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PubMedDate not supplied

An analysis of the epistemic orientation of first- and third-year students in a physiotherapy program.

Previous research has demonstrated that practitioners within the same profession share a common approach to knowledge acquisition and transmission. A search for the identification of this common approach to knowledge in physiotherapy was undertaken using the Epistemic Orientation Model. The research reported was premised on the assumption that students admitted to physiotherapy programs in Canada possess an epistemic orientation that is similar to the epistemological structure of the knowledge base considered important to the program. Using a standardized instrument known as the Knowledge Accessing Modes Inventory (KAMI) to measure epistemic orientation, data were collected from a sample (N = 59) of first- and third-year students registered in a physiotherapy program in a central Canadian university. The data indicated that a high degree of association exists between the epistemological structure subsumed in the knowledge base deemed essential to gain admission to the program and the dominant rational epistemic mode of the practitioners-to-be. Based on the results, the article examines the usefulness of the epistemic orientation concept on activities within the profession. Implications for professional development are noted and avenues for further research are suggested.

Canada↗

PubMed1995

An educational model for the acute care nurse practitioner.

As new opportunities for acute care nurse practitioners (ACNP) evolve, there is increasing recognition of the need to distinguish between the knowledge base and the role functions generic to all advanced practice nurses, and the knowledge base specific to different areas of clinical specialization. This necessitates differentiating between converging core curriculum elements and merging the roles of advanced practice nurses. This article presents an educational model for the ACNP.

Acute Disease↗

PubMed2006

Development of a specialty-wide web-based medical knowledge assessment tool for resident education.

Medical knowledge is one of six core competencies identified by the Accreditation Council for Graduate Medical Education. The authors present a tool for assessment of medical knowledge developed by the Council of Emergency Medicine Residency Directors. This tool is Internet based and consists of more than 50 online tests that emergency medicine residents are able to access. Test results are available to a resident's residency, along with the mean and standard deviation of all takers of that particular test. The result is a collaborative specialty-wide approach to the common problem of formatting tests to assess medical knowledge. The tool has been widely accepted by both residents and residencies.

Clinical Competence↗

PubMed2005

A review on the integration of artificial intelligence into coastal modeling.

With the development of computing technology, mechanistic models are often employed to simulate processes in coastal environments. However, these predictive tools are inevitably highly specialized, involving certain assumptions and/or limitations, and can be manipulated only by experienced engineers who have a thorough understanding of the underlying theories. This results in significant constraints on their manipulation as well as large gaps in understanding and expectations between the developers and practitioners of a model. The recent advancements in artificial intelligence (AI) technologies are making it possible to integrate machine learning capabilities into numerical modeling systems in order to bridge the gaps and lessen the demands on human experts. The objective of this paper is to review the state-of-the-art in the integration of different AI technologies into coastal modeling. The algorithms and methods studied include knowledge-based systems, genetic algorithms, artificial neural networks, and fuzzy inference systems. More focus is given to knowledge-based systems, which have apparent advantages over the others in allowing more transparent transfers of knowledge in the use of models and in furnishing the intelligent manipulation of calibration parameters. Of course, the other AI methods also have their individual contributions towards accurate and reliable predictions of coastal processes. The integrated model might be very powerful, since the advantages of each technique can be combined.

Artificial Intelligence↗

PubMed2006

Assessing behavioural change support abilities of the oral healthcare team.

Competent behavioural change intervention can be learned, practised and developed. Therefore, the teaching and assessment of this ability should be within the scope of both the undergraduate and post-graduate curriculum. Assessment should target knowledge base and skills in the areas of counselling, communication and behaviour. Assessment of the knowledge base should ideally be conducted in a comprehensive, multidisciplinary, centrally based manner in the pre-clinical curriculum. Assessment of skills in the areas of communication, counselling and behaviour change is a wider aim that should be integral throughout the curriculum. In continuing education (CE) environments, an initial 'screening' assessment would help educators to adjust the course to the participants' background and needs. Furthermore, three major assessment schemes are proposed: (1) assessment of knowledge and skills, (2) evaluation of the whole course by the participants, and (3) assessment of the implementation process, four to six months after completion.

Attitude of Health Personnel↗

PubMed1998

Functional food science and defence against reactive oxidative species.

