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PubMed1991

The Basic HIV Disease Knowledge Questionnaire: a Rasch-scaled instrument to measure essential HIV knowledge.

The need for improvement in HIV disease-related psychometric questionnaires is noted. In response to this need a Rasch-scaled measure to ascertain basic HIV disease knowledge was developed and calibrated on 1092 subjects. Four studies conducted with the measure suggest adequate test-retest reliability. Three validity studies also conducted with this questionnaire suggest that the measure is sensitive to knowledge obtained from HIV-related training and education. Potential uses and limitations of this new questionnaire are discussed.

Adult↗

PubMed2006

The Recovery Knowledge Inventory: assessment of mental health staff knowledge and attitudes about recovery.

In order to assess knowledge of and attitudes toward recovery-oriented practices among providers of mental health and substance abuse treatment and rehabilitation services throughout the state of Connecticut, an instrument named the Recovery Knowledge Inventory (RKI) was developed and administered. The items that comprise the instrument are based on the emerging literature on recovery in psychiatric and substance use disorders, and assess four different domains of understanding, namely: 1) roles and responsibilities in recovery, 2) non-linearity of the recovery process, 3) the roles of self-definition and peers in recovery, and 4) expectations regarding recovery. This paper describes the instrument and its preliminary psychometric properties, and provides an example of its utility in assessing the training needs of staff who increasingly are being expected to deliver recovery-oriented care.

Attitude of Health Personnel↗

PubMed1993

Automatic knowledge base refinement: learning from examples and deep knowledge in rheumatology.

MESICAR is a second generation expert system which contains very general descriptions of rheumatological disorders in the primary medical care field. With the help of a detailed hierarchical description of the human anatomy the system is able to support diagnostic decisions. The paper describes how machine learning techniques are used to automatically construct more specific disease descriptions for common, frequently occurring cases. The system MESICAR-LEARN implements a learning method which integrates analytical and empirical learning techniques. Cases diagnosed by MESICAR form the training examples, and MESICAR's knowledge base is used as domain theory. The learned concepts are integrated into a hierarchy of disease descriptions. They support efficient and fast reasoning on common cases in addition to the general diagnostic support afforded by MESICAR's deep knowledge.

Algorithms↗

PubMed2000

Knowledge discovery and knowledge validation in intensive care.

Operational protocols are a valuable means for quality control. However, developing operational protocols is a highly complex and costly task. We present an integrated approach involving both intelligent data analysis and knowledge acquisition from experts that support the development of operational protocols. The aim is to ensure high quality standards for the protocol through empirical validation during the development, as well as lower development cost through the use of machine learning and statistical techniques. We demonstrate our approach of integrating expert knowledge with data driven techniques based on our effort to develop an operational protocol for the hemodynamic system.

Artificial Intelligence↗

PubMed2001

Stories as case knowledge: case knowledge as stories.

INTRODUCTION: Every case contains a human story of illness and a medical story of disease, which together cover person management, case management, health system management and self-management. Much of that management can be learned via a thorough set of stories of typical and atypical core cases compiled by clinical teachers. Stories provide a highly flexible framework for illustrating the lessons of experience, the tips and traps for young players, and the dilemmas requiring careful judgement in the trade-offs between benefits and risks. Listening to real stories unfold is much more fun than being lectured (and better remembered). DISCUSSION: Stories illustrate 'what can happen' in a case as a guide to 'what to do'. A story begins with a real world situation with some predicament and a (causal) sequence of events or plot in which things are resolved one way or another. Patients tell their illness story; their clinician translates that into a disease story. Stories sort out what is important in such a predicament, consider the strategy and tactics of what to do, and speak about the outcomes. Each local situation provides relevance, context and circumstantial detail. Stories about case management can encapsulate practical knowledge, logical deduction, judgement and decision making, sharing with the student all the ingredients that develop expertise. Sometimes it is the plot that is important, sometimes the detail, sometimes it is the underlying message, the parable that resonates with the listener's experiences and feelings.1 Stories can also accommodate the complexity of multiple variables and the influence of other stakeholders, the uncertainties and dilemmas within the trade-offs, and the niceties of 'informed judgement'. CONCLUSION: This paper makes four points. First, clinical stories recount pointed examples of 'what happened' that expand our expertise in handling 'a case like that'. Second, cases are the unit of clinical work. Case stories expand the dimensions and details of case knowledge, case-based reasoning and case management. Carefully collated case stories can comprise the 'real life' clinical curriculum. Third, stories provide a framework for 'web' or 'net' thinking that links all the objective and subjective details within the multifaceted complexity of case management. Fourth, personal stories explain how both numerical and non-linear influences determined what decision was actually made in that case.

