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At least 1,189 records · Page 66Linked to original sources
PubMed1994

Effect of advanced cardiac life-support training in rural, community hospitals.

OBJECTIVES: To define the effectiveness of training personnel in rural, community hospitals in advanced cardiac life support (ACLS) and the changes that result in the process and quality of care to patients with ischemic heart disease that can be attributed to participation by team members in an ACLS course. DESIGN: Case-controlled, retrospective abstraction of hospital records of 869 consecutive patients with ischemic heart disease, who were admitted during the year preceding and the year following the ACLS course. SETTING: Seven rural, community hospitals in Wisconsin. SUBJECTS: Physicians, nurses, and other critical care staff (others). INTERVENTIONS: Training in ACLS using 12 3-hr sessions in an interdisciplinary format by a multidisciplinary faculty. MEASUREMENTS AND MAIN RESULTS: Rates of successful attainment of the terminal behavior objectives by physicians and nurses were 84.0% and 78.8%, respectively. Less than 50% of others achieved a satisfactory level of competence. Performance on an examination of cognitive ability improved significantly for all groups (p < .005 for nurses; p < .05 for physicians). Enhancement of knowledge base and integrative skills occurred in all areas of designated ACLS content. Difficulty remained apparent relative to the pharmacologic effects of epinephrine and atropine. No statistically significant deterioration in didactic knowledge base could be detected 1 to 2 yrs after completion of the ACLS course. Slight deterioration in intubation and defibrillation skills occurred in < 3 months after completion of the course. Substantial costs were encumbered by the hospitals, despite the free training provided to the institutions. After ACLS training had been given, overall mortality rates decreased from 17.4% to 13.4% (p < .05). A pooled estimate of the decrease in the mortality rate was 1.4 +/- 3.8%/quarter. Across the entire spectrum of severity of illness, the probabilities for survival increased at a given severity of illness following completion of the course (p = .06). When extremes of severity of illness were excluded from the analysis, the differences in probability for survival over the midrange of severity were statistically significant (p < .05). CONCLUSIONS: Training directed to the entire team likely to participate in the provision of ACLS in the community hospital favorably affects the overall practice of ACLS and the survival rate of patients with ischemic heart disease.

Aged↗
PubMedDate not supplied

Attitudes of staff towards mothers affected by substance abuse.

The purpose of this study was to explore the influence of education and experience on the attitudes of neonatal nurses/midwives when caring for mothers and infants affected by substance abuse. A self-report questionnaire was completed by 50 nurses/midwives. The attitude of nurses/midwives towards mothers affected by substance abuse was generally negative/judgemental, and their knowledge base was low. The most experienced nursing staff generally had a more negative attitude than those nurses/midwives with less neonatal experience. Formal neonatal education did not appear to have a positive effect on knowledge base or attitudes; however, results implied that in-service education on substance abuse might have a mildly positive effect on attitudes. Results indicate a need for formal education on substance abuse and its effect on the neonate and mother, and that specialist education on substance abuse may influence attitudes.

Adult↗
PubMed2002

A hybrid supervisory system to support WWTP operation: implementation and validation.

Integrated operation of Wastewater Treatment Plants is still far from being solved. A reasonable proposal should link advanced and robust control algorithms to some knowledge-based techniques, allocating the detailed engineering to numerical computations, while delegating the logical analysis and reasoning to supervisory intelligent systems. This paper describes the development and implementation of a knowledge-based Hybrid Supervisory System to support the operation of a real Wastewater Treatment Plant. The system integrates different reasoning modules, overcoming the limitations in the use of each single technique, while providing an agent based architecture with additional modularity and independence. It is structured into three separated levels: data gathering, diagnosis, and decision support. The different tasks of the system are performed in a seven-step cycle: data gathering and update, diagnosis, supervision, prediction, communication, actuation, and evaluation phase. In spite of certain reservations of the scientific community about the use of these techniques, the system is successfully performing real-time support to the operation of the Granollers facility since September 1999. Results of the first four-month validation period are shown and discussed. An example of the system behavior is also shown in the paper. The conclusions indicate the key steps which are necessary to transfer the system to another facility.

Algorithms↗
PubMed1993

Prediction of the three-dimensional structures of the biotinylated domain from yeast pyruvate carboxylase and of the lipoylated H-protein from the pea leaf glycine cleavage system: a new automated method for the prediction of protein tertiary structure.