This paper assesses critically the science base that underpins the argument that oxidative damage is a significant causative factor in the development of human diseases and that antioxidants are capable of preventing or ameliorating these disease processes. The assessment has been carried out under a number of headings, and some recommendations for future research are made based on the present day knowledge base. The knowledge database (1) Consideration of the basic science that underlies understanding of the role of free radicals in causing cellular pathologies, and the role of antioxidants in preventing this, shows that an imbalance of reactive oxygen species and antioxidant defence systems may lead to chemical modifications of biologically relevant macromolecules. This imbalance provides a logical pathobiochemical mechanism for the initiation and development of several disease states. Experimental data obtained in vivo provide evidence that antioxidants function in systems that scavenge reactive oxygen species and that these are relevant to what occurs in vivo. The relevance in vivo of these observations depends inter alia on knowledge of the uptake and distribution of the antioxidant within the human body, and on what tissue levels of the antioxidant may be expected in relation to dietary levels. (2) There is some way to go until validated precise methods are available for measuring biomarkers of oxidative damage in human subjects in vivo under minimally invasive conditions. With respect to oxidative damage in DNa, HPLC and GC-mass spectrophotometry methods have both merits and limitations. Lipid oxidation products in plasma are best measured as isoprostanes or as lipid hydroperoxides using specific HPLC techniques. Development of isoprostane measurement will advance specificity and precision. The measurement of oxidative damage to proteins has some potential but such methods have not been effectively exploited. (3) Epidemiological studies support the hypothesis that the major antioxidant nutrients vitamin E and vitamin C, and beta-carotene (which may or may not be acting as an antioxidant in vivo), may play a beneficial role in prevention of several chronic disorders. More research is needed on the impact of other non-nutrient compounds, such as other carotenoids and flavonoids, on human health. In general, human intervention studies using hard end-points are the gold standard. Trials are restricted mainly to the major antioxidants and do not allow firm conclusions because of inconsistent findings, an insufficient number of studies and the use of varying doses. There is evidence that large doses of beta-carotene may be deleterious to the health of certain subgroups of the population such as heavy habitual smokers. (4) With respect to the safety of administration of supplementary vitamins, vitamin C is safe at levels of supplementation up to 600 mg/d, and higher levels, up to 2000 mg/d, are without risk. Vitamin E has a very low human toxicity and an intake of 1000 mg/d is without risk; 3200 mg/d has been shown to be without any consistent risk. Large intakes of beta-carotene must be viewed with caution because they have been shown to confer detriment to a population at high risk of lung cancer when administered after many years of high risk (smoking) behaviour. Until further work clarifies the situation in heavy smokers with respect to taking supplements, larger doses should be avoided by such individuals. There is little reliable information about the human toxicology of flavonoids and related non-nutrient antioxidant constituents of the diet. (5) The food industry has long experience in the control of oxidative damage in foods and this experience can be used to advantage for the protection of food antioxidants which are beneficial. Some of these, such as vitamins C and E and beta-carotene, are well known, and strategies for their protection in foods are already exploited by food technologies. (ABSTRACT TRUNCATED)

Antioxidants↗

PubMed1993

Competence reasoning--handling ambiguous and imprecise data in the Pro.M.D. expert system shell.

The Pro.M.D. expert system shell (Pohl and Trendelenburg, Methods Inf Med 1988;27:111-117) is a computer program tool for knowledge-based computer interpretation of laboratory data. Competence reasoning deals with more or less vague knowledge. Vague knowledge is knowledge using vague data. In Pro.M.D. terminology, vague data are called 'semi-known'. Examples of semi-known numbers are numeric intervals like [5.2,8.8] (= all numbers between lower limit 5.2 and upper limit 8.8 are possible), or imprecise numbers like N[4,1] (= numbers vary around mean of 4 with standard deviation of 1). Semi-known qualitative data are ambiguous information on alternative values like low or normal (= from three alternatives low or normal are possible and high is impossible) or probability distributions on the alternatives like low in 60% or normal in 30% or high in 10% (= low, normal and high appear with the respective probabilities). Regarding vagueness, data may be divided into known data (unambiguous and precise information), semi-known data (ambiguous or imprecise information) or unknown data (no information). Semi-known data may be further subdivided into probabilistic data, where the probability distribution of domain values is known (e.g. Gaussian distribution) and possibilistic data, where probability distribution of domain values is not known (e.g. intervals). Probabilistic data may be obtained either by completely counting the population's individuals or by estimation from samples. In the latter case sample size is another measure for data vagueness. In the Pro.M.D. expert system shell functions are being implemented for input, output, calculation and testing of semi-known data. Thus, instruments for competence reasoning in Pro.M.D. will help to build up reliable and user friendly knowledge-based systems.

Clinical Laboratory Information Systems↗

PubMed2000

Development of an expert system rulebase for the prospective identification of photoallergens.

