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At least 1,315 records · Page 73Linked to original sources

PubMed2007

Viral infections of the central nervous system in Brazil.

OBJECTIVE: Epidemiological studies have shown that most central nervous system (CNS) infections are viral. The objective of this study is to contribute to the knowledge base concerning viral CNS infections in Ribeirão Preto, Brazil. METHODS: Two hundred cerebrospinal fluid (CSF) samples were taken from patients with clinically suspected viral CNS infection and analyzed for herpesvirus, enterovirus, alphavirus and flavivirus using PCR assays. RESULTS: Viral genome was detected in 43 CSF samples (23.34%): 6% cytomegalovirus (CMV), 5% herpes simplex virus type 1 (HSV-1), 0.5% each varicella-zoster virus (VZV) and Epstein-Barr virus (EBV), and 11.34% enterovirus. Co-infections (CMV-enterovirus and CMV-HSV-1) were found in 3 patients. CSF parameters such as cytology and protein level were normal in many patients with viral genome-positive CSF. CONCLUSIONS: Data obtained in this study contribute to the knowledge base concerning viral CNS infections in Brazil. This information will have a major impact on the clinical management of patients with CNS disease.

Adolescent↗

PubMedDate not supplied

Food matters: changing dimensions of science and practice in the nutrition profession.

OBJECTIVE: This qualitative research describes some of the social organization of the American nutrition profession set in place by an apparent competition between two kinds of knowledge-a science-based knowledge and another more experimental knowledge drawn from practice. DESIGN: The methodological approach is constructivist and uses the theoretical framework of sociologist Dorothy Smith. SUBJECTS AND SETTINGS: Multiple data sources include: interviews and bibliographic data from 23 purposefully selected subjects who taught or studied in a graduate-level Nutrition Program at Teacher College, Columbia University from 1937 to 1992; administrative reports of the Program; faculty writings; dissertations approved by the program; the author's twenty-five years of experience in the nutrition profession; and a series of diagrams drawn to interpret and describe the data. Subjects recounted their varied professional experience during the 55-year period as a part of a larger study. MAIN OUTCOME MEASURES: The research traces changes in the relationship between nutrition science and practice as shaped by underlying sciences (food, agriculture, nutrition and health), related industries (food and health care), and culturally-bound gender ideals. DATA ANALYSIS: Data analysis was based on recommended strategies for an inductive, interpretive, ethnographic case study. RESULTS: Subjects identified three forms of the construct of food-as nutrients, as marketable products, and as nurturance. This research suggests that the nurturing properties of food, the knowledge this generates, and the practitioners associated with nurturance are vulnerable and risk disappearance inside the profession, due to a history of resistance to this aspect of our discipline. IMPLICATIONS: The author recommends collaborative research between nutritionists and historians, sociologists and others to bring forth a more critical history of this profession.

Female↗

PubMed1989

Use of the Quick Medical Reference (QMR) program as a tool for medical education.

The original goal of the INTERNIST-1 project, as formulated in the early 1970s, was to develop an expert consultant program for diagnosis in general internal medicine. By the early 1980s, it was recognized that the most valuable product of the project was its medical knowledge base (KB). The INTERNIST-1/QMR KB comprehensively summarizes information contained in the medical literature regarding diagnosis of disorders seen in internal medicine. The QMR program was developed to enable its users to exploit the contents of the INTERNIST-1/QMR KB in educationally, clinically, and computationally useful ways. Utilizing commonly available microcomputers, the program operates at three levels--as an electronic textbook, as an intermediate level spreadsheet for the combination and exploration of simple diagnostic concepts, and as an expert consultant program. The electronic textbook contains an average of 85 findings and 8 associated disorders relevant to the diagnosis of approximately 600 disorders in internal medicine. Inverting the disease profiles creates extensive differential diagnosis lists for the over 4250 patient findings known to the system. Unlike a standard printed medical textbook, the QMR knowledge base can be manipulated "on the fly" to format displays that match the information needs of users. Preliminary use of the program for education of medical students and medical house officers at several sites has met with an enthusiastic response.

Computer-Assisted Instruction↗

PubMed2003

Spinal cord injury computer-assisted instruction for medical students.

