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PubMed1999

A study of PROforma, a development methodology for clinical procedures.

Knowledge engineering has shown that besides the general methodologies from software engineering it is useful to develop special purpose methodologies for knowledge based systems (KBS). PROforma is a newly developed methodology for a specific type of knowledge based systems. PROforma is intended for decision support systems and in particular for clinical procedures in the medical domain. This paper reports on an evaluation study of PROforma, and on the trade-off that is involved between general purpose and special purpose development methods in Knowledge Engineering and Medical AI. Our method for evaluating PROforma is based on re-engineering a realistic system in two methodologies: the new and special purpose KBS methodology PROforma and the widely accepted, and more general KBS methodology CommonKADS. The four most important results from our study are as follows. Firstly, PROforma has some strong points which are also strong related to requirements of medical reasoning. Secondly, PROforma has some weak points, but none of them are in any way related to the special purpose nature of PROforma. Thirdly, a more general method like CommonKADS works better in the analysis phase than the more special purpose method PROforma. Finally, to support a complementary use of the methodologies, we propose a mapping between their respective languages.

Artificial Intelligence↗
PubMedDate not supplied

Managing knowledge workers in clinical systems.

In Future Work, Coates and colleagues cite seven forces that are reshaping work and the workforce. One is the advent of "knowledge workers," who gather, distribute, and add value to information. In health care, the transition to integrated delivery systems, replete with care plans, critical paths, and assessment of clinical outcomes supported by information technology, is driving the need to reeducate for a knowledge-based workforce. Managers of clinical systems need to be familiar with the characteristics of knowledge workers affecting the delivery environment, organizational structure, and culture of an organization. These same managers will be expected to develop strategies to manage the transition to a knowledge-based workforce.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

[Gender based violence: knowledge and attitudes of health care providers in Nicaragua].

OBJECTIVE: To assess the knowledge and attitudes of health care personnel towards the identification and referral of gender-based violence victims (GBV). Also, to identify barriers to identification and referral of GBV, and to assess the levels of knowledge about Norms and Procedures for Intra-Family Violence Care by the health care personnel of the Nicaraguan's Minister of Health (MINSA, for its initials in Spanish). MATERIAL AND METHODS: A cross-sectional study was conducted among healthcare professionals, including physicians, nurses and nursing technical aides (n=213), in 5 of the 17 Local Systems of Integral Attention (SILAIS) from the Integral Program of Attention for Women, Children and Adolescence (AIMNA) in the primary level of attention in MINSA, from April to June 2003. Attitude was measured with a Likert scale and an awareness index was created for intra-family violence care guidelines. The information was obtained using a self-administered instrument, based on the questionnaire of the study made among the personnel of the Mexican Institute for Social Security (IMSS, for its initials in Spanish), Morelos, Mexico. A logistic regression model was used to evaluate the association between attitude and several factors, as well as with the knowledge of care guidelines. RESULTS: In our population, 76.06% showed an attitude opposing GBV. In the multivariate analysis, the factors associated with opposition to GBV were: medical profession (OR 6.5, 95%CI 2.70-15.82), having a middle (OR 4.3, 95%CI 1.87-10.26) or high level (OR 3.3, 95%CI 1.03-10.75) of knowledge about intra-family violence guidelines and the closeness to relatives or friends who were victims of gender violence (OR 3.2, 95%CI 1.56-6.80). The lack of training on the subject (59.9%), fear of getting involved in legal issues (52.6%), and the concept that violence is a private affair and not a social one (50.7%), constituted the most important barriers to providing medical care. CONCLUSIONS: The health care personnel generally were observed to have high values in regard to an attitude of rejection towards GBV. However, we found barriers that show persisting traditional beliefs, such as considering violence to be a personal issue. Therefore, in order, to ensure a substantial improvement, better training about this subject is needed in medical school curricula with an emphasis on the gender perspective. The finding of the present study will allow improvements in health care reforms at the first level of care in the health sector in Nicaragua.

Adolescent↗
PubMed1987

Telephone assessment of parents' knowledge of home-care treatments and readmission outcomes for high-risk infants and toddlers.

Medical technology is enabling many high-risk infants and toddlers to be cared for at home. However, techniques for evaluation of home-care and discharge-planning outcomes have not been well documented. Using 60 subjects, we performed telephone assessment of home-care givers' knowledge base in basic knowledge of treatment, operation and maintenance of supplies and equipment, and vendor information, using standard questions, 48 hours following discharge from the hospital. Families giving apnea monitoring or Broviac catheter care as a single treatment scored 100% in all three areas. However, the scores for care givers providing gastrostomy care (54%, 100%, and 91%), tracheostomy care (80%, 70%, and 50%), or total parenteral nutrition (88%, 50%, and 100%) as single treatments were lower. Care givers providing multiple home-care treatments had the lowest scores (65%, 65%, and 76%). However, care givers of patients who were subsequently readmitted scored well (80%, 85%, and 85%), and none of the readmissions were due to a failure of home-care management. Telephone assessment 48 hours after discharge can be used to document home-care and discharge-planning outcomes for high-risk infants and toddlers.

