Explaining risk factors to patients during a general practice consultation. Conveying group-based epidemiological knowledge to individual patients.
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Epidemiology↗
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Results for “Knowledge base”
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The mind-body connection: the psychophysiology of many traditional nursing interventions.
The bidirectional relationship between mind and body and the concept that psychological processes can produce attendant physiologic changes are explored in this article. The mind-body connection provides a framework for exploring a psychophysiologic explanation for the therapeutic properties of some traditional nursing interventions to potentiate health and healing. This model allows nurses to move from tradition-based practice to knowledge-based practice. CNSs provide direct patient care, consult with staff nurses, influence systems of care, and engage in outcome research. This mind-body paradigm provides a model for practice and a framework for quantifying outcomes.
Holistic Health↗
Infection in prolonged pediatric critical illness: A prospective four-year study based on knowledge of the carrier state.
OBJECTIVE: This study was performed to determine the rate, timing, and incidence density of infections occurring in a subgroup of patients requiring a prolonged stay in a regional pediatric intensive care unit. DESIGN: Prospective, observational cohort study over 4 yrs. SETTING: This epidemiologic descriptive study was performed in a university hospital 20-bed pediatric intensive care unit. PATIENTS: Critically ill children requiring > or = 4 days of intensive care. INTERVENTIONS: The microbial carrier state of the children was monitored by surveillance cultures of throat and rectum, obtained on admission and twice weekly afterward. MEASUREMENTS AND MAIN RESULTS: Data are presented on a total of 1,241 children, accounting for 1,443 admissions to the unit, corresponding to 18,203 patient days. The median pediatric index of mortality was 0.063 (interquartile range, 0.025-0.131), and the mortality rate in this subset of children was 9.6%. Five hundred twenty children had infections, an overall infection rate of 41.9% (520 of 1,241); 14.5% (180 of 1,241) of the children developed viral and 33.0% (410 of 1,241) developed bacterial/yeast infections. The incidence of bloodstream infection was 20.1 and lower airway infection 9.1 episodes per 1,000 patient days. We found that 13.3% of the children were infected with a bacterial/yeast microorganism acquired on the pediatric intensive care unit; 4.0% (50 of 1,241) of children developed infections due to resistant microorganisms. There were a total of 803 bacterial/yeast infectious episodes, of which 59.8% (480) were due to microorganisms imported in the patients' admission flora. These primary endogenous infections predominantly occurred within the first week of pediatric intensive care unit stay. The other 38.9% (312) were caused by microorganisms acquired on the pediatric intensive care unit. A total of 38 viral infections (24.5%) were acquired during pediatric intensive care unit stay. CONCLUSIONS: Two thirds of all infections diagnosed in children with prolonged illness on pediatric intensive care unit were due to microorganisms present in the patients' admission flora.
Carrier State↗
Origins and early development of human body knowledge.
As a knowable object, the human body is highly complex. Evidence from several converging lines of research, including psychological studies, neuroimaging and clinical neuropsychology, indicates that human body knowledge is widely distributed in the adult brain, and is instantiated in at least three partially independent levels of representation. Sensorimotor body knowledge is responsible for on-line control and movement of one's own body and may also contribute to the perception of others' moving bodies; visuo-spatial body knowledge specifies detailed structural descriptions of the spatial attributes of the human body; and lexical-semantic body knowledge contains language-based knowledge about the human body. In the first chapter of this Monograph, we outline the evidence for these three hypothesized levels of human body knowledge, then review relevant literature on infants' and young children's human body knowledge in terms of the three-level framework. In Chapters II and III, we report two complimentary series of studies that specifically investigate the emergence of visuo-spatial body knowledge in infancy. Our technique is to compare infants'responses to typical and scrambled human bodies, in order to evaluate when and how infants acquire knowledge about the canonical spatial layout of the human body. Data from a series of visual habituation studies indicate that infants first discriminate scrambled from typical human body picture sat 15 to 18 months of age. Data from object examination studies similarly indicate that infants are sensitive to violations of three-dimensional human body stimuli starting at 15-18 months of age. The overall pattern of data supports several conclusions about the early development of human body knowledge: (a) detailed visuo-spatial knowledge about the human body is first evident in the second year of life, (b) visuo-spatial knowledge of human faces and human bodies are at least partially independent in infancy and (c) infants' initial visuo-spatial human body representations appear to be highly schematic, becoming more detailed and specific with development. In the final chapter, we explore these conclusions and discuss how levels of body knowledge may interact in early development.
Child↗
The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines for sexual medicine.