A new, automated, knowledge-based method for the construction of three-dimensional models of proteins is described. Geometric restraints on target structures are calculated from a consideration of homologous template structures and the wider knowledge base of unrelated protein structures. Three-dimensional structures are calculated from initial partly folded states by high-temperature molecular dynamics simulations followed slow cooling of the system (simulated annealing) using nonphysical potentials. Three-dimensional models for the biotinylated domain from the pyruvate carboxylase of yeast and the lipoylated H-protein from the glycine cleavage system of pea leaf were constructed, based on the known structures of two lipoylated domains of 2-oxo acid dehydrogenase multienzyme complexes. Despite their weak sequence similarity, the three proteins are predicted to have similar three-dimensional structures, representative of a new protein module. Implications for the mechanisms of posttranslational modification of these proteins and their catalytic function are discussed.

Amino Acid Oxidoreductases↗
PubMed1983

Using SEEK for multichannel pattern recognition.

The author's work on computerized analysis of the 2-channel, 24-hr electrocardiogram has previously resulted in the development of multichannel signal processing systems that learn by observation. A new tool for implementing such algorithms is described: the pattern recognition language SEEK. Programs written in SEEK build a knowledge base containing treelike data structures, each of which stores acquired information about a particular multichannel waveform. Input data are interpreted by performing an efficient parallel evaluation of the structures in the knowledge base. The work is applicable to a wide variety of pattern recognition problems that arise in medical signal processing. The approach is illustrated with examples drawn from ECG analysis.

Computers↗
PubMed1994

The use of medical logic modules at LDS hospital.

The development of medical knowledge bases for use in a clinical information system (HELP) has been an ongoing goal at LDS Hospital in Salt Lake City, Utah, for the past 25 years. In building our medical knowledge base we felt the need to implement a decision support syntax which could capture the logic of our experts in a way that was not only executable, but also easily read and shared by others. During these 25 years we defined several simple syntaxes to express this medical logic. Our current approach is to cooperate with international standards groups (ASTM) and use the Arden Syntax for medical logic modules. We are working with the 3M Corporation in the joint development of an Arden Compiler for HELP. We plan to use the Arden Syntax initially to support our alert/reminder system and computerized management protocols.

Artificial Intelligence↗
PubMed2002

Safety evaluation of the drugs available to prevent malaria.

All drugs used for malaria prophylaxis have common adverse effects, in addition to rare and/or severe adverse effects. For many of the drugs in current use, the common adverse effects include neuropsychiatric harms. This property makes these drugs unpopular with tourists and business travellers, most of whom will be well at the start of chemoprophylaxis. Drugs available to prevent malaria have not been rigorously researched in terms of the phenomenology of their unwanted effects. Consequently, prescribers are not well placed to give useful information to travellers on the incidence, natural history and avoidability of the harms they may experience from malaria chemoprophylaxis. There is some evidence that the adverse effects of mefloquine may be a post-hepatic syndrome caused by drug-induced liver damage with, in some users, symptomatic thyroid disturbance. However, confusion in the interpretation of the scientific evidence has led to conflicting messages regarding the safety of mefloquine and other antimalaria drugs, and to incorrect self-therapy by individual travellers, sometimes with fatal outcomes. In this review, the existing knowledge base for the safety of drugs currently used to prevent malaria is described along with present designs for future studies that would allow a rigorous safety assessment of candidate chemoprophylactic agents and of new drugs introduced to prevent malaria. There is an urgent need for internationally-agreed, evidence-based malaria prevention guidelines. These guidelines should be explicitly linked to the best available research evidence (normally systematic reviews of trials and individual randomised trials) and should highlight gaps in the knowledge base as priority areas for research.

Adult↗
PubMed2004

Medical information portal.

The classic function of the library was to build and maintain a knowledge base and to provide an access to that collective memory for the purposes of learning, teaching, caring for patients, research work or managing an organization. The formats and presentation of that knowledge base are changing rapidly, as the methods and techniques for accessing information. (Fig. 1, Ref. 1.)

Internet↗
PubMed1986

Medical libraries and computers. The role of medical libraries in medical informatics.

The classic function of health sciences libraries is to build and maintain a knowledge base and to provide timely access to that collective memory for the purpose of learning, teaching, caring for patients, conducting research or managing an organization. The formats and representation of that knowledge base are changing rapidly, as are the methods and techniques for gaining access to information. Medical libraries have long used computers for cataloging and controlling records but are now shifting to acquiring, managing and distributing bibliographic and full-text information to local library "networks."

Computer Communication Networks↗
PubMed1999

Nurses' knowledge about pharmacological and nonpharmacological pain management in children.

The purpose of this study was to investigate the knowledge base and practices of Finnish nurses in the area of children in pain. The convenience sample consisted of 265 nurses working on children's wards in university hospitals. Data were collected using an instrument designed for the study. The results showed that there remain gaps in the knowledge base of nurses with regard to both pharmacological and nonpharmacological pain management in children. The education and the area of expertise were significant influences on knowledge scores. Nurses used a fairly wide range of nonpharmacological pain alleviation methods but most of these were such that the nurse was in an active role and the child was passive. There is a clear need for further education. Nurses should take a more active role in seeking new information and also should be encouraged to use nonpharmacological methods that let the children be active participants in their own care.

