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PubMed1986

The INTERNIST-1/QUICK MEDICAL REFERENCE project--status report.

INTERNIST-1 and its successor, QUICK MEDICAL REFERENCE (QMR), are computer programs designed to provide health care professionals with diagnostic assistance in general internal medicine. Both programs rely on the INTERNIST-1 computerized knowledge base, which comprehensively describes 570 diseases in internal medicine. The philosophies behind the development of each program differ. Whereas INTERNIST-1 functions solely as a high-powered diagnostic consultant program, the QMR program acts more as an information tool, providing users with multiple ways of reviewing and manipulating the diagnostic information in the program's knowledge base. At the lowest level, the program can be viewed as an electronic textbook of medicine. In addition, the QMR program has the ability to assist users with generating hypotheses in complex patient cases. The QMR program has not been evaluated formally as an information tool for practicing physicians. A preliminary study indicates that QMR's case-analysis capabilities are of potential benefit in most patients in internal medicine admitted for diagnostic evaluation.

Diagnosis, Computer-Assisted↗

PubMed1996

An intelligent system for the diagnosis of complex images.

An intelligent system suitable to perform a computer aided diagnosis of complex images should have a knowledge base containing all information related both to the images to be interpreted and to their symbolic description. In this paper, a system able to classify unknown medical digital images into four classes is proposed (searched pathology recognized, searched pathology absent, different pathology from the searched one recognized, unknown pathology). A main component of this system is a knowledge base that, startling from information deduced from sample images, can be processed to create synthetic reference models that, in turn, permit the interpretation of real scenes. The system has been tested on digitized plain film of the thorax, in order to perform a computer-aided diagnosis of pneumothorax cases.

Artificial Intelligence↗

PubMed2003

Step-by-step mark-up of medical guideline documents.

Approaches to formalization of medical guidelines can be divided into model-centric and document-centric. While model-centric approaches dominate in the development of clinical decision support applications, document-centric, mark-up-based formalization is suitable for application tasks requiring the 'literal' content of the document to be transferred into the formal model. Examples of such tasks are logical verification of the document or compliance analysis of health records. The quality and efficiency of document-centric formalization can be improved using a decomposition of the whole process into several explicit steps. We present a methodology and software tool supporting the step-by-step formalization process. The knowledge elements can be marked up in the source text, refined to a tree structure with increasing level of detail, rearranged into an XML knowledge base, and, finally, exported into the operational representation. User-definable transformation rules enable to automate a large part of the process. The approach is being tested in the domain of cardiology. For parts of the WHO/ISH Guidelines for Hypertension, the process has been carried out through all the stages, to the form of executable application, generated automatically from the XML knowledge base.

Artificial Intelligence↗

PubMed2004

Moving forward? Complementary and alternative practitioners seeking self-regulation.

Complementary and alternative medicine (CAM) occupations continue to struggle towards achieving professional status, especially in the form of statutory regulation. Many consider professional status a worthwhile goal for CAM occupations, yet it is a process fraught with tensions. In this paper we present in-depth interview data from the leaders of three CAM groups (naturopaths, traditional Chinese medicine practitioners acupuncturists, and homeopaths) in Ontario, Canada that demonstrate four main strategies used by these groups to professionalize. The strategies discussed are related to how the knowledge base of each group is organised and transmitted. These strategies include: improving educational standards, improving practice standards, engaging in peer-reviewed research and increasing group cohesion. At the core of these strategies is the demarcation of who is qualified to practice, and a signalling to 'outsiders', such as medicine and the government, that practitioners are qualified and legitimate. Across the three groups, the leaders referred to the inclusion of medical science as a basis for distinguishing between 'science' and 'non-science' as well as who should practice and who should not. We highlight how internal battles over the infusion of medical science into the knowledge base are part of the process for establishing legitimacy for the three CAM groups in our study. We end with a brief discussion of the implications of these internal battles over medical science knowledge for the future of CAM groups.

Attitude of Health Personnel↗

PubMedDate not supplied

A computer-based AIDS education program for nursing students.

A multidisciplinary team has developed a computer-based software program for educating nursing students and other college students about six sexually transmitted diseases (STDs). The program for educating about Acquired Immune Deficiency Syndrome (AIDS) is the first of the six "Smartbooks" to be completed, using the Hypercard Expert System shell on the Macintosh computer. Information is organized within a framework known as a concept map, and the student user progresses through the program in a self-directed way by "clicking" on the portion of the concept map that is of interest. Thus, the knowledge base can be accessed in many different ways, and is not restricted to a linear format. Comparative quantitative analysis using a control program shows consistently better student retention of information presented within the program that features concept maps. Qualitative results indicate that students find the conceptually-arranged knowledge base implicitly easy to understand, "fun" to use, and interesting to explore. Educational theory suggests that the success of such a format may be related to the schematic nature of memory.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Humanism and positivism in nursing: contradictions and conflicts.