Relationships between the structure and properties of chemicals can be programmed into knowledge-based systems such as DEREK (an acronym for 'Deductive Estimation of Risk from Existing Knowledge'). The DEREK knowledge-based computer system contains a sub-set of over 50 rules describing chemical substructures (toxophores) responsible for skin sensitization. This rulebase, based originally on Unilever historical in-house guinea pig maximisation test data, is largely complete and is undergoing refinement as the next stage of its development. As part of an ongoing program of validation and testing, the predictive ability of the sensitization rule set was assessed by processing the structures of over 100 chemical substances in the list of contact allergens identified by the BgVV (German Federal Institute for Health Protection of Consumers). The exercise highlighted areas of chemistry where further development of the rulebase was required, either by extension of the scope of existing rules or by generation of new rules where a sound mechanistic rationale for the biological activity could be established. Several chemicals likely to be acting as photoallergens were identified and rules for photoallergenicity were written covering three classes of chemicals. This paper describes work to extend the DEREK rules for photoallergenicity as part of the European Phototox Project.

Allergens↗

PubMed1999

Public health nursing practice guidelines: an evaluation of dissemination and use.

Public health nursing needs to build a practice on research-based knowledge. Public health guidelines are one strategy to achieve this goal. Using research-based knowledge, the Minnesota Practice Enhancement Project (MPEP) developed positive parenting and family violence prevention guidelines for public health nurses (PHNs). The purpose of this study was to evaluate the dissemination and use of the MPEP guidelines using a survey of PHNs and telephone interviews of public health nursing directors. Results indicated that respondents viewed the guidelines as important, but identified numerous barriers to integrating the guidelines into their practice. Major barriers included lack of time in their work day, complex guideline structure, and competing agency demands and priorities. Findings were consistent with Roger's Diffusion of Innovations theory, which describes factors associated with the adoption of a new idea or practice. Recommendations for effective dissemination include administrative support and structure to increase PHN intentional use of practice guidelines, a simplified guideline format, and mentorship in guideline use.

Attitude of Health Personnel↗

PubMed2002

[Knowledge management in rehabilitation--proposal for a systematic development of clinical practice guidelines].

In the past ten years, the German pension scheme has launched several initiatives that can be regarded as milestones on the way to a scientifically founded rehabilitation system. These initiatives were: the Rehab Commission (1989 - 1991), the Quality Assurance Programme (since 1994), and the German Research Funding Programme "Rehabilitation Sciences" (in cooperation with the Federal Ministry for Education and Research, since 1996). As a next step on this way, we propose an initiative aiming at a systematic development and implementation of clinical practice guidelines for the main diagnostic groups in rehabilitation. Guidelines for diagnostic and therapeutic decisions are an instrument to sift through the abundance of fast changing knowledge in medicine, to assess the existing knowledge according to its scientific evidence, and to transform it into recommendations for clinical practice. In rehabilitation, guidelines seem to be particularly needed because specialized knowledge is mostly disseminated through an informal "training on the job". Our proposal intends to establish a reference centre for each of the main indications (cardiology, musculoskeletal diseases, etc.). These centres should cooperate with experts from clinical practice and research, as well as with representatives of the cost-carrying agencies and patient organisations, and should systematically analyse the processes of rehabilitation in the most important diagnostic groups. Guided by a "process matrix of rehabilitation", these analyses should identify the points at which far-reaching decisions are called for during the processes of rehabilitation. At these points, the knowledge base available for rational decisions should be examined. When there is no sufficient scientific knowledge, consensus conferences should be organized in order to collect and assess the available expertise of practitioners and to establish guidelines for clinical practice. Since compliance with such guidelines could be easily checked in the routine quality assurance programme, this proposal seems to be a promising way of improving the knowledge base in rehabilitation in a rather short time.

Diagnosis-Related Groups↗

PubMed1998

Knowledgebased segmentation.

The segmentation of medical images like CT or MRI scans represents a great challenge to researchers in computer vision, due to the variability of the individual anatomy and the different characteristics of the scanning systems. As an anatomical knowledge base improves the recognition of structures in CT or MRI scans, we chose a knowledge based segmentation in our approach, which will be explained in the following.

Algorithms↗

PubMed1997

Design and validation of an intelligent patient monitoring and alarm system based on a fuzzy logic process model.