Anecdotes as Topic↗

PubMed1995

Discrete cortical regions associated with knowledge of color and knowledge of action.

The areas of the brain that mediate knowledge about objects were investigated by measuring changes in regional cerebral blood flow (rCBF) using positron emission tomography (PET). Subjects generated words denoting colors and actions associated with static, achromatic line drawings of objects in one experiment, and with the written names of objects in a second experiment. In both studies, generation of color words selectively activated a region in the ventral temporal lobe just anterior to the area involved in the perception of color, whereas generation of action words activated a region in the middle temporal gyrus just anterior to the area involved in the perception of motion. These data suggest that object knowledge is organized as a distributed system in which the attributes of an object are stored close to the regions of the cortex that mediate perception of those attributes.

Adult↗

PubMed2006

Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients.

At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.

Decision Support Systems, Clinical↗

PubMed1990

Body knowledge and concerns of children with cancer as compared with the knowledge and concerns of other children.

This is a report of a comparative study of body-related knowledge and concerns expressed by three groups of school-age children with (a) a diagnosis of cancer, (b) a chronic or acute orthopedic problem of the extremities, and (c) no serious health problem. Information was obtained from interviews using the Gellert index of Body Knowledge, a sentence-completion test, and a freehand drawing of a house. Data were examined using distributive and comparative statistics. The meaning and clinical usefulness of the findings are discussed.

Adolescent↗

PubMed1988

The knowledge workstation: an electronic environment for knowledge management.

This paper focuses on the creation of the IAIMS workstation in the context of the outcomes of a year-long IAIMS strategic planning process at the Johns Hopkins Medical Institutions (JHMI). These outcomes include a long-term institutional vision for a functional knowledge management environment, a JHMI IAIMS model, a strategic plan, and two model prototypes. The functional requirements and specific implementation strategies for the IAIMS workstation, the prototype for managing the knowledge base of the published biomedical literature, are discussed in detail.

Academic Medical Centers↗

PubMed1997

Development of an instrument to measure knowledge in individuals with rheumatoid arthritis: the ACREU rheumatoid arthritis knowledge questionnaire.

OBJECTIVE: Education is an important component of community based rehabilitation programs for people with rheumatoid arthritis (RA). This study describes the development of a questionnaire to measure knowledge in this context. METHODS: Items were generated using focus group methodology and covered the domains of prognosis, pain management, medications, joint protection, energy conservation, exercise, and coping strategies. RESULTS: After extensive pretesting, the questionnaire was administered to 252 people with RA. The final 31 item questionnaire had acceptable internal consistency (Cronbach's alpha: 0.76, n = 185), test-retest reliability (r = 0.91, p < or = 0.001), content and construct validity. Sensitivity to change was confirmed in the context of a 6 week home based physiotherapy educational intervention. CONCLUSION: The RA knowledge questionnaire is a reliable, valid, and sensitive instrument for measuring the effect of a RA educational intervention.

Adult↗

PubMed1998

Towards knowledge-based retrieval of medical images. The role of semantic indexing, image content representation and knowledge-based retrieval.

Medicine is increasingly image-intensive. The central importance of imaging technologies such as computerized tomography and magnetic resonance imaging in clinical decision making, combined with the trend to store many "traditional" clinical images such as conventional radiographs, microscopic pathology and dermatology images in digital format present both challenges and an opportunities for the designers of clinical information systems. The emergence of Multimedia Electronic Medical Record Systems (MEMRS), architectures that integrate medical images with text-based clinical data, will further hasten this trend. The development of these systems, storing a large and diverse set of medical images, suggests that in the future MEMRS will become important digital libraries supporting patient care, research and education. The representation and retrieval of clinical images within these systems is problematic as conventional database architectures and information retrieval models have, until recently, focused largely on text-based data. Medical imaging data differs in many ways from text-based medical data but perhaps the most important difference is that the information contained within imaging data is fundamentally knowledge-based. New representational and retrieval models for clinical images will be required to address this issue. Within the Image Engine multimedia medical record system project at the University of Pittsburgh we are evolving an approach to representation and retrieval of medical images which combines semantic indexing using the UMLS Metathesuarus, image content-based representation and knowledge-based image analysis.