Nursing and nurse education have been influenced by a shift towards a broadly humanistic philosophy as a basis for practice. At the same time, in attempts to develop a knowledge base and credibility as a profession, the vital importance of research has been acknowledge. Both these aspects of nursing are increasingly forming the basis for all nursing courses. However, in this paper, it is argued that the implicit adoption of notions of science based in a positivistic paradigm gives rise to conflicts with a humanistic philosophy. It is contended that nursing has inherited a 'legacy of positivism', which promotes objectivity and reductionism and which excludes subjective meaning and the personal from the research process. In part this has been due to the powerful influence of medical hegemony, which has defined the nature of legitimate knowledge and controlled nursing research through the gatekeeping function of doctors. If nursing is to make progress in the development of a knowledge base, the contradictions between humanism and positivism must be acknowledged as a barrier to an integration of the art and science of nursing. This paper suggests that what is required is a paradigm shift, a redefinition of nursing science, which not only rehumanizes the nature of research, but also refutes and challenges the notion of objectivity and the objective attitude.

Conflict, Psychological↗

PubMed2003

Public education regarding resuscitation: effects of a multimedia intervention.

STUDY OBJECTIVE: Previous studies have demonstrated inaccuracies in knowledge and perceptions regarding cardiopulmonary resuscitation (CPR) among the general public. This study was undertaken to determine the effect of a multimedia educational intervention on knowledge base and resuscitation preferences among the lay public. METHODS: In this prospective interventional study with preintervention and postintervention measurements, a validated multisite survey was administered to 310 volunteer lay participants in community-based settings during 2001 and 2002. The survey was piloted and validated (percentage of agreement index 98.6%; 95% confidence interval [CI] 0.9810 to 0.9900). An original 8-minute multimedia educational video was written and produced by physicians to provide educational information about cardiac resuscitation to the lay public. RESULTS: Among 310 participants, the mean age was 40 years (range 17 to 92 years), 67% were female, and 57% reported household incomes of more than 30,000 US dollars. Participants' median estimates of predicted postcardiac arrest survival rate before and after the educational intervention were 50% and 16%, respectively (median change 30%; 95% CI 25% to 35%). Median estimated durations of resuscitative efforts in the emergency department before and after the educational intervention were 30 minutes and 19 minutes, respectively (median change 10 minutes; 95% CI 5 to 15 minutes). For a series of hypothetical scenarios, significantly more participants indicated that they would refuse resuscitative efforts in scenarios involving terminally ill patients after the educational intervention. CONCLUSION: Inaccurate perceptions regarding cardiac resuscitation and postarrest survival exist among the lay public. A novel educational intervention demonstrated effective improvements in knowledge base regarding resuscitation, resulting in significant effects on resuscitation preferences among the lay public. Improved public education regarding resuscitation is needed to improve knowledge regarding CPR among the lay public.

Adolescent↗

PubMed2004

Structured representation of the pharmacodynamics section of the summary of product characteristics for antibiotics: application for automated extraction and visualization of their antimicrobial activity spectra.

OBJECTIVE: The aim of this study was to construct automatically a knowledge base concerning the pharmacodynamic properties of antibiotics and a visualization tool. DESIGN: The authors studied the various guidelines used to write the pharmacodynamics section of the Summary of Product Characteristics (SPC) for antibiotics and constructed a conceptual model of the information. Particular words, syntagms, and punctuation elements were marked in the SPC texts, and automatic extraction was then used to build a knowledge base. This base was used to create dynamic HTML tables displaying the activity spectra of the antibiotics. MEASUREMENTS: The authors analyzed the performances of automatic extraction (recall and precision). RESULTS: The conceptual pharmacodynamics model dealt with antibiotics, pathogens, susceptibility tests, and the prevalence of resistance. Automatic extraction had a recall rate of 97.9% and a precision of 96.2%. The tool displaying antibiotic spectra and resistance prevalences used color codes to identify differences in susceptibility. CONCLUSION: This tool can provide an overview of the prevalence of resistance as expressed in SPC in primary care settings. Its potential impact should be evaluated.

Anti-Bacterial Agents↗

PubMed2001

Counseling and treating bad breath patients: a step-by-step approach.

