlight opportunities for balancing the current reliance on blockbuster drugs with a more patient-centric focus on human health, which is now becoming possible.

Animals↗
PubMed2005

The Virtual Naval Hospital: the digital library as knowledge management tool for nomadic patrons.

OBJECTIVE: To meet the information needs of isolated primary care providers and their patients in the US Navy, a digital health sciences library, the Virtual Naval Hospital, was created through a unique partnership between academia and government. METHODS: The creation of the digital library was heavily influenced by the principles of user-centered design and made allowances for the nomadic nature of the digital library's patrons and the heterogeneous access they have to Internet bandwidth. RESULTS: The result is a digital library that has been in operation since 1997, continues to expand in size, is heavily used, and is highly regarded by its patrons. CONCLUSIONS: The digital library is dedicated to delivering the right information at the right time to the right person so the right decision can be made, and therefore the Virtual Naval Hospital functions as a knowledge-management system for the US Navy Bureau of Medicine and Surgery.

Health Education↗
PubMed1990

Computers in medical education: information and knowledge management, understanding, and learning.

Desktop computers have evolved to permit physicians in practice and/or training to access and manage information to enhance knowledge, understanding, and learning. There are compelling reasons why the personal computer is key to learning and important in medical education. Above all, the computer enhances and amplifies the learning process. Using the desktop computer effectively is relatively easy. We teach our students to research information in books and journals and hope that, as practicing physicians, they do it even more to be current and maintain their competency. Why not a desktop computer to access and manage information, analyze it, and present findings? Computer technology is available to do virtually all of these tasks. Some tools are critical for medical students. For some time, all medical students have needed a black bag and microscope. Now every medical student needs a computer. Ample courseware is available and expanding rapidly for basic sciences and clinical disciplines. The explosion in biomedical information will continue. Finding information is key to understanding and learning rather than depending solely on memory, recall, or library trips for information. The desktop computer will benefit students, faculty, and future physicians and other health professionals as life-long learners.

Artificial Intelligence↗
PubMedDate not supplied

Self-management, knowledge, and functioning and well-being of patients on hemodialysis.

Past research suggests that patients' self-management behavior and knowledge about their condition/treatment may impact functioning and well-being. Specific self-management activities used by patients on hemodialysis have included cooperative/participatory and protective/proactive strategies. In this cross-sectional study, measures of self-management and knowledge were administered to 372 patients on hemodialysis-from 17 dialysis facilities. Findings suggest that the patients studied were low self-managers. The most commonly used self-management strategies were the cooperative/participatory activities of self-care during hemodialysis and shared responsibility in care. Multiple linear regression showed self-care during hemodialysis to be positively associated with physical functioning, measured by the SF-12 Physical Component Summary (PCS-12) scale. Age, diabetes, and two protective/proactive strategies (selective symptom management and assertive self-advocacy) were negatively associated with the PCS-12. Selective symptom management was also negatively associated with mental health functioning measured by the SF-12 Mental Component Summary (MCS-12), whereas patient knowledge of kidney disease/treatment was positively associated with the MCS-12. Because past research has shown the SF-36 PCS and the MCS scores to be associated with mortality and hospitalizations, using cooperative/participatory self-management behaviors, minimizing the need for protective/proactive strategies, and increasing patients' knowledge of kidney disease may have long-term benefits.

Cross-Sectional Studies↗