Adult↗
PubMed2000

'Science', 'critical thinking' and 'competence' for tomorrow's doctors. A review of terms and concepts.

CONTEXT: The recommendations of the General Medical Council in Tomorrow's Doctors renewed efforts to define core knowledge in undergraduate medical education. They also encouraged better use of the medical knowledge base in nurturing clinical judgement, critical thinking, and reflective practice. What then does the medical world understand by 'science', 'critical thinking' and 'competence', given the need to address both growth and uncertainty in the knowledge base and to practise evidence-based healthcare? AIM AND OBJECTIVES: This review aims to outline the role of these key concepts in preparing undergraduate medical students for professional practice. Specifically, it explores: the fallibility of the 'scientific' foundations of medical practice; the role of understanding and thinking in undergraduate medical education; the need for a broad interpretation of competence and its relationship to transferability, and the nature of clinical judgement. COMMENT: Tensions are seen to lie in the varying interpretations of clinical decision making as art or science; the varying characterizations of the nature of skilled performance in the novice, the competent and the expert practitioner, and the varying reactions to the acceptability and usefulness of 'meta-' concepts in capturing the essence of professional practice. Habitual self-conscious monitoring of mental processes may be the key to the flexible transfer and application of knowledge and skills across the contexts, characterized by uncertainty and incomplete evidence, for which doctors must be prepared.

Clinical Competence↗
PubMed1996

Blood pressure measurement in the community: do guidelines help?

The measurement of blood pressure (BP) is a crucial part of clinical assessment and hypertension management, and is commonly performed inaccurately despite the publication of National and International consensus guidelines for its measurement. There have been no previous reports on the self-reported knowledge-base of General Practitioners (GPs) and Practice Nurses (PNs) with regard to BP measurement. A postal questionnaire survey was conducted of 831 community-based practitioners (550 GPs and 281 PNs) in north west London. The overall response rate was 61%. Previous education in BP measurement was recorded in 87% of the GPs and 95% of the nurses. Precision factors were recorded for the GPs and nurses respectively including rounding up or down (GP 67%, PNs 48%), routine use of diastolic phase V (GP 63%, PNs 70%), reading the BP to the nearest 2 mm mercury (GP 54%, PNs 70%) and failure to use a large BP cuff in the past 4 weeks (GP 33%, PNs 26%). Only 12% of the GPs and 19% of the nurses were able to name the source of the published guidelines. Overall the nurses had a statistically significantly greater knowledge base than the GPs, and both community groups had a greater knowledge for core questions than hospital practitioners from two previous surveys. Knowledge of a guideline source was associated with improved self-reported BP technique. There was a difference between reading and recording accuracy which deserves further study. These results show that there are important gaps in the knowledge of community practitioners with regard to the technique of BP measurement.

Blood Pressure Determination↗
PubMedDate not supplied

An Expert PArasite IdentificatiON (EPAION) system with multimedia support.

Until now computer-assisted parasite identification was based on database applications requiring data specification on an individual basis, thus limiting the ability of the system to handle rule-based knowledge as humans are used to do. A new Expert PArasite IdentificatiON (EPAION: Greek term for expert) system was developed to serve as an interface between the database and the user, where the database is a repository for bionomic and morphological facts about the parasites for the expert system. The system was developed by using a logic-based computer language which allows the definition of rules and facts to assist the creation of queries to the database. The components of the system are the knowledge base, the multimedia data base, the inference mechanism, and the graphical user interface. The operational modules of the system are the Parasite Identifier and the system Utilities. This expert system facilitates knowledge incorporation in a manner simulating the natural mental process, thus allowing the checking of the accuracy of the information that the user feeds to the computer and the creation of intelligent queries to the database. These characteristics accelerate focusing and optimize the parasite identification scheme regardless of the user's profile of competency.

Animals↗
PubMed2005

A conjugated diene identified as a prohapten: contact allergenic activity and chemical reactivity of proposed epoxide metabolites.