Evaluation Studies as Topic↗
PubMed2003

How well can we predict native contacts in proteins based on decoy structures and their energies?

One strategy for ab initio protein structure prediction is to generate a large number of possible structures (decoys) and select the most fitting ones based on a scoring or free energy function. The conformational space of a protein is huge, and chances are rare that any heuristically generated structure will directly fall in the neighborhood of the native structure. It is desirable that, instead of being thrown away, the unfitting decoy structures can provide insights into native structures so prediction can be made progressively. First, we demonstrate that a recently parameterized physics-based effective free energy function based on the GROMOS96 force field and a generalized Born/surface area solvent model is, as several other physics-based and knowledge-based models, capable of distinguishing native structures from decoy structures for a number of widely used decoy databases. Second, we observe a substantial increase in correlations of the effective free energies with the degree of similarity between the decoys and the native structure, if the similarity is measured by the content of native inter-residue contacts in a decoy structure rather than its root-mean-square deviation from the native structure. Finally, we investigate the possibility of predicting native contacts based on the frequency of occurrence of contacts in decoy structures. For most proteins contained in the decoy databases, a meaningful amount of native contacts can be predicted based on plain frequencies of occurrence at a relatively high level of accuracy. Relative to using plain frequencies, overwhelming improvements in sensitivity of the predictions are observed for the 4_state_reduced decoy sets by applying energy-dependent weighting of decoy structures in determining the frequency. There, approximately 80% native contacts can be predicted at an accuracy of approximately 80% using energy-weighted frequencies. The sensitivity of the plain frequency approach is much lower (20% to 40%). Such improvements are, however, not observed for the other decoy databases. The rationalization and implications of the results are discussed.

Algorithms↗
PubMed1999

Virtual management of radiology examinations in the virtual radiology environment using common object request broker architecture services.

In the Department of Defense (DoD), US Army Medical Command is now embarking on an extremely exciting new project--creating a virtual radiology environment (VRE) for the management of radiology examinations. The business of radiology in the military is therefore being reengineered on several fronts by the VRE Project. In the VRE Project, a set of intelligent agent algorithms determine where examinations are to routed for reading bases on a knowledge base of the entire VRE. The set of algorithms, called the Meta-Manager, is hierarchical and uses object-based communications between medical treatment facilities (MTFs) and medical centers that have digital imaging network picture archiving and communications systems (DIN-PACS) networks. The communications is based on use of common object request broker architecture (CORBA) objects and services to send patient demographics and examination images from DIN-PACS networks in the MTFs to the DIN-PACS networks at the medical centers for diagnosis. The Meta-Manager is also responsible for updating the diagnosis at the originating MTF. CORBA services are used to perform secure message communications between DIN-PACS nodes in the VRE network. The Meta-Manager has a fail-safe architecture that allows the master Meta-Manager function to float to regional Meta-Manager sites in case of server failure. A prototype of the CORBA-based Meta-Manager is being developed by the University of Arizona's Computer Engineering Research Laboratory using the unified modeling language (UML) as a design tool. The prototype will implement the main functions described in the Meta-Manager design specification. The results of this project are expected to reengineer the process of radiology in the military and have extensions to commercial radiology environments.

Algorithms↗
PubMed1987

Psyxpert: an expert system prototype for aiding psychiatrists in the diagnosis of psychotic disorders.

Psyxpert is an expert computer system prototype designed to aid psychiatrists in the diagnosis of mental disorders, in cases where psychotic features are the prominent part of the presenting clinical picture. The knowledge base contains psychiatric knowledge in the form of production rules. The system uses a backward-chaining control strategy to guide the consultation. Psyxpert provides a menu-driven user interface and an explanation subsystem. The system uses certainty and importance measures to produce a diagnosis with an attached certainty factor and recommendations for further evaluation or therapy. Psyxpert is written in Virginia Tech HC Prolog and runs on Digital Equipment Corporation's VAX 11/780 under the VMS operating system.

Computer Systems↗
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↗
PubMedDate not supplied

Design methods and architectural issues of integrated medical image data base systems.