OBJECTIVE: To determine if a computer-assisted instruction program would improve fourth-year medical students' knowledge base related to spinal cord injury, as determined by pretest and posttest scores. DESIGN: A multimedia computer-assisted instruction program was developed and offered on a volunteer basis to an entire class of fourth-year medical students (n = 168). Effectiveness of the instructional content was evaluated with pretests and posttests, and overall user satisfaction with the module was assessed with the courseware evaluation. RESULTS: The responses yielded 83 sets of completed pretest and posttest pairs and 80 sets of fully completed courseware evaluations. Mean posttest score was significantly higher than the mean pretest score (pretest, 6.65 +/- 1.44, vs. posttest, 7.36 +/- 1.38; df = 82, t = -4.74, P < 0.001). Courseware evaluations yielded positive ratings in all areas, including applicability and usability. CONCLUSIONS: The significantly increased posttest scores suggest that the students left the program with an expanded knowledge base in the content areas of spinal cord injury medicine covered in the computer-assisted instruction program.

Clinical Competence↗

PubMed2006

A novel point-of-care information system reduces anaesthesiologists' errors while managing case scenarios.

BACKGROUND AND OBJECTIVES: The On-Line Electronic Help (OLEH) is a point-of-care information system for anaesthesia providers prepared by the European Society of Anaesthesiologists. In this preliminary study the effect of the OLEH availability on the incidence of knowledge-based errors during the management of case scenarios and participants' subjective evaluation of the OLEH were evaluated. METHODS: After a short training session, 48 anaesthesiologists (24 junior residents, 12 senior residents and 12 board-certified) were presented randomly with six computer screen-based case scenarios with, and six without, the option of using the OLEH. Two reviewers evaluated the answers independently according to preconfigured guidelines. RESULTS: The availability of the OLEH was associated with higher scores in 11 of the 12 scenarios, and with a decrease in the incidence of critical errors in 10 scenarios. Time to task completion was increased in one scenario only when the OLEH was used. The degree of professional experience was associated with better scores in five of the scenarios and with a reduced occurrence of critical errors in three scenarios. Forty-two out of 48 participants stated that finding information in the OLEH software was easy and that the system was helpful in managing the scenarios. CONCLUSIONS: This preliminary study demonstrates the potential value of the OLEH in decreasing the number of knowledge-based errors made by anaesthesiologists. According to the encouraging results, the OLEH system is currently under evaluation using full-scale simulation scenarios in an operating room environment.

Anesthesia↗

PubMed2004

Comparing and contrasting undergraduate competence in musculoskeletal medicine with cardiovascular medicine and neurology.

OBJECTIVES: With an increasing prevalence of musculoskeletal conditions within the UK, specialty bodies are concerned that graduating medical students may lack appropriate knowledge in this system. We investigated the knowledge base of final year Sheffield medical students in the musculoskeletal system, compared with other major body systems. METHODS: A computer-based assessment was designed covering core topics that a pre-registration house officer should know about in musculoskeletal medicine, cardiology and neurology, using a predesigned testing format. The test was blueprinted against internal and external guidelines. It comprised 24 extended matching questions, each with three stems. A sample of 74 volunteer students from the final year (year 5) of the medical course at the University of Sheffield took part in the assessment. RESULTS: Overall scores of students on the test ranged from a baseline of 45% to a maximum of 85%. Test reliability was 0.75 (Cronbach's alpha). On stratifying the overall percentages into marks for individual systems, it was found that there were no significant differences between scores in musculoskeletal medicine, cardiovascular medicine or neurology. CONCLUSIONS: Despite the disparity of teaching between musculoskeletal medicine and other major organ systems within Sheffield's integrated medical curriculum, the knowledge base of medical students in the basic and clinical musculoskeletal sciences appears to be similar to that for cardiovascular medicine and neurology by the time of graduation. Nevertheless, several important issues must be addressed before these findings can be generalized.

Adult↗

PubMed1991

Epidemiology and preventive interventions: parental death in childhood as a case example.