Bad breath (oral malodor, halitosis) can be detrimental to one's self-image and confidence causing social, emotional, and psychological anxiety. With the majority of breath problems having an oral origin, the dental office is the most logical place for patients to seek treatment. When patients look to dental professionals for expert advice, it is critical they have the knowledge base and communication techniques to provide quality clinical assessment and implement effective intervention programs. Moreover, dental professionals should feel comfortable proactively counseling patients about oral malodor without fear of offending the patient. Numerous continuing education programs and journal articles related to the diagnosis and treatment of oral malodor are available. In addition, electronic sources are accessible for dental professionals to expand their knowledge base regarding oral malodor information. Fewer resources are available, however, regarding techniques to facilitate an effective dialogue with patients on this sensitive issue. This article seeks to provide such information and to help professionals tailor the target communication message to meet the specific needs of individual patients.

Communication↗

PubMed2006

Dentists' preparedness for responding to bioterrorism: A survey of Hawaii dentists.

BACKGROUND: The authors conducted a survey of dentists in Hawaii to assess their knowledge of, perceived readiness for and willingness to respond to bioterrorist (BT) events. METHODS: Using a cross-sectional study design to access a random sample (n = 240) of all licensed dentists residing in the state of Hawaii (N = 1,016), the authors mailed study participants an anonymous survey up to three times during June and July 2004. Knowledge-based questions were taken from accredited Internet-based free continuing medical education offerings. RESULTS: Of 234 deliverable surveys, 133 were returned (response rate of 56.8 percent). Only 2.3 percent of respondents reported having received prior BT preparedness training. A total of 14.5 percent felt able to identify and recognize a BT event, and 9.2 percent indicated they were able to respond effectively to a BT attack. A total of 73.8 percent expressed willingness to provide assistance to the state in the event of a BT attack. Dentists scored a mean of 62 percent correct (5.6 of nine questions) on the objective knowledge-based questions. CONCLUSIONS: A low prevalence of prior training coupled with a high degree of willingness to provide assistance indicates the need for additional BT preparedness training. This should be provided as continuing education offerings to practicing dentists and incorporated into the dental school curriculum. CLINICAL IMPLICATIONS: Dentists have the basic knowledge and experience to perform a number of key roles in a BT event; however, additional training must be provided to develop BT preparedness competencies.

Adult↗

PubMed2000

Neurological rehabilitation nursing: a review of the research.

Neurological rehabilitation is increasingly seen as a specialist form of rehabilitation requiring specialist nursing knowledge. However, as in many areas of nursing, nurses in this field recognize that there is a need to increase their knowledge base to ensure that they provide the best and most up-to-date quality care for their patients and their families. To achieve high levels of competence, neurological rehabilitation nurses need to be aware of the existing body of research in this field so that they can make sound decisions regarding their practice and future research endeavours. This review aims to validate the existing knowledge base in this area by identifying and critically analysing research conducted in the area of neurological rehabilitation nursing during the decade 1988-1998 and by identifying any gaps and weaknesses that may be addressed by future research. Studies were included in the review if they examined an aspect of rehabilitation nursing, were concerned predominately with the neurological patient and were conducted in an in-patient setting. Research with a medical focus was not included and only research published in English was reviewed. Relevant research located examined the following areas: (1) the role of the rehabilitation nurse; (2) specific problems concerning the neurological rehabilitation patient; (3) specific nursing interventions; (4) rehabilitation nursing practice; (5) the delivery of rehabilitation programmes and team working; and (6) the family of the rehabilitation patient. The review concludes that research in this speciality remains limited both in quantity and quality. Most of the studies lack rigour and, because they were conducted at a single site, their generalizability to other clinical sites may be limited.

Brain Diseases↗

PubMed1991

Changing trends in melanoma treatment and the expanding role of the dermatologist.

