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PubMed1991

Computer-aided diagnosis and negligence.

The phrase 'expert system' has been widely used to describe computer systems which are capable of performing at or near to the level of an expert. Expert systems may be recognized by their construction or by their performance. Structurally, expert systems usually comprise a knowledge-base, an inference engine and an interface with the user as shown in Figure 1. The knowledge-base contains the raw material of the expert system; the rules and facts representing the expertise. An important part of that knowledge-base usually will be heuristic in nature and this is particularly so with respect to expert systems in medicine. A large amount of a specialist's knowledge is informal and experimential in nature and this heuristic knowledge is often what sets the specialist apart from the general practitioner or indeed sets the latter apart from the medical student. The inference engine is a computer program which attempts to resolve the user's enquiries by operating on and interacting with the knowledge-base. Finally, the interface with the user serves two purposes: first, to make the system relatively easy to use and second, and very importantly, to provide an explanation and justification for the results, advice and suggestions obtained from using the system (Winfield, 1982). There will be other parts to an expert system which are used to refine and modify the knowledge-base. The performance of an expert system is of utmost importance and it is the most fundamental test for whether a computer system falls into this classification. d'Agapeyeff (1984) defines expert systems as being: a) programmed to a significant extent, from an explicit representation of empirical human knowledge; b) readable by those who provided the knowledge and, potentially, by similarly knowledgeable users and managers; c) able to provide explanations of their reasoning on demand; d) quickly alterable with (comparatively) low risk of unwanted side effects.' d'Agapeyeff describes the knowledge-base as being empirical, suggesting that it is informal or heuristic knowledge rather than comprising clear and formal rules as written in textbooks. This does not preclude the inclusion of formal knowledge in the expert system but it is clear that heuristic knowledge occupies a key role in the development of expert systems. Much medical knowledge is heuristic in nature; for example, an experienced doctor might use a rule in diagnosis such as: 'If symptoms A and B are observed then C is plausible but certainly not D'. In the field of medicine, expert systems will enable specialist expertise (a rare commodity) to be available to non-specialists such as general practitioners.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnosis, Computer-Assisted↗
PubMed1996

Breast-feeding: current knowledge, attitudes and practices of paediatricians and obstetricians.

OBJECTIVE: To assess the current knowledge, attitudes and practices of Paediatricians and Obstetricians in the greater Johannesburg area, using WHO/UNICEF 10 Steps to Successful Breastfeeding as a guideline. DESIGN: Survey. SUBJECTS: All Paediatricians and Obstetricians registered with the SAMDC and practising in the greater Johannesburg area. RESULTS: Most Paediatricians and Obstetricians advocate breastfeeding, but very few conform adequately to recommended guidelines. CONCLUSION: Doctors, as part of the healthcare team, can have a significant impact on the successful initiation and maintenance of breastfeeding. There is a need for ongoing education and intervention programmes to update current knowledge on breastfeeding management.

Adult↗
PubMed1998

Knowledge and attitudes of health-care providers toward cancer pain management: a comparison of physicians, nurses, and pharmacists in the state of New Hampshire.

The knowledge and attitudes toward cancer pain management of physicians, nurses, and pharmacists in the state of New Hampshire were examined through the use of a statewide survey. Many of the providers who completed the survey, and thus indicated that they treated patients with cancer pain on a regular basis, were not pain or oncology specialists. Most of these providers were quite well informed about the fundamentals of cancer pain management. Approximately 90% of providers in all three groups were not concerned about addiction among cancer patients. Yet, there was a small percentage of providers who responded in less than optimal ways to items dealing with opioid pharmacology, pain assessment, and the importance of pain relief. Comparison of responses among provider groups indicated that nurses were the most knowledgeable and pharmacists the least knowledgeable about pain assessment. Physicians were the most knowledgeable regarding opioid pharmacology but seemed the least committed to providing optimal pain relief. Further analysis identified a small group of physicians that included a disproportionately high percentage of family practitioners and surgeons who consistently responded in less than optimal ways to items dealing with the importance of pain relief. The results of this study indicate a continuing need for broad-based educational programs in cancer pain management and for new initiatives focused on practitioners who see relatively few cancer patients and may have difficulty accessing traditional educational programs.

Attitude of Health Personnel↗
PubMed2005

Qualitative evaluation of Chronic Disease Self Management Program (CDSMP) in Shanghai.