The past 20 years have seen tremendous changes in medical imaging techniques. New modalities and protocols are expanding the available digital image data at a rapid rate. Yet a framework for gathering, managing, and using multimodal image information is an integrated database environment is missing. The purpose of this paper is to present the experience of implementing an integrated medical image database system at UCSF. We discuss the general system architecture, software design methods, and specific database tools and illustrate them with application examples. Two immediate issues conforming the building of medical image database systems are: lack of supporting infrastructure and inability to index images by contest. To circumvent these problems, the evolutionary medical image database system being implemented at UCSF is based on a three-tiered client-server architecture: client medical workstations, database application servers, and a hospital-integrated picture archiving and communication system (HIP-PACS). The approach used to integrate content-based retrieval and knowledge base techniques within the existing HI-PACS to make the whole database system useful in medicine.

Adult↗
PubMed2003

The Newell Test for a theory of cognition.

Newell (1980; 1990) proposed that cognitive theories be developed in an effort to satisfy multiple criteria and to avoid theoretical myopia. He provided two overlapping lists of 13 criteria that the human cognitive architecture would have to satisfy in order to be functional. We have distilled these into 12 criteria: flexible behavior, real-time performance, adaptive behavior, vast knowledge base, dynamic behavior, knowledge integration, natural language, learning, development, evolution, and brain realization. There would be greater theoretical progress if we evaluated theories by a broad set of criteria such as these and attended to the weaknesses such evaluations revealed. To illustrate how theories can be evaluated we apply these criteria to both classical connectionism (McClelland & Rumelhart 1986; Rumelhart & McClelland 1986b) and the ACT-R theory (Anderson & Lebiere 1998). The strengths of classical connectionism on this test derive from its intense effort in addressing empirical phenomena in such domains as language and cognitive development. Its weaknesses derive from its failure to acknowledge a symbolic level to thought. In contrast, ACT-R includes both symbolic and sub-symbolic components. The strengths of the ACT-R theory derive from its tight integration of the symbolic component with the sub-symbolic component. Its weaknesses largely derive from its failure, as yet, to adequately engage in intensive analyses of issues related to certain criteria on Newell's list.

Adaptation, Psychological↗
PubMedDate not supplied

Drug-like index: a new approach to measure drug-like compounds and their diversity.

Combinatorial organic synthesis (combinatorial chemistry or CC) and ultrahigh-throughput screening (UHTS) are speeding up drug discovery by increasing capacity for making and screening large numbers of compounds. However, a key problem is to select the smaller set of "representative" compounds from a virtual library to make or screen. Our approach is to select drug-like as well as structurally diverse compounds. The compounds, which are not very drug-like, are less taken into account or excluded even if they contribute to the diversity of the collection. Hence, the first step in the compound selection is to rank compounds in drug-like "degree". To quantify the drug-like "degree", drug-like index (DLI) is introduced in this paper. A compound's DLI is calculated based upon the knowledge derived from known drugs selected from Comprehensive Medicinal Chemistry (CMC) database. The paper describes the way of this knowledge base is formed and the procedure for selecting drug-like compounds.

Algorithms↗
PubMedDate not supplied

RECAP--retrosynthetic combinatorial analysis procedure: a powerful new technique for identifying privileged molecular fragments with useful applications in combinatorial chemistry.

The use of combinatorial chemistry for the generation of new lead molecules is now a well established strategy in the drug discovery process. Central to the use of combinatorial chemistry is the design and availability of high quality building blocks which are likely to afford hits from the libraries that they generate. Herein we describe "RECAP" (Retrosynthetic Combinatorial Analysis Procedure), a new computational technique designed to address this building block issue. RECAP electronically fragments molecules based on chemical knowledge. When applied to databases of biologically active molecules this allows the identification of building block fragments rich in biologically recognized elements and privileged motifs and structures. This allows the design of building blocks and the synthesis of libraries rich in biological motifs. Application of RECAP to the Derwent World Drug Index (WDI) and the molecular fragments/ building blocks that this generates are discussed. We also describe a WDI fragment knowledge base which we have built which stores the drug motifs and mention its potential application in structure based drug design programs.

Artificial Intelligence↗
PubMed2000

Clinical effectiveness in the post-anaesthesia care unit: how nursing knowledge contributes to achieving intended patient outcomes.