Illustrates how standard epidemiologic principles form the knowledge base to justify a preventive intervention for an at-risk population. These principles were applied to a sample of 92 from the population of children aged 8 to 15 at alleged risk for mental health disorders because a parent died. Prior work on this alleged risk population is sparse and flawed. Validly determining the population effect of an alleged risk factor requires assessing the influence of sampling bias. The bias found, underrepresentation of deaths of a mother, did not influence the relations among death of a parent and children's depression and conduct disorder, and the modifiable mediators of risk to be changed by the preventive intervention. The epidemiologic measure of effect indicated that death of a parent is a risk factor for major depression but not for conduct disorder among youth. Families recruited for the preventive intervention by epidemiologic methods (ES families) did not differ significantly from the earlier families on whom the knowledge base was formed. Families referred to the intervention by self or others significantly differed from the ES families in two ways that constituted serious biases. The implications of these biases for prevention were discussed.

Adolescent↗

PubMedDate not supplied

[Realization of an assisted system for medical decision and follow-up in hematologic diseases treated with sequential chemotherapy].

The follow-up of patients treated with sequential chemotherapy in internal medicine departments with special interest in haematology imposes a heavy burden on the entire treating staff. The chances of errors, notably in medical prescriptions and care, are not negligible, and these errors result in iatrogenic complications, readmissions and prolonged stays in hospitals. Designing a medical decision and therapeutic follow-up aid system should be time-saving for the staff and ensure good quality and safe prescriptions as well as reliable therapeutic evaluations and better hospital management. The system described here is developed on 4D Macintosh computer which handles a relational data-base. It includes the data-base, i.e. a knowledge-based system devised by the expert clinician containing "declarative" data and deduced rules which represent the expert's reasoning and determine the action to be taken, and the interface between them. The system easily accepts many parameters, thereby enabling medical knowledge and therapeutic attitudes to be updated.

Decision Making, Computer-Assisted↗

PubMed2004

'Caught in the middle'? Mental nurse training in England 1919-51.

The early history of mental health nurse training is one that has only been partially researched. While some writers have discussed the content and impact of training on the development of mental health nursing, little has been written on the professional and institutional factors that influenced this development. The medical profession, psychiatry, was to play an important role in the development of training and regulation of nursing staff in the large Victorian asylums and was an important influence on the knowledge base of mental health nursing. Their professional organization, the Medico-Psychological Association (the Royal Medico-Psychological Association after 1926 when they acquired a royal prefix) produced the first textbook for asylum nurses in 1885 and established a national training scheme for them 4 years later. However, in 1919 the Nurses Registration Act established the General Nursing Council for England and Wales and this body was given statutory responsibility for the training and registration of nurses, including 'mental' nurses. They were soon to be in conflict with the Medico-Psychological Association. The two organizations continued to run their own rival training schemes for mental health nurses for over 30 years, the Royal Medico-Psychological Association finally relinquishing their role in 1951. The Royal Medico-Psychological Association scheme proved far more popular than the General Nursing Councils, with significantly more nurses participating in it. This paper discusses these organizational influences on the development of 'mental nurse' training and discusses the possible impact that they have had on the knowledge base of mental health nursing.

Education, Nursing↗

PubMed1993

Gender, health, and responsible research.

In women, the prevention or management of diseases and disorders particular to middle-age, as well as those that do not present until later life, requires a substantially improved knowledge base to differentiate those conditions whose causes stem from ovarian hormone insufficiency (and thus are treatable by hormone therapy) from those that do not. Only then can we prevent misdiagnosis, avoid dismissing middle-aged women's medical complaints as "menopausal," and attempt to change the perception that physicians do not render the same attention to women or take women's health care concerns seriously. It is inevitable that dramatic changes in the health care system will be required to accommodate changing population demographics resulting from the burgeoning aging population. Currently, more than 35 million women, or one third of the total female population, is postmenopausal. Last year alone, the number of women reaching age 50 (the average age for menopause in the United States), reached 1.3 million, and this number will approach 2 million per year in the first decade of the 21st century as peak numbers of women from the baby-boom generation reach this milestone. Clearly, as the proportion of older women continues to grow, the need to expand our scientific and medical knowledge base assumes even greater urgency in order to develop efficacious strategies for the delivery of preventive, diagnostic, and clinical health care to older women. These strategies are crucial in reducing morbidity and maintaining the independence of this rapidly growing segment of the population.

Aged↗

PubMed2005

Caring for older Americans: the future of geriatric medicine.