OBJECTIVES: To explore the impact of Chronic Disease Self-Management Program (CDSMP) on participants' perception of their behavior, health status and quality of life and how the program achieve its benefits, and to collect suggestions for future improvement and dissemination. METHODS: Qualitative data were obtained from 57 participants attending all sessions of the CDSMP course using semi-structured interviews and analyzed using content analysis. RESULTS: The interviewees perceived that CDSMP improved their knowledge, self-management skills, positive health behavior, increased self-confidence, health status and quality of life. Behavior change and self-efficacy were the two main transmitters of the effectiveness of CDSMP in Shanghai. The identified deficiencies focused on language, size and style of helpbook and the lack of Chinese relaxing exercises. CONCLUSION: CDSMP was perceived to be effective to participants mainly through behavior change and self-efficacy development, though it had a few deficiencies to be modified. PRACTICE IMPLICATIONS: CDSMP in Shanghai needs further work and research on the content and delivery modification for future improvement and dissemination.

Aged↗
PubMed2006

An interactive medical image segmentation system based on the optimal management of regions of interest using topological medical knowledge.

This paper presents an original interactive system for efficient medical image segmentation in computer aided diagnosis. The main originality concerns the method used to manage, according to an a priori topological-based structural model, regions of interest (ROIs) within which computations can be constrained. The goal is then to avoid the processing of irrelevant image points, therefore improving and accelerating segmentations. In the case of a hierarchical modeling procedure, our ROI management method enables, for delineating a given medical structure, to optimally determine image points of interest by taking previously segmented structures into account. We propose a mathematical formulation of the method as well as a possible implementation within an interactive system. We also detail an experience report focussing on the segmentation of several abdominal structures from a CT image. It illustrates the behavior and the potential of our method.

Abdomen↗
PubMedDate not supplied

Increasing returns and the new world of business.

Our understanding of how markets and businesses operate was passed down to us more than a century ago by English economist Alfred Marshall. It is based on the assumption of diminishing returns: products or companies that get ahead in a market eventually run into limitations so that a predictable equilibrium of prices and market shares is reached. The theory was valid for the bulk-processing, smokestack economy of Marshall's day. But in this century, Western economies have gone from processing resources to processing information, from the application of raw energy to the application of ideas. The mechanisms that determine economic behavior have also shifted--from diminishing returns to increasing returns. Increasing returns are the tendency for that which is ahead to get further ahead and for that which is losing advantage to lose further advantage. If a product gets ahead, increasing returns can magnify the advantage, and the product can go on to lock in the market. Mechanisms of increasing returns exist alongside those of diminishing returns in all industries. But, in general, diminishing returns hold sway in the traditional, resource-processing industries. Increasing returns reign in the newer, knowledge-based industries. Modern economies have split into two interrelated worlds of business corresponding to the two types of returns. The two worlds have different economics. They differ in behavior, style, and culture. They call for different management techniques, strategies, and codes of government regulation. The author illuminates those differences by explaining how increasing returns operate in high tech and in service industries. He also offers advice to managers in knowledge-based markets.

Commerce↗
PubMed2006

Cervical cancer screening, abnormal cytology management, and counseling practices in the United States.

OBJECTIVE: We assessed clinician knowledge and practices since the marketing of tests for sexually transmitted human papillomavirus (HPV) and the release of HPV testing guidelines for two indications: 1) as an adjunct to cytologic screening and 2) to guide colposcopic triage of patients with atypical squamous cells of undetermined significance (ASC-US) cytology results. METHODS: In mid-2004, we surveyed nationally representative, random samples of clinicians practicing specialties that provide cytologic screening. Mail surveys addressed HPV-related knowledge, screening, abnormal cytology management, HPV testing, and counseling practices. RESULTS: The overall adjusted response rate was 82%. Of the 2,980 (89%) clinicians providing cytologic screening, 99% knew that HPV infection increases cervical cancer risk, and 91% were aware of HPV tests. Of the 21% who reported ever using HPV tests as an adjunct to cytology, more reported usually testing patients aged less than 30 years (which guidelines do not recommend) than older patients (which guidelines do recommend). Of the 63% of clinicians who ever ordered HPV tests for abnormal cytology results, 84% usually ordered tests for ASC-US results and preferentially advised colposcopy if HPV tests were positive, as guidelines recommend. However, more than 60% usually ordered HPV tests for higher-grade abnormalities, which is not recommended for colposcopy triage. Although few sought HPV test consent, most discussed sexually transmitted HPV with patients with abnormal cytology or positive HPV tests despite potentially negative psychosocial consequences. CONCLUSION: New HPV tests and testing guidelines have transformed screening, abnormal cytology management, and counseling practices. Although many U.S. clinicians reported using HPV tests according to guidelines, many also reported inappropriate use.