Clinical effectiveness in the post-anaesthesia care unit: how nursing knowledge contributes to achieving intended patient outcomes This paper reports part of an ongoing study on how nursing knowledge develops in practice and influences patient outcomes. The practice focus is post-anaesthesia nursing, an area which has been under-represented in nursing research. A qualitative approach was used to explore narrative data, collected by in-depth interviews, with 32 experienced post-anaesthesia nurses. Data analysis and interpretation were informed by a phenomenological perspective consistent with a research focus on individual experiences. Interpretation of the narratives gave rise to a description of knowledge development which occurred as nurses gained experience, drew on the available knowledge base, and used knowledge in practice. This led to the identification and description of 'referential' and 'effective' types of knowledge. Referential knowledge comprises the variety of external knowledge sources available to inform practice. When referential knowledge was incorporated into the personal knowledge of the individual nurse in everyday practice, it was transformed into effective knowledge which was used by nurses to achieve desired patient outcomes. The study findings indicate that nurses used effective knowledge as evidence for decision making and interventions in everyday practice. The key finding of the study is that effective nursing knowledge requires practice for its development.

Anesthesia↗
PubMed2002

Being in a fragmented and isolated world: interviews with carers working with a person with a severe autistic disorder.

AIM: To illuminate the meaning of being a carer for a person with a severe autistic disorder. BACKGROUND: Carers working with people with severe autism are occasionally exposed to residents' self-injurious behaviours and violent actions and at time residents appear resistant to all forms of treatment. DESIGN/METHOD: A qualitative case study was conducted. Six Swedish carers enrolled nurses (ENs), working on a special ward in a nursing home were interviewed about their lived experiences when caring for an individual with a severe autistic disorder. Narrative interviews were conducted and interpreted using a phenomenological-hermeneutic method inspired by Paul Ricoeur. FINDINGS: Two themes were formulated which describe the carers' reality and their dream of an ideal. This ideal described carers' experiences of being trapped in a segmented and isolated care reality and their longing to achieve a sense of wholeness. The findings were interpreted and reflected on in the light of a framework inspired by the German philosopher Karl Jaspers in order to achieve a deeper understanding of the text. CONCLUSIONS: In their desperation, the carers used their empirical knowledge based on scientific knowledge, which could be understood as a substitute for their vision of a consolating wholeness. This paper shows that searching for a substitute to consolation seems to be an important aspect of the meaning of being a carer for a person with a severe autistic disorder.

Adult↗
PubMedDate not supplied

Sibling bereavement: a concept analysis.

Investigators of sibling bereavement contend that the death of a sibling represents a unique and intense loss experience. The empirical literature, however, lacks conceptual clarity about the characteristics of sibling bereavement. Metaphors of siblingship are widely applied and may compromise the integrity of theory development specific to sibling bereavement, particularly as this knowledge base is broadened. There is an immediate need to extend the descriptive knowledge base for sibling bereavement beyond adolescence, in large part to prepare to address the needs of the great number of adults whose brothers and sisters have died as a result of AIDS. The purpose of this article is to examine the concept of sibling bereavement by reviewing the empirical literature and by applying the Wilsonian Method (1963) of concept analysis. A preliminary model addressing the factors of critical attributes and personal outcome variables for bereavement research specific to sibling loss is presented.

Adult↗
PubMedDate not supplied

A culturally competent approach to cancer news and education in an inner city community: focus group findings.

Ethnic minorities who live in socioeconomically disenfranchised communities suffer disproportionately from many health problems including cancer. In an effort to reduce these disparities, many health-care practitioners and scholars have promoted "culturally competent" health education efforts. One component of culturally competent education is a grounded knowledge base. To obtain knowledge about the cancer-related ideas of members of one African American community, researchers conducted focus groups with public housing residents and used the findings to develop a five-part television news series about breast, prostate, and cervix cancers. We found that participants gathered information from the folk, popular, and professional health sectors and constructed their cancer-related ideas from this information. Furthermore, experiences of racism, sexism, and classism colored their beliefs and behaviors regarding the prevention, detection, and treatment of common cancers. For this community "cancer" represents a giant screen upon which individual fears and societal ethnic, political, and economic tensions are projected.

Adult↗
PubMed2005

Fundamental aspects of learning minimally invasive surgical skills.

With the introduction of minimally invasive surgery (MIS) the necessity to develop training methods to learn skills outside the operating room (OR) became clear. Several training simulators have become commercially available. However, fundamental research into the requirements for effective and efficient training in MIS is still lacking. Yet in the literature several learning models have been described that may be used when designing the structure of a training program. While learning skills, three stages can be observed: cognitive, associative and autonomous. The learning cycle also includes different learning styles and, moreover, every trainee has his/her preferred learning style. Furthermore, training should be adapted to the level of behaviour: skill-based, rule-based or knowledge-based. Training of complex skills should include multiple performance objectives, such as just-in-time supportive information and part-task practice. Finally, motivation for training can be created by assessment. In conclusion, several theories on learning can be found in the literature. These theories may help in the development of effective training programs for training MIS skills outside the OR.

Journal Article↗