INTRODUCTION: Erectile dysfunction (ED) is a highly prevalent disorder associated with a significant burden of illness. The prevalence and incidence of ED are strongly age-related, affecting more than half of men >60 years. The first Princeton Consensus Conference (Princeton I) in 1999 developed guidelines for safe management of cardiac patients regarding sexual activity and the treatment of ED. AIM: The second conference (Princeton II) was convened to update the recommendations based on the expanding knowledge base and new treatments available. This article reviews and expands on the Princeton II guidelines to address sexual dysfunction and cardiac risk. METHODS: A consensus panel of experts reviewed recent multinational studies in safety and drug interaction data for three phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety of these agents in men with ED and concomitant cardiovascular disease. RESULTS: Erectile dysfunction is an early symptom or harbinger of cardiovascular disease, due to the common risk factors and pathophysiology mediated through endothelial dysfunction. Major comorbidities include diabetes, hypertension, hyperlipidemia and heart disease. Any asymptomatic man who presents with ED that does not have an obvious cause (e.g., trauma) should be screened for vascular disease and have blood glucose, lipids, and blood pressure measurements. Ideally, all patients at risk but asymptomatic for coronary disease should undergo an elective exercise electrocardiogram to facilitate risk stratification. Lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease, is literature-supported. CONCLUSIONS: The recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise. Men with ED and other cardiovascular risk factors (e.g., obesity, sedentary lifestyle) should be counseled in lifestyle modification.
Adult↗
Aprotinin in the management of Achilles tendinopathy: a randomised controlled trial.
BACKGROUND: Achilles tendinopathy is a common condition, which can become chronic and interfere with athletic performance. The proteinase inhibitor aprotinin (as injection) has been found to improve recovery in patellar tendinopathy (evidence level 1b) and Achilles tendinopathy. Internationally this therapy is being used based on this limited knowledge base. AIM: To evaluate whether aprotinin injections decrease time to recovery in Achilles tendinopathy. METHOD: A prospective, randomised, double blind, placebo controlled trial was performed comparing saline (0.9%) plus local anaesthetic injections and eccentric exercises with aprotinin (30,000 kIU) plus local anaesthetic injection and eccentric exercise. Three injections were given, each a week apart. In total, 26 patients, with 33 affected tendons, were enrolled for this study. RESULTS: At no follow up point (2, 4, 12, or 52 weeks) was there any statistically significant difference between the treatment group and placebo. This included VISA-A scores and secondary outcome measures. However, a trend for improvement over placebo was noted. CONCLUSION: In this study on Achilles tendinopathy, aprotinin was not shown to offer any statistically significant benefit over placebo. Larger multicentre trials are needed to evaluate the efficacy of aprotinin in Achilles tendinopathy.
Achilles Tendon↗
Automated metabolic reconstruction for Methanococcus jannaschii.
We present the computational prediction and synthesis of the metabolic pathways in Methanococcus jannaschii from its genomic sequence using the PathoLogic software. Metabolic reconstruction is based on a reference knowledge base of metabolic pathways and is performed with minimal manual intervention. We predict the existence of 609 metabolic reactions that are assembled in 113 metabolic pathways and an additional 17 super-pathways consisting of one or more component pathways. These assignments represent significantly improved enzyme and pathway predictions compared with previous metabolic reconstructions, and some key metabolic reactions, previously missing, have been identified. Our results, in the form of enzymatic assignments and metabolic pathway predictions, form a database (MJCyc) that is accessible over the World Wide Web for further dissemination among members of the scientific community.
Computational Biology↗
Audiologic management of older adults with hearing loss and compromised cognitive/psychoacoustic auditory processing capabilities.
The number and proportion of older adults in the United States population is increasing, and more clinical audiologists will be called upon to deliver hearing care to the approximately 35% to 50% of them who experience hearing difficulties. In recent years, the characteristics and sources of receptive communication difficulties in older individuals have been investigated by hearing scientists, cognitive psychologists, and audiologists. It is becoming increasingly apparent that cognitive compromises and psychoacoustic auditory processing disorders associated with aging may contribute to communication difficulties in this population. This paper presents an overview of best practices, based on our current knowledge base, for clinical management of older individuals with limitations in cognitive or psychoacoustic auditory processing capabilities, or both, that accompany aging.
Age Factors↗
Homology induction: the use of machine learning to improve sequence similarity searches.
BACKGROUND: The inference of homology between proteins is a key problem in molecular biology The current best approaches only identify approximately 50% of homologies (with a false positive rate set at 1/1000). RESULTS: We present Homology Induction (HI), a new approach to inferring homology. HI uses machine learning to bootstrap from standard sequence similarity search methods. First a standard method is run, then HI learns rules which are true for sequences of high similarity to the target (assumed homologues) and not true for general sequences, these rules are then used to discriminate sequences in the twilight zone. To learn the rules HI describes the sequences in a novel way based on a bioinformatic knowledge base, and the machine learning method of inductive logic programming. To evaluate HI we used the PDB40D benchmark which lists sequences of known homology but low sequence similarity. We compared the HI methodology with PSI-BLAST alone and found HI performed significantly better. In addition, Receiver Operating Characteristic (ROC) curve analysis showed that these improvements were robust for all reasonable error costs. The predictive homology rules learnt by HI by can be interpreted biologically to provide insight into conserved features of homologous protein families. CONCLUSIONS: HI is a new technique for the detection of remote protein homology--a central bioinformatic problem. HI with PSI-BLAST is shown to outperform PSI-BLAST for all error costs. It is expect that similar improvements would be obtained using HI with any sequence similarity method.
Algorithms↗
A model for developing effective treatments: progression and interplay of theory, research, and practice.