In response to the needs and demands of an aging population, geriatric medicine has grown rapidly during the past 3 decades. The discipline has defined its core values as well as the knowledge base and clinical skills needed to improve the health, functioning, and well-being of older persons and to provide appropriate palliative care. Geriatric medicine has developed new models of care, advanced the treatment of common geriatric conditions, and advocated for the health and health care of older persons. Nevertheless, at the beginning of the 21st century, the health care of older persons is at a crossroads. Despite the substantial progress that geriatric medicine has made, much more remains to be done to meet the healthcare needs of our aging population. The clinical, educational, and research approaches of the 20th century are unable to keep pace and require major revisions. Maintaining the status quo will mean falling further and further behind. The healthcare delivery and financing systems need fundamental redesign to improve quality and eliminate waste. The American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has identified five goals aimed at optimizing the health of older persons: To ensure that every older person receives high-quality, patient-centered health care; To expand the geriatrics knowledge base; To increase the number of healthcare professionals who employ the principles of geriatric medicine in caring for older persons; To recruit physicians and other healthcare professionals into careers in geriatric medicine; To unite professional and lay groups in the effort to influence public policy to continually improve the health and health care of seniors. Geriatric medicine cannot accomplish these goals alone. Accordingly, the Task Force has articulated a set of recommendations primarily aimed at the government, organizations, agencies, foundations, and other partners whose collaboration will be essential in accomplishing these goals. The vision described in this document and the accompanying recommendations are only the broad outline of an agenda for the future. Geriatric medicine, through its professional organizations and its partners, will need to mobilize resources to identify and implement the specific steps that will make the vision a reality. Doing so will require broad participation, consensus building, creativity, and perseverance. The consequences of inaction will be profound. The combination of a burgeoning number of older persons and an inadequately prepared, poorly organized physician workforce is a recipe for expensive, fragmented health care that does not meet the needs of our older population. By virtue of their unique skills and advocacy for the health of older persons, geriatricians can be key leaders of change to achieve the goals of geriatric medicine and optimize the health of our aging population. Nevertheless, the goals of geriatric medicine will be accomplished only if geriatricians and their partners work in a system that is designed to provide high-quality, efficient care and recognizes the value of geriatrics.

Aged↗

PubMed1998

Developing online support for clinical information system developers: the FAQ approach.

OBJECTIVE: We investigate a knowledge-based help system for developers of an integrated clinical information system (CIS). The first objective in the study was to determine the system's ability to answer users' questions effectively. User performance and behavior were studied. The second objective was to evaluate the effect of using questions and answers to augment or replace traditional program documentation. DESIGN: A comparative study of user and system effectiveness using a collection of 47 veritable questions regarding the CIS, solicited from various CIS developers, is conducted. Most questions were concerning the clinical data model and acquiring the data. MEASUREMENTS: Answers using current documentation known by users were compared to answers found using the help system. Answers existing within traditional documentation were compared to answers existing within question-answer exchanges (Q-A's). RESULTS: The support system augmented 39% of users' answers to test questions. Though the Q-A's were less than 5% of the total documentation collected, these files contained answers to nearly 50% of the questions in the test group. The rest of the documentation contained about 75% of the answers. CONCLUSIONS: A knowledge-based help system built by collecting questions and answers can be a viable alternative to large documentation files, providing the questions and answers can be collected effectively.

Artificial Intelligence↗

PubMed1998

An update on adolescent psychopharmacology.

Adolescent pediatricians are being asked to assume a larger role in the management of psychiatric disorders. Therefore, dissemination of the knowledge base regarding the use of psychotropic medications to treat these disorders in children and adolescents is critical. This chapter is an update to the previous "Primer on Adolescent Psychopharmacology" by Bailey and Hendren. Many of the disorders that occur in adolescence are associated with significant morbidity and functional impairment. While the evaluation of adolescents involves a careful assessment of the psychosocial milieu and the implementation of an intervention that involves the use of multiple modalities, pharmacotherapy can diminish symptom severity and thereby assist in the process of recovery. Successful pharmacotherapy begins with the development of an active and reciprocal alliance with the patient and family that allows for sharing of critical information and provision of support. The initiation of treatment should include a clear definition of target symptoms, the potential risks and benefits of the proposed intervention, and a discussion that includes a review of the current treatment experiences in both adult and child psychiatry. The establishment of a method that allows for adequate monitoring of both response and side effects is critical. Clearly, this is a field in its infancy. Thus, practitioners must be acutely aware of both the extent and limitations of the existing knowledge base as well as critical need for more controlled studies of these interventions in adolescence.