Adolescent↗
PubMed1999

Human immunodeficiency virus disease. Managing respiratory complications through the life span.

HIV infection is a chronic illness that affects individuals of all ages. The pulmonary system is the most common body system affected by the disease. Management of these complications has improved over the years and has resulted in a decline in mortality. Critical care nurses should understand the complications that develop and be knowledgeable about the management to improve the patient's clinical outcomes. Assessment for complications must begin once an individual is diagnosed as being infected with HIV and continue throughout the course of the disease. Prevention is the key to limiting respiratory complications and thus improving survival rates.

Adolescent↗
PubMedDate not supplied

Childhood epilepsy: knowledge and attitude of primary school teachers in Port Harcourt, Nigeria.

BACKGROUND: This study was conducted to determine the knowledge of primary school teachers in Port Harcourt metropolis of epilepsy, their knowledge of the management of an attack of epilepsy and the attitude of these teachers towards epilepsy in children. METHODS: This is a questionnaire-based, cross-sectional study of 118 school teachers from five randomly selected primary schools in Port Harcourt metropolis, Nigeria. RESULTS: Ten percent (12) of the 118 teachers were graded "Good", 45% (54) "Fair" and 43% (52) "Poor" in overall knowledge score. Sixty six teachers (56%) accept applying crude oil on the body as useful in stopping epileptic attacks in children. There was no significant association between overall knowledge score and sex, year of experience as a teacher and experience with a child with epilepsy. Only 10% of the teachers studied were classified as having overall good knowledge of epilepsy. Sixty nine teachers (58.5%) were graded as having good knowledge of cause of epilepsy. Only 38 (32%) disagree that the saliva drooled during an epileptic attack is contagious; one hundred (84.8%) and 65 (55.1%) agree that some childhood illnesses can cause epilepsy and that it runs in families respectively. Overall, 54 teachers (45.8%) had a cumulative score of negative attitude towards epilepsy. Eighty three teachers (73.3%) would want all children with epilepsy put in a special school whilst 57 (48%) agree that children with epilepsy should be withdrawn from schools. The longer the teacher's professional experience, the more the likelihood of positive attitude towards epilepsy but the association did not reach statistically significant level (p = 0.076). Attitude was not statistically associated with sex and educational qualification. CONCLUSIONS: The overall knowledge of primary school teachers in Port Harcourt metropolis of epilepsy and the first-aid management of an epileptic attack is poor. The attitude of these teachers towards epilepsy is negative. Education of the primary school teacher and general public on epilepsy is recommended.

Adult↗
PubMed2000

An ethnographic study of factors influencing cancer pain management in South Africa.

Although the knowledge exists to relieve cancer pain, inadequate pain relief persists as an international health problem. The World Health Organization has recommended a threefold strategy to improve cancer pain management: health policy, drug availability, and education. Yet major barriers to effective cancer pain management exist in every country of the world. Effective strategies to improve pain management must be based on an understanding of the issues in individual countries. This report evaluates cultural and other factors influencing cancer pain management in the Republic of South Africa. This ethnographic field study included multiple methods of data collection: analysis of documents, participant observation, focused interviews, and in-depth interviews of informants (n = 33) who represented multiple stakeholders in a variety of settings. Cultural beliefs and practices form the context for understanding cancer pain and how it is managed. Cultural variability exists regarding cancer as a disease, pain expectations, pain tolerance, pain expression, and health care practices. Key factors that influence how pain is managed included standards, knowledge, resources, communication and the patient-provider relationship, and teamwork and professional relationships. The existence of these factors promotes effective pain management, whereas their absence creates a barrier to achieving this aim.

Cultural Characteristics↗
PubMed1991

A computer-assisted health care cost management system.

To our knowledge, First Chicago has developed and implemented the first operational integrated health data computer system that includes the traditional occupational medicine data base together with medical claims and health risk appraisal data. OMNIS has combined medical claims, personnel, disability, employee assistance program, wellness program participation, administrative functions, laboratory, periodic health evaluation data, and health risk appraisal data in a single system. OMNIS provides data that are being used to more accurately predict health care and disability costs and design intervention strategies. Clearly, the integrated health data computer system provides information to manage increasingly complex issues of health care quality and cost. For companies concerned about the quality as well as the cost of health care, an integrated health data computer system (OMNIS) may be a valuable tool to objectively assess quality of care. For example, a company could evaluate how effectively various providers (eg, health maintenance organizations, preferred provider organizations, indemnity plan) control medical conditions such as hypertension. Integrated health data management systems have the potential to assist in the selection of the highest quality and most cost-effective health care plans.