The central thesis of this article is that advances in psychotherapy research for children and adolescents are limited, despite the large number of controlled studies and consistent conclusions about demonstrated effectiveness. The ways in which individual studies are conducted and the lack of an overall plan for the progression of research to identify effective treatments have contributed to the limited conclusions. In this article, I identify steps toward developing effective treatment that entail conceptualization and investigation of clinical problems, processes of change, and conditions that influence treatment outcome. Progress will not only require more systematic accretion of research, but also expansion in the range of questions, outcomes, and models of treatment delivery that are examined. Efforts to improve the knowledge base and to integrate knowledge into clinical practice can also be greatly enhanced by modifying the ways in which clinical work is conducted and specifically by systematically monitoring treatment implementation and patient progress.
Adolescent↗
Nurses' confidence and pharmacological knowledge: a study.
The introduction of nurse prescribing will assist the government to deliver its agenda of providing patients with faster access to advice and health services. This study evaluated the knowledge base, self-rated knowledge and confidence, for a prescribing role, in a group of community nurses in Essex. A questionnaire was distributed to 183 community nurses recruited using a random, stratified method, and 110 nurses returned completed forms. Nurse prescribers in the sample were more confident and rated their knowledge more highly when compared with non-prescribing nurses. However, prescribers' actual medication-related knowledge, relative to their high levels of confidence, was not confirmed with performance on case scenarios. In responses to the case scenarios, prescribers did not perform as well as non-prescribers on all five analysed scenarios. The overall assessment of the nurses' response to the OTC case scenarios showed a poor performance when compared with prescription cases. There is a need to improve community nurses' levels of confidence and their abilities in coping with medication-related issues at pre-registration and post-registration level.
Attitude of Health Personnel↗
Clinical skills: nursing considerations in patients with faecal incontinence.
Faecal incontinence is a distressing and socially debilitating problem. Nurses are ideally placed to support patients and assist them in improving their quality of life. In order to provide the necessary holistic care the nurse needs to understand the nature of the patient's symptoms and be aware of a variety of management interventions. In this article the author outlines the various causes of faecal incontinence and highlights the importance of a thorough nursing assessment which takes into account the physical, psychological and social aspects of the symptoms. Planned care should be based on a firm knowledge base, but should reflect the needs of the individual. A good nurse-patient interaction facilitates this process and should be valued.
Fecal Incontinence↗
Automated sleep stage detection with a classical and a neural learning algorithm--methodological aspects.
For classification tasks in biosignal processing, several strategies and algorithms can be used. Knowledge-based systems allow prior knowledge about the decision process to be integrated, both by the developer and by self-learning capabilities. For the classification stages in a sleep stage detection framework, three inference strategies were compared regarding their specific strengths: a classical signal processing approach, artificial neural networks and neuro-fuzzy systems. Methodological aspects were assessed to attain optimum performance and maximum transparency for the user. Due to their effective and robust learning behavior, artificial neural networks could be recommended for pattern recognition, while neuro-fuzzy systems performed best for the processing of contextual information.
Algorithms↗
A modified, event-related potential-based guilty knowledge test.
Subjects chose and pretended to steal one object from a box of nine. They then watched a visual display of verbal representations of objects including their chosen object or one of eight novel objects on each trial. They were told to count one of the novel objects and that although they were welcome to try to beat our test, they would be unable to avoid noticing the chosen object. P3 responses were obtained only to counted and to chosen objects in 7 of 10 subjects not eliminated for artifact or noncooperation.
Guilt↗
An efficient screening approach for anti-Microcystis compounds based on knowledge of aquatic microbial ecosystem.
To improve the efficiency of screening for anti-Microcystis compounds, we planned to use algae-lysing bacteria that kill the organisms of water blooms. A two step-screening process was carried out, i.e., the screening of algae-lysing bacteria and the selection of anti-Microcystis producers from the bacteria. Sources for the isolation of the bacteria were a co-cultivated fluid of a water sample with axenic Microcystis viridis, a water sample collected in a water bloom season, and a water bloom sample. The water bloom sample was the best source for the isolation of the algae-lysing bacteria and such bacteria were shown to exhibit potent activity. Seventeen strains out of 20 isolated algae-lysing bacteria produced anti-Microcystis activities, and one of the principles was the previously reported argimicin A. These results indicate that algae-lysing bacteria in water blooms may be good sources for potent and selective anticyanobacterial compounds.
Cell Extracts↗
Arterial blood gases and acid-base balance. Knowledge of bicarbonate concentrations is needed to assess respiratory failure.
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Bicarbonates↗
A method for an automated decomposition of a complex term into its conceptual components.
The paper deals with the improvement of the MAOUSSC model (Modèle d'Aide et d'Orientation d'un Utilisateur au Sein des Systèmes de Codage) and system. Its specific purpose is the automation of the description of medical and surgical procedures. We have developed an automatic decomposition method using a linguistic and conceptual approach based on the UMLS knowledge base. This work concerns the processing of 100 procedure wordings from the digestive surgery domain. We introduce a prototype of such a system automating the decomposition through a web interface.
Artificial Intelligence↗
[The base of knowledge in psychiatry].
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Humans↗