Adolescent↗

PubMed1998

TACHY: an expert system for the management of supraventricular tachycardia in the elderly.

PURPOSE: Many physicians find the management of supraventricular tachyarrhythmia (SVT) in the elderly complex and challenging. With the use of artificial intelligence theory, we developed an interactive computer expert system, TACHY, to recommend therapies and warn physicians of potential therapeutic side effects. METHODS: We developed a knowledge base that stores guidelines for the management of SVT in the elderly. After the diagnosis of current SVT was input into the computer, TACHY generated a list of therapeutic options as hypotheses. TACHY then prompted the user to provide current patient-specific clinical information, and the optimal therapeutic option was then selected. Potential therapeutic side effects were also displayed. TACHY was tested in a retrospective and a prospective study. The retrospective study, comprising 96 patients with 126 episodes of SVT, was performed to determine the concordance of therapy between TACHY and cardiologists. A prospective study in 18 patients with 26 episodes of SVT was also performed to validate TACHY's recommendations in restoring sinus rhythm. RESULTS: In the retrospective study the concordance between TACHY and the cardiologist's first therapeutic option was 95.9% (121 of 126 episodes). In the prospective study sinus rhythm was restored in 18 (69%) of 26 episodes of SVT by the first therapeutic option recommended by TACHY. In the remaining eight episodes use of the second or third suggestion of TACHY was successful in controlling the ventricular response to SVT. No adverse reaction to the therapeutic options suggested by TACHY occurred. CONCLUSION: TACHY, a knowledge-based computer expert system that simulates human decision making, produced promising results in the management of SVT in the elderly.

Aged↗

PubMed1988

Micromorphometry of colonic lesions.

In the formulation of a quantitative component for the knowledge base of a diagnostic expert system, we developed a mathematical model to describe nuclear placement patterns in colon. Glands from normal colon, tubular adenomas, and adenocarcinomas were studied, and a ratio developed of percentage internally displaced nuclei to percentage displacement area. This displacement area represented an inner epithelial zone bounded centrally by the lumen and peripherally by the apical limit of basal nuclei. The mean percentage internally displaced nuclei to percentage displacement area ratio was 0.15 +/- 0.13 for normal glands, 0.75 +/- 0.09 for adenomas, and 1.04 +/- 0.13 for carcinomas. When the percentage internally displaced nuclei to percentage displacement area ratio was plotted against total number of nuclei, there was statistically significant separation of the diagnostic categories at alpha less than or equal to 0.05. Relative nuclear area and its variance were also studied for normal colonic glands, adenomas, and adenocarcinomas. Mean relative nuclear area for cells from normal glands was 284.2, from adenomas 342.4, and from adenocarcinomas 416.4, these being statistically significantly different at alpha less than or equal to 0.05. Variance of relative nuclear area, compared for the three diagnostic categories, was statistically significantly increased only in adenocarcinoma. Quantitation of nuclear placement patterns appears to provide a useful diagnostic clue for the knowledge base of a diagnostic expert system in the discrimination among normal colonic glands, adenomas, and adenocarcinomas.

Adenocarcinoma↗

PubMed2004

Combined use of physicochemical data and small-molecule crystallographic contact propensities to predict interactions in protein binding sites.

Knowledge-based methods are a good alternative to force-field-based methods for the analysis of sites of interaction in protein binding cavities. Both the Protein Data Bank (PDB) and the Cambridge Structural Database (CSD) offer a good amount of data on non-covalent interactions. Although different from protein-derived data, small-molecule crystal data from the CSD are worth looking at as they provide a much more abundant and diverse set of intermolecular contacts. CSD data, when properly corrected by use of octanol-water pi values, can be used to predict the type of ligand chemical group most likely to occupy a given position within a protein binding site. Comparison with observed positions of ligand groups shows that the success rates of these predictions vary from 23% to 84%. Often, the group predicted to be most preferred at a given position is similar but not identical to the observed ligand group; if these are considered successes, prediction success rates range from 71% to 94%. Using PDB data, the corresponding rates are 16% to 79%, and 61% to 96%. Specificity of prediction of NH groups is somewhat better when using PDB interaction data, but results of prediction of hydrophobic groups seem worse than those obtained with CSD data. We have analysed the importance of data selection by applying different filters to eliminate unwanted interactions from our knowledge-base. The presence of certain types of interactions can be undesirable if they are unrepresentative of biological situations (contact to solvent molecules in small-molecule crystal structures, secondary crystallographic contacts) or if they are likely to add noise to the data without conveying much new information (long-distance contacts, sparsely-populated data sets). The elimination of solvent contacts was found to have no effect on the prediction of ligand groups in our test set. Both secondary-contact filtering and noise filtering were found to have a clear beneficial effect on predictive ability.