Abstracting and Indexing↗

PubMed2006

Knowledge for knowledge translation: the role of the Cochrane Collaboration.

Knowledge-translation (KT) activities, including continuing education, should be informed by the totality of available research evidence. Systematic reviews are a generic methodology used to synthesize evidence from a broad range of research methods addressing different questions. Over the past decade, there has been a dramatic increase in the availability of systematic reviews that could support KT activities. However, the conduct of systematic reviews is technically challenging, and it is not surprising that the quality of available reviews is variable. In addition, unless attempts are made to update systematic reviews, they rapidly become out of date. The Cochrane Collaboration is a unique, worldwide, not-for-profit organization that aims to help people make well-informed decisions about all forms of health care by preparing, maintaining, and promoting the accessibility of systematic reviews of the effects of health care interventions. Globally, over 13, 000 consumers, clinicians, policymakers, and researchers are involved with The Cochrane Collaboration and have to date produced over 2, 500 systematic reviews that can be used to inform KT activities. The Cochrane Collaboration publishes its reviews quarterly in The Cochrane Library. Cochrane reviews have been used to develop a number of KT-derivative products for professionals, consumers, and policymakers. Whereas most Cochrane Review groups focus on specific clinical areas, the Cochrane Effective Practice and Organisation of Care Group undertakes reviews of interventions to improve health care delivery and health care systems, including reviews of different KT activities. We summarize the activities of The Cochrane Collaboration and how these can contribute to KT activities.

Canada↗

PubMed2001

Knowledge of results for motor learning: relationship between error estimation and knowledge of results frequency.

The authors of the present study investigated the apparent contradiction between early and more recent views of knowledge of results (KR), the idea that how one is engaged before receiving KR may not be independent of how one uses that KR. In a 2 &times: 2 factorial design, participants (N = 64) practiced a simple force-production task and (a) were required, or not required, to estimate error about their previous response and (b) were provided KR either after every response (100%) or after every 5th response (20%) during acquisition. A no-KR retention test revealed an interaction between acquisition error estimation and KR frequencies. The group that received 100% KR and was required to error estimate during acquisition performed the best during retention. The 2 groups that received 20% KR performed less well. Finally, the group that received 100% KR and was not required to error estimate during acquisition performed the poorest during retention. One general interpretation of that pattern of results is that motor learning is an increasing function of the degree to which participants use KR to test response hypotheses (J. A. Adams, 1971; R. A. Schmidt, 1975). Practicing simple responses coupled with error estimation may embody response hypotheses that can be tested with KR, thus benefiting motor learning most under a 100% KR condition. Practicing simple responses without error estimation is less likely to embody response hypothesis, however, which may increase the probability that participants will use KR to guide upcoming responses, thus attenuating motor learning under a 100% KR condition. The authors conclude, therefore, that how one is engaged before receiving KR may not be independent of how one uses KR.

Adult↗

PubMed2005

[Knowledge, attitudes, and behaviour of the population of the Czech Republic to self-medication I: Knowledge of and information on drugs].

A large survey carried out from June to September 2002 in the territory of the Czech Republic found and analyzed the knowledge of the population of the Czech Republic in relation to self-medication and o-t-c drugs and revealed the main problematic areas from the viewpoint of the public. The survey was particularly focused on the comprehensibility of information in drug information sheets, potential habit-formation, possible misuse and overdose of o-t-c drugs, safety of natural remedies, and possible interactions between o-t-c and prescription drugs. It is obvious that people continue to be afraid of possible undesirable effects of drugs. More than one third of responders consider o-t-c drugs safe from the viewpoint of habit-formation, more than 75% of responders are aware of a risk of misuse and overdose, 79% of responders view natural drugs as safer than the synthetic ones, and 73% of responders are completely sure that there exist possible interactions between drugs.

Adult↗

PubMed2005

[Knowledge, attitudes, and behaviour of the population of the Czech Republic to self-medication--II. Knowledge of and information about drugs].