The process of patient care performed by an anaesthesiologist during high invasive surgery requires fundamental knowledge of the physiologic processes and a long standing experience in patient management to cope with the inter-individual variability of the patients. Biomedical engineering research improves the patient monitoring task by providing technical devices to measure a large number of a patient's vital parameters. These measurements improve the safety of the patient during the surgical procedure, because pathological states can be recognised earlier, but may also lead to an increased cognitive load of the physician. In order to reduce cognitive strain and to support intra-operative monitoring for the anaesthesiologist an intelligent patient monitoring and alarm system has been proposed and implemented which evaluates a patient's haemodynamic state on the basis of a current vital parameter constellation with a knowledge-based approach. In this paper general design aspects and evaluation of the intelligent patient monitoring and alarm system in the operating theatre are described. The validation of the inference engine of the intelligent patient monitoring and alarm system was performed in two steps. Firstly, the knowledge base was validated with real patient data which was acquired online in the operating theatre. Secondly, a research prototype of the whole system was implemented in the operating theatre. In the first step, the anaesthetists were asked to enter a state variable evaluation before a drug application or any other intervention on the patient into a recording system. These state variable evaluations were compared to those generated by the intelligent alarm system on the same vital parameter constellations. Altogether 641 state variable evaluations were entered by six different physicians. In total, the sensitivity of alarm recognition is 99.3%, the specificity is 66% and the predictability is 45%. The second step was performed using a research prototype of the system in anaesthesiological routine. The evaluation of 684 events yielded a sensitivity, specificity and predictability of the alarm recognition of more than 99%.

Anesthesiology↗

PubMed2000

[Office-based pediatricians' knowledge and adherence to a consensus statement on acute rhinopharyngitis in the child].

AIM: To assess the impact on community-based pediatricians of the conclusions of the 10th Conférence de Consensus en Thérapeutique Anti-Infectieuse (CCTAI) on the antibiotic treatment in acute nasopharyngitis (ANP). METHODS: Fifty-six pediatricians took part in the study. Over a period of 15 days in October 1998, all the children (n = 997) presenting an ANP were prospectively included. The prescription of an antibiotic treatment as well as the clinical criteria authorizing it, according to the conclusions of the 10th CCTAI, were recorded. The participants were not told the purpose of the study. RESULT: Sixty percent of the pediatricians questioned were familiar with the 10th CCTAI. Forty-five percent said they complied with it, but only 7% stated it had changed their day-to-day clinical practice. Based on the conclusions of the 10th CCTAI, an antibiotic treatment would have been discussed for 38% of the children. Twenty-four percent of them were given one. For 54% of the children that were given an antibiotic, such treatment was disapproved by the 10th CCTAI. No significant association has been established between familiarity with the 10th CCTAI and the following criteria: gender, age, hospital activity, years of practice, medical journals read, and belief in the existence of a license for one or more antibiotics for ANP in children. However, this last criterion was significantly (P = 0.03) associated with an increase in the percentage of antibiotics prescribed: 29% vs 16%. DISCUSSION AND CONCLUSION: The 10th CCTAI has had a moderate impact on the day-to-day practice of the pediatricians who took part in our study. Several explanations are discussed. The authors emphasize the virtual lack of indications of antibiotics in ANP.

Adult↗

PubMed2006

Exceptional disease courses after the use of CAM: selection, registration, medical assessment, and research. an international perspective.

OBJECTIVES: To describe the different approaches that investigators in several countries have used to obtain, register, assess, and research exceptional case histories after the use of complementary and alternative medicine (CAM). METHODS: Searches have been carried out currently in the databases PubMed and MEDLINE((R)) using the keywords: exceptional disease course/best and worst cases/best-case series + use of CAM. We have only found a few papers limited to best-case series and cancer. Furthermore, we have used the "snowball method" by contacting researchers in different countries starting with with the National Cancer Institute in the United States in order to get information about ongoing approaches to obtain, register, assess, and research exceptional case histories after the use of CAM. RESULTS: There appears to be a gap between "evidence-based" knowledge drawn from randomized controlled trials, systematic reviews, and meta-analyses and experience-based knowledge of treatment outcomes reported by patients and CAM providers. Several research groups in different countries have initiated studies on patients experiencing exceptional treatment outcomes after the use of CAM. Four different approaches to collecting and assessing such case histories have been identified. Three of the approaches collect histories from the treatment providers, whereas the fourth recruits case histories mainly from patients themselves. The medical assessments are generally similar, and seek to document whether the course of disease is different than would have been expected in a conventional treatment situation. CONCLUSIONS: Given differences in the current procedures, the establishment of an international formal collaboration for the recruitment, assessment, and study of exceptional patients is likely to take time. Comparative studies may, however, generate new knowledge about exceptional disease courses across disease categories, cultural contexts, and national boundaries. Our recommendations are that therapeutic approaches that show promising results should warrant prospective study and randomized clinical trials. In addition we recommend that there be (1) agreement on the definition of an exceptional patient, (2) agreement on the interpretation of treatment results, (3) agreement on content requirements of medical records, (4) more consideration of worst cases, (5) more international exchange of experience with registration procedures, and (6) more international exchange of experience with medical assessment procedures.