As the incidence of melanoma continues to increase, so does the role of the dermatologist as both medical and surgical oncologist for these patients, especially those with stage I disease. The dermatologist holds a key role in all phases of care, including prevention, diagnosis, treatment, and follow-up. The dermatologist is best trained to complete a full and thorough skin examination and is best able to recognize a melanoma at its earliest stages of radial growth. In large part because of advances in dermatology, the dysplastic nevus syndrome has been identified as an important marker and precursor lesion for melanoma; the dermatologist has the best knowledge base for the recognition and management of both sporadic and familial dysplastic nevi. Dermatologists also have the unique opportunity (by virtue of their patient population concerned with skin problems) to prevent melanoma through patient education concerning sun protection, self-examinations, and the ABCDs of melanoma recognition. The dermatologist is well trained to obtain an appropriate, full-thickness skin biopsy specimen and is also knowledgeable to interpret the pathologist's report, understanding the significance of the various histologic prognostic indices. Because of the changing trends in excisional margin size and fewer recommendations for ELND, the dermatologist is becoming more active in the surgical management of melanoma patients. In the MDMC, the dermatologist was clearly recognized as a capable surgeon to perform the wide local excisions for stage I patients. Almost one half of the patients seen (49%) were surgically treated in the department of dermatology. Of group I patients, 78% were treated by dermatologists. The dermatologist as surgeon should be capable of performing a wide local excision to the level of deep subcutaneous tissue or muscle fascia with an appropriate primary layered closure, local flap, or graft. Our experience confirms that the majority of patients present with local disease and a thin Breslow depth and thus can be skillfully treated in an outpatient setting under local anesthesia by a dermatologic surgeon. In follow-up, the dermatologist should provide continuity of care and should be knowledgeable in appropriate interval examinations and tests. The dermatologist is thoroughly skilled at the cutaneous examination and has the knowledge base to perform a careful and competent lymph node examination. As primary medical oncologist to these patients, the dermatologist needs to recognize stage II and stage III disease and be able to comprehensively discuss with the patient the options for treatment and how they affect their prognosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Combined Modality Therapy↗

PubMed1997

A university-affiliated community hospital inpatient geriatrics program functioning in an administrative and educational capacity.

OBJECTIVE: To demonstrate an unusual form of inpatient geriatric assessment with unique outcomes. DESIGN: A prospective evaluation of patients admitted to a community hospital-based inpatient geriatrics unit utilizing traditional members of the assessment team along with educational assessment of nurses and satisfaction profiles of patients and/or families. SETTING: A non-profit community hospital in Northeast Washington, DC. PARTICIPANTS: All patients older than age 62 admitted to the 42-bed Geriatric Unit during a 4 1/2 year time period. MEASUREMENTS: Number of total and category recommendations taken by attending physicians from the Inpatient Geriatric Assessment Team, periodic evaluation of unit nurses' geriatric knowledge base and certification, and patient satisfaction through periodic surveys. RESULTS: More than 4500 patients have been evaluated during the past 4 1/2 years. The number of recommendations taken by attending physicians has averaged 31.3 to 50.7% during four consecutive chart reviews involving the first 25 consecutive patients for the month each performed every six months (n = 100). The average age of patients evaluated was 77.2 (minimum of 62 and maximum of 97); 67% were females and 33% males. The average number of recommendations communicated per patient was 4.1, and the average number adhered to 1.6/patient. The overall knowledge base and certification in geriatric nursing has increased significantly over a 2.5-year period. Composite monthly unit patient satisfaction survey scores increased as well. CONCLUSIONS: The program is unique in its development, limitations, and outcomes. Other than the cost of limited geriatric nurse practitioner and faculty salary support, the program has been implemented using only current hospital department personnel. The role of the assessment team is to educate attending nurses and staff physicians. It has not yet been possible to measure objective outcomes. However, the current program also serves the purpose of introducing a new medical program to a community hospital in a nonthreatening way and offers opportunities for research. In addition, the program offers further opportunity for expansion and change.

Aged↗

PubMed2001

Color image detection by biomolecular photoreceptor using bacteriorhodopsin-based complex LB films.

A biomolecular photoreceptor consisting of bacteriorhodopsin (bR)-based complex Langmuir-Blodgett (LB) films was developed for color image detection. By mimicking the functions of the pigments in retina of human visual system, biomolecules with photoelectric conversion function were chosen and used as constituents for an artificial photoreceptor. bR and flavin were deposited onto the patterned (9-pixelized) ITO glass by LB technique. A 9-pixel biomolecular photoreceptor was fabricated with a sandwich-type structure of ITO/LB films/electrolyte gel/Pt. Since each functional molecule shows its own response characteristic according to the light illumination in the visible region, the simplified knowledge-based algorithm for interpretation of the incident light wavelength (color) was proposed based on the basic rule describing the relationship between the photoelectric response characteristics and the incident light wavelength. When simple color images were projected onto the photoreceptor, the primary colors in visible light region, red, green, and blue were clearly recognized, and the projected color images were fairly well reproduced onto the color monitor by the proposed photoreceptor with the knowledge-based algorithm. It is concluded that the proposed device has a capability of recognizing the color images and can be used as a model system to simulate the information processing function of the human visual system.

Algorithms↗

PubMed2006

On measuring the change in size of pulmonary nodules.