Chicago↗
PubMed1993

Airway management and sedation for pediatric transport.

Appropriate airway management is essential for the successful transport of sick children. Airway management begins with a thorough history and physical examination and may proceed to invasive therapeutic interventions. Successful care of the pediatric airway can be achieved only with a thorough knowledge of airway management technique and equipment. In addition, familiarity and understanding of the pharmacologic adjuvants to airway management and sedation will help to achieve the primary objective of any transport team, namely a safe and smooth transport of the critically ill child.

Airway Obstruction↗
PubMed1997

Contested terrain: the incomplete closure of managerialism in the health service.

Focuses on feelings about culture and change in the health service and the impact of management development programmes on the change process. The issues raised in a series of semistructured interviews are taken forward to a case study, a medium-sized hospital Trust. The researcher "hangs around and listens into" a management development programme aimed at middle managers with a nursing background. The theme of ideological conflict comes into central focus. Analysis of outcomes suggests that the managerial assumptions on which the programme is based result in resistance from participants. They resist the attempts of facilitators to provide "closure" whereby managerial ways of doing things are suggested as the "obvious way ahead". Advocates that management education particularly in the health service should have a pluralistic orientation. As part of such pluralism, more critical approaches should be considered beyond conventional and problematic conceptions of knowledge relating to management. These are reductionist in considering a manager as "having a set of technical competences" rather than exhibiting "a way of being".

Administrative Personnel↗
PubMed1991

Implementing an AIDS policy. Retaining and promoting productivity in the workplace.

1. Managers must be knowledgeable about AIDS and able to act on issues that surface in the workplace. Some of these issues are discrimination, fear, and confidentiality. 2. Fear of AIDS is being managed better in places of business where education is provided to employees. This education results in a more productive work environment. 3. To deal with AIDS in the workplace in a socially responsible manner, every company must have guidelines and provide a source of education. This education must be readily available and easily understood by all employees, who may have differing educational levels.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Basic principles of quality management in public health service].

Philosophy, objectives and tools of Total Quality Management are applicable in Public Health services as in every other business. However, they need special adaptation. In Public Health offices requirements of an effective Total Quality Management are the commitment of the top management, an appropriate structure of the quality management system, customer orientation and quality awareness of the personnel, quality indicators and the existence of procedures for problem recognition, good command of the tools of quality management, and the knowledge of the effectiveness of implemented traditional quality assurance measures. Certification procedures following the European Quality Award seem to be appropriate for a global evaluation of quality and quality management of a Public Health office.

Forecasting↗
PubMed2005

The impact of corporate memory loss: What happens when a senior executive leaves?

PURPOSE: The author is a nursing management practitioner, whose purpose in writing this paper is twofold: to examine the impact of corporate memory loss on a health care institution, caused by increasing retirement rates of senior executives; and to use this research as an opportunity for action learning where both the author and the institution can benefit from the learning outcomes. DESIGN/METHODOLOGY/APPROACH: Using qualitative research methods based on ethnographic interviewing techniques and grounded theory, the author interviews 12 senior executives from four diverse health care facilities. The purpose is to determine the point at which corporate memory loss, in the form of tacit knowledge in the heads of departing executives, becomes a problem for the institution. FINDINGS: The research determined that the requisite managerial competencies normally assumed for senior management positions are insufficient to minimize the negative impacts of corporate memory loss caused by departing senior executives. Effective knowledge management and knowledge transfer within the organization are fundamental for ongoing organizational effectiveness. RESEARCH LIMITATIONS/IMPLICATIONS: The research is limited to 12 senior executives. The grounded theory nature of the research provides a framework for more research in other institutions to test and further explore some of the findings. PRACTICAL IMPLICATIONS: One of the most significant threats facing the majority of health care organizations related to the aging workforce is the greater number of staff who are retiring from all levels within the organization. The development of techniques to reducing the impact of corporate memory loss on the culture of an organization will increase its effectiveness, help build continuity, and provide a more secure footing for the workforce of the future. ORIGINALITY/VALUE: The exit of knowledge workers is causing a major problem for Canada's health care organizations. This study throws more light on to this problem from the point of view of senior executives who have been specifically impacted by the problem of corporate memory loss.

Canada↗