Complementary Therapies↗

PubMed2004

MRI-based individual 3D region-of-interest atlases of the human brain: a new method for analyzing functional data.

OBJECTIVES: Introduction of a new atlas-based method for analyzing functional data which takes into account the variability of individual human brains and the partial volume, effects of functional emission computed tomography, images in complex anatomical 3D regions, as well as, describing the underlying multi-modal image processing, principles. METHODS: 3D atlas extraction is done directly by automated segmentation of individual magnetic resonance images of the patient's head. This is done in two steps: voxel-based classification of T1-weighted images for tissue differentiation (low-level processing) is followed by knowledge-based analysis of the classified images for extraction of 3D anatomical regions (high-level processing). For atlas-based quantification of co-registered functional images, 3D anatomical regions can be convoluted with an idealized point spread function of the emission computed tomography system, after which a partial volume-dependent threshold can be determined. RESULTS: Quantitative evaluation studies, based on 50 realistic software head phantoms and 24 image data sets obtained from healthy subjects and patients, show low misclassification rates and stable results for the neural network-based classification approach (mean +/- SD 3.587 +/- 0.466%, range 2.726-4.927%) as well as for the adjustable parameters of the knowledge-based approach. Computation time is <5 min for classification, <1 min for most of the extraction algorithms. The influence of the partial volume-dependent threshold is shown for an activation study. CONCLUSIONS: This new method allows 3D atlas generation without the need to warp individual image data to an anatomical or statistical brain atlas. Going beyond the purely tissue-oriented approach, partial volume effects of emission computed tomography images can be analyzed in complex anatomical 3D regions.

Algorithms↗

PubMed2002

Teaching the International Law of Armed Conflict to a wide military community.

The rules governing armed conflict are numerous and in many respects complex. In areas that are very complex, experts such as lawyers may be called in to assist, especially in the planning of military action. But the nature and tempo of warfare rarely allows a person in the field to enjoy such a luxury. Therefore, everyone involved in a military mission must have a basic working knowledge of their responsibilities according to the Law of Armed Conflict. The type and degree of knowledge will differ depending on the role and responsibility of the person. Accordingly, the knowledge base necessary for a foot soldier is often different from that which is required by a pilot. Even within a select group of combatants, the knowledge base required may differ from subgroup to subgroup. The knowledge required by a fighter pilot may be different, in some respects, from that of a pilot of an aircraft that provides transportation and logistical support. The fighter pilot must know what is an appropriate target; the transportation/logistical pilot may not need such knowledge.

Education, Medical, Continuing↗

PubMedDate not supplied

Issues in doctoral education in nursing.

In this article, I have traced some of the evolutionary threads that have contributed to current patterns of doctoral education in nursing. Although current programs may differ in the title of the degree offered, all are structured as research doctoral programs. Because they try to be all things to all people, they fail to prepare either competent researchers or applied practitioners. Cluttered with too much general content and not enough content specific to the particular career track of the student, they fail to provide an adequate foundation for future career pathways. As a result, preparation of leaders for academic and administrative roles, clinical teachers, practitioners, and researchers is limited. Nursing has a vital contribution to make to the health of the American people. To do so we must ensure that our researchers are providing a substantive knowledge base for the field, that our leaders in academic and practice fields have a solid knowledge base of nursing coupled with administrative preparation and applied research skills, and that our clinical teachers and practitioners are skilled in their clinical specialties and in applied research in their fields. Finally, we need expert practitioners who deliver and manage truly comprehensive, quality health care services for persons in all stages of the health-illness continuum.

Education, Nursing, Graduate↗

PubMed2003

Evolutionary Local Search of Fuzzy Rules through a novel Neuro-Fuzzy encoding method.

This paper proposes a new approach for constructing fuzzy knowledge bases using evolutionary methods. We have designed a genetic algorithm that automatically builds neuro-fuzzy architectures based on a new indirect encoding method. The neuro-fuzzy architecture represents the fuzzy knowledge base that solves a given problem; the search for this architecture takes advantage of a local search procedure that improves the chromosomes at each generation. Experiments conducted both on artificially generated and real world problems confirm the effectiveness of the proposed approach.

Algorithms↗