A hapten causing allergic contact dermatitis binds covalently to macromolecules via nucleophilic-electrophilic reactions or radical couplings. A prohapten can be seen as a chemically inert compound without electrophilic or radical forming properties. To exert its activity, the prohapten is activated, for example, metabolically, to the hapten. We have investigated the contact allergenic properties of a diene, (5R)-5-isopropenyl-2-methyl-1-methylene-2-cyclohexene (1), as a potential prohapten, and we found it to be a sensitizer in animal studies. The activity is likely to be exerted via epoxide metabolites. Thus, two potential metabolites of the investigated diene, (4S)-1,2-epoxy-4-isopropenyl-1-methyl-6-methylene-cyclohexane (3) and (7R)-7-isopropenyl-4-methyl-1-oxa-spiro[2.5]oct-4-ene (4), were synthesized and subjected to animal tests. Both epoxides were sensitizers. They also elicited significant reactions when tested in animals induced with 1, which indicates that they are formed from the diene in the skin. Furthermore, incubation of 1 with human liver microsomes produced both epoxides. The chemical reactivity of 1, 3, and 4 was investigated in relation to a hexapeptide, H-Pro-His-Cys-Lys-Arg-Met-OH. No adducts were obtained from reactions between the peptide and 1. However, epoxide 3 bound covalently to the cysteine residue and epoxide 4 to both the cysteine and proline residues. Since it is possible to relate the sensitizing capacity of a compound to its key physicochemical properties, knowledge-based expert systems have been developed to predict the toxicity of novel compounds by comparing the structure with activity data stored in the computer database. A diene related to 1 found in the knowledge-based expert system DEREK was considered as a nonsensitizer by this system. Our study indicates that conjugated dienes can be metabolized to contact allergens in the skin. Thus, when constructing predictive test methods based on SARs, it is important to analyze not only the virtual chemical structure of a compound but also its ability to act as a prohapten.

Alkadienes↗
PubMed2005

Screening, safety, and adverse events in physical activity interventions: collaborative experiences from the behavior change consortium.

Researchers who conduct physical activity (PA) intervention studies provide an invaluable opportunity to further the prevention science knowledge base for implementing and delivering PA programs. Despite recommendations that screening is important to increase patient safety, the specific screening criteria best suited for different community applications are unknown. To add to the limited knowledge base, we examined the screening procedures and the occurrence of adverse events among more than 5,500 participants from 11 diverse PA interventions participating in a trans-National Institutes of Health (NIH) collaborative known as the Behavior Change Consortium (BCC). Numerous adverse events occur in sedentary, chronically ill, or older populations, although few are attributed to activity/exercise interventions. No serious study-related adverse events (SRAEs) were reported across different screening practices, interventions, and/or populations. Relatively few minor SRAEs were reported (primarily musculoskeletal injuries), emphasizing the need to be aware of potential musculoskeletal sequelae during exercise interventions. One common characteristic of these studies is that they recommended "start low and go slow" strategies, with moderate intensity PA as the goal behavior. Recommendations to reframe the meaning and use of screening criteria to initiate PA in the community are discussed. Although we were unable to conduct generalizable quantitative analyses from our data, the combined experience of the BCC studies provides a unique opportunity to examine PA-related screening and safety issues across diverse populations, settings, and intervention programs.

Behavior Therapy↗
PubMed1994

HYCONES II: a tool to build hybrid connectionist expert systems.

This paper describes HYCONES II--a tool to enable the construction of hybrid connectionist expert systems to solve classification problems. HYCONES II offers to the knowledge engineer a hybrid knowledge base that integrates frames with three different neural network models: the combinatorial neural model--CNM, the Fuzzy ARTMAP and the Semantic ART--SMART models. The latter is a new model, introduced by this paper, based on a combination of the two previous models. The validation section compares the performance of these three neural models to solve diagnostic problems in two medical domains. This paper also presents HYCONES II knowledge representation features, built in the symbolic component of its hybrid knowledge-base, to deal and represent fuzzy medical variables. Finally, the present status and future developments of the project are presented.

Algorithms↗
PubMed2002

Correlation of problem-based learning facilitators' scores with student performance on written exams.

Problem-based learning (PBL) is widely used in medical education. In some cases, facilitators assign a grade to reflect a student's performance in small-group sessions. In our PBL track, facilitators were asked to assess student knowledge base independent of their group participatory skills. To determine if facilitators' grades were correlated with student performance in written exams, a retrospective study of data from our PBL track was undertaken. Data from 156 students and 107 facilitators in six years of a PBL track at Penn State College of Medicine was analyzed by the Pearson correlation after pairing facilitator grades with written exam grades for each of the eight blocks of the curriculum. Exam reliability and validity were assessed by Cronbach's alpha and correlation with USMLE I board scores. The mean alpha was 0.549 +/- 0.221. The mean correlation with USMLE scores was 0.558 +/- 0.151. Facilitators' scores for knowledge were positively associated with students' exam grades. The corresponding significant Pearson correlation coefficients were between 0.342-0.622. However, the coefficients of determination showed that the correlation was not significant. Coefficients of determination showed that the knowledge scores explained only 12 to 39% of the variance in exam scores. Overestimation by facilitators was significantly (p < 0.0001) greater for students in the bottom 25% of the class by exam score than for students in the top 25% of the class. On the basis of this study, we concluded that facilitator assessment of student knowledge base is not useful.

Curriculum↗