A large survey carried out from June to September 2002 in the territory of the Czech Republic found and analyzed the knowledge of the population of the Czech Republic in relation to self-medication and o-t-c drugs and revealed the main problematic areas from the viewpoint of the public. The survey was particularly focused on the attitudes to the extending assortment of OTC drugs, self-medication in pregnancy, keeping drug records in pharmacies, and the introduction of basic, general advice on medicaments to the education in elementary schools. The results reveal that 36% of respondents think that the assortment of OTC drugs should be extended. There is also a highly alarming finding that for 36% of respondents the use of common OTC drugs during pregnancy represents a small risk and for approximately 5% it is completely riskless. Only 19% confirmed a great risk and 41% do not know. Drug records have won support of 31% of respondents, and 76% of respondents lend support to the inclusion of instruction on medicament to school education.

Adult↗

PubMed1989

The Diagnostic Knowledge Inventory: a measure of knowledge about psychiatric diagnosis.

A psychometrically sound measure of knowledge of psychiatric disorders and diagnoses (consistent with both DSM-III and DSM-III-R) was constructed for use by mental health and health care professionals. No such measure otherwise exists, in spite of its potential value as an educational tool and in research on clinical diagnosis. The diagnostic accuracy (content validity) of a large item pool of brief case vignettes was verified in a prestudy by a team of experts. This item pool then was reduced by half, and two forms of the measure were constructed based on an item analysis that used a heterogeneous sample of clinically trained and untrained respondents (Study 1). Reliability and validity were demonstrated using a cross-validation sample (Study 2). Finally, comparisons were made between practicing mental health professionals and controls; these supported the measure's validity (Study 3). Overall, the measure demonstrated concurrent validity (by distinguishing clinically trained from untrained respondents) and reliability (by showing internal consistency and inter-form association). Potential uses of the measure in research and training concerned with clinical diagnosis are discussed.

Adult↗

PubMed1999

Slow information processing after very severe closed head injury: impaired access to declarative knowledge and intact application and acquisition of procedural knowledge.

As an explanation of the pattern of slow information processing after closed head injury (CHI), hypotheses of impaired access to declarative memory and intact application and acquisition of procedural memory after CHI are presented. These two hypotheses were tested by means of four cognitive reaction-time tasks, a semantic memory task, a memory comparison task, a mental rotation task and a mirror reading task. These tasks were administered on two different days to 12 survivors of a CHI tested more than 5 years after injury and a healthy control group of comparable age and education. In three tasks the difficulty of access to declarative knowledge was varied and it was expected that this would slow the CHI group more than the controls. In two tasks opportunities for procedural learning were provided by repeatedly presenting the same cognitive tasks and in one task, the difficulty of access to procedural memory was varied. It was expected that the CHI group would profit as much from this as would the control group. Both hypotheses were supported.

Adolescent↗

PubMedDate not supplied

Motivation and organizational principles for anatomical knowledge representation: the digital anatomist symbolic knowledge base.

OBJECTIVE: Conceptualization of the physical objects and spaces that constitute the human body at the macroscopic level of organization, specified as a machine-parseable ontology that, in its human-readable form, is comprehensible to both expert and novice users of anatomical information. DESIGN: Conceived as an anatomical enhancement of the UMLS Semantic Network and Metathesaurus, the anatomical ontology was formulated by specifying defining attributes and differentia for classes and subclasses of physical anatomical entities based on their partitive and spatial relationships. The validity of the classification was assessed by instantiating the ontology for the thorax. Several transitive relationships were used for symbolically modeling aspects of the physical organization of the thorax. RESULTS: By declaring Organ as the macroscopic organizational unit of the body, and defining the entities that constitute organs and higher level entities constituted by organs, all anatomical entities could be assigned to one of three top level classes (Anatomical structure, Anatomical spatial entity and Body substance). The ontology accommodates both the systemic and regional (topographical) views of anatomy, as well as diverse clinical naming conventions of anatomical entities. CONCLUSIONS: The ontology formulated for the thorax is extendible to microscopic and cellular levels, as well as to other body parts, in that its classes subsume essentially all anatomical entities that constitute the body. Explicit definitions of these entities and their relationships provide the first requirement for standards in anatomical concept representation. Conceived from an anatomical viewpoint, the ontology can be generalized and mapped to other biomedical domains and problem solving tasks that require anatomical knowledge.

Anatomy↗