Binding Sites↗

PubMed2003

Toxicogenomic approach for assessing toxicant-related disease.

The problems of identifying environmental factors involved in the etiology of human disease and performing safety and risk assessments of drugs and chemicals have long been formidable issues. Three principal components for predicting potential human health risks are: (1) the diverse structure and properties of thousands of chemicals and other stressors in the environment; (2) the time and dose parameters that define the relationship between exposure and disease; and (3) the genetic diversity of organisms used as surrogates to determine adverse chemical effects. The global techniques evolving from successful genomics efforts are providing new exciting tools with which to address these intractable problems of environmental health and toxicology. In order to exploit the scientific opportunities, the National Institute of Environmental Health Sciences has created the National Center for Toxicogenomics (NCT). The primary mission of the NCT is to use gene expression technology, proteomics and metabolite profiling to create a reference knowledge base that will allow scientists to understand mechanisms of toxicity and to be able to predict the potential toxicity of new chemical entities and drugs. A principal scientific objective underpinning the use of microarray analysis of chemical exposures is to demonstrate the utility of signature profiling of the action of drugs or chemicals and to utilize microarray methodologies to determine biomarkers of exposure and potential adverse effects. The initial approach of the NCT is to utilize proof-of-principle experiments in an effort to "phenotypically anchor" the altered patterns of gene expression to conventional parameters of toxicity and to define dose and time relationships in which the expression of such signature genes may precede the development of overt toxicity. The microarray approach is used in conjunction with proteomic techniques to identify specific proteins that may serve as signature biomarkers. The longer-range goal of these efforts is to develop a reference relational database of chemical effects in biological systems (CEBS) that can be used to define common mechanisms of toxicity, chemical and drug actions, to define cellular pathways of response, injury and, ultimately, disease. In order to implement this strategy, the NCT has created a consortium of research organizations and private sector companies to actively collaborative in populating the database with high quality primary data. The evolution of discrete databases to a knowledge base of toxicogenomics will be accomplished through establishing relational interfaces with other sources of information on the structure and activity of chemicals such as that of the National Toxicology Program (NTP) and with databases annotating gene identity, sequence, and function.

Animals↗

PubMed1999

Analysis of questions asked by family doctors regarding patient care.

OBJECTIVES: To characterise the information needs of family doctors by collecting the questions they asked about patient care during consultations and to classify these in ways that would be useful to developers of knowledge bases. DESIGN: Observational study in which investigators visited doctors for two half days and collected their questions. Taxonomies were developed to characterise the clinical topic and generic type of information sought for each question. SETTING: Eastern Iowa. PARTICIPANTS: Random sample of 103 family doctors. MAIN OUTCOME MEASURES: Number of questions posed, pursued, and answered; topic and generic type of information sought for each question; time spent pursuing answers; information resources used. RESULTS: Participants asked a total of 1101 questions. Questions about drug prescribing, obstetrics and gynaecology, and adult infectious disease were most common and comprised 36% of all questions. The taxonomy of generic questions included 69 categories; the three most common types, comprising 24% of all questions, were "What is the cause of symptom X?" "What is the dose of drug X?" and "How should I manage disease or finding X?" Answers to most questions (702, 64%) were not immediately pursued, but, of those pursued, most (318, 80%) were answered. Doctors spent an average of less than 2 minutes pursuing an answer, and they used readily available print and human resources. Only two questions led to a formal literature search. CONCLUSIONS: Family doctors in this study did not pursue answers to most of their questions. Questions about patient care can be organised into a limited number of generic types, which could help guide the efforts of knowledge base developers.

Adult↗