The pulmonary nodule is the most common manifestation of lung cancer, the most deadly of all cancers. Most small pulmonary nodules are benign, however, and currently the growth rate of the nodule provides for one of the most accurate noninvasive methods of determining malignancy. In this paper, we present methods for measuring the change in nodule size from two computed tomography image scans recorded at different times; from this size change the growth rate may be established. The impact of partial voxels for small nodules is evaluated and isotropic resampling is shown to improve measurement accuracy. Methods for nodule location and sizing, pleural segmentation, adaptive thresholding, image registration, and knowledge-based shape matching are presented. The latter three techniques provide for a significant improvement in volume change measurement accuracy by considering both image scans simultaneously. Improvements in segmentation are evaluated by measuring volume changes in benign or slow growing nodules. In the analysis of 50 nodules, the variance in percent volume change was reduced from 11.54% to 9.35% (p = 0.03) through the use of registration, adaptive thresholding, and knowledge-based shape matching.

Algorithms↗

PubMed2001

Factors predicting trust between GPs and OPs.

PURPOSE: To study possible differences in trust between general practitioners (GPs) and occupational physicians (OPs) and the explanatory factors for trust. Insight into the factors predicting trust can improve programmes for stimulating the co-operation of GPs and OPs. THEORY: On the basis of theories of trust and of social identity theory we expected, (1) in both professions a higher level of knowledge-based trust than of identification-based trust, (2) a relationship between higher levels of identification-based trust and higher frequency of contact, (3) OPs to have a higher level of identification-based trust than GPs. We hypothesised (4) that OPs perceiving an equal status have higher levels of trust and (5) GPs perceiving a higher status have lower levels of trust. METHODS: A mail survey sent to 2297 doctors (1728 GPs and 569 OPs) of which we used 547 questionnaires. RESULTS: Hypotheses 1 and 2 were supported. Hypothesis 3 was not supported. Hypotheses 4 and 5 were supported for knowledge-based trust. On the basis of these findings it is possible that co-operation between the two groups is still in its early stages. CONCLUSIONS: Programmes to improve the co-operation of GPs and OPs should focus on equalising status and stimulating contacts to build (identification-based) trust.

Journal Article↗

PubMedDate not supplied

A social services-public health partnership in child protection: a rural model.

It is widely recognized that the amelioration of individual and family problems which contribute to child abuse and neglect requires a multidisciplinary effort. Unfortunately, however, these efforts are often sporadic or disjointed. This article is a description of a county social service-public health partnership in rural Minnesota which can serve as a model for other agencies interested in developing more interactive relationships with one another to the benefit of dysfunctional families and vulnerable children. A respect for one another's professional knowledge base and skills, a shared philosophy of intervention, and supportive agency administrators are the key components that make this model successful. Social workers and public health nurses working together--and in cooperation with still other professionals in the community--can identify and help to resolve those unmet social, psychological, and health needs which often are found in dysfunctional families. Public health nurses have many talents and a very diverse knowledge base that can be tapped by legally designated social workers who are charged by State statutes with intervening in cases involving physical or sexual abuse or neglect of children. The Brown County, MN, model is an example of a collaborative strategy that can be replicated nationwide.

Adolescent↗

PubMed1999

Improvement of side-chain modeling in proteins with the self-consistent mean field theory method based on an analysis of the factors influencing prediction.

With the objective of improving side-chain conformation prediction, we have analyzed the influence of various factors on prediction by the Self-Consistent Mean Field Theory method, applied to a set of high resolution x-ray protein structure models. These factors may be classed as variations in the mean field optimization protocol, variations in the potential energy function, and variations in rotamer library completeness. We have developed an optimization protocol that consistently reached lower mean field conformational free energies than two other protocols. This protocol led to an important improvement in prediction. We observed a major improvement in prediction with two more detailed van der Waals parameter sets, which we found to be due mainly to the introduction of scaling of 1-4 interactions. In a comparison of two knowledge-based rotamer libraries of considerably different size, we observed an unexpected decrease in prediction with an increase in library completeness. However, when we introduced a torsion potential term in the potential energy function, we found an important increase in average prediction and in the prediction of almost all residue types with a more complete rotamer set. The two knowledge-based rotamer libraries now became equivalent in terms of average prediction. The results we obtained in an analysis of the effect of the introduction of an additional electrostatic term in the potential energy function were largely inconclusive. However, we found a small increase in average prediction for an electrostatic potential term with a fixed dielectric constant of 15. The combined effect of all the factors we analyzed in this study resulted in average prediction accuracies of 79.9% for X1, 68.1% for X1 + 2, and 1.590 A for global rms deviation (RMSD); the corresponding values for core residues were 88.2%, 78.6%, and 1.171 A. These values represent improvements in average prediction of 6.5% for X1, 9.1% for X1 + 2, and 0.163 A for global RMSD over the original conditions; the corresponding improvements in the core were 5.9%, 9.0%, and 0.180 A, respectively.

Amino Acids↗