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PubMed1993

Unique theory--is it essential in the development of a science of nursing?

This paper is concerned with the struggle to develop unique theories of nursing and their contribution to clinical practice and the nursing profession. The nature of nursing is briefly discussed and the knowledge base explored. It is argued that nursing knowledge is not unique, but the perspective with which the knowledge is applied to practice is unique. This perspective is achieved and defined through unique theories of nursing. The value and contribution of nursing theories in Britain to date is then questioned and critically discussed, with arguments made to show that nursing theory has at times been more concerned with achieving a higher professional status, than with the advancement of clinical practice. The paper concludes with a discussion on the need for theories which define and value all aspects of the art and the science of nursing practice, and are both useful and acceptable to practitioners.

Clinical Competence↗

PubMed1995

Control theory as a conceptual framework for intensive care monitoring.

Monitoring patients hospitalized in hemato-oncology departments to undergo clinical protocols of therapy is a complex task. The main difficulty arises in the management of the oncology protocol as well as in the management of critical episodes of acute illness which frequently occur due to high toxicity of the used antimitotics. This problem of controlling a patient's condition can be conceptualized within the control theory paradigm as the task of controlling a process whose state changes over time and can deviate unacceptably from a normal range. Upon request of a French clinical department of hemato-oncology, we developed an intelligent patient monitor named SEPIA to assist clinicians in this task. Following the control theory analogy at the level of knowledge bases design, we have modeled the medical knowledge as control information to represent the medical actions, and state information is used as feedback control to characterize the patient's state. After a general presentation of SEPIA, the analogies between control theory actors and SEPIA's components are specified. The article then focuses on state variables representation. The data reduction process, activated as new data are given to the system, is described. A simulated running session is finally presented to illustrate the whole reasoning process.

Algorithms↗

PubMed1999

Hepatitis B core particles as a universal display model: a structure-function basis for development.

Because it exhibits a remarkable capability to accept mutational intervention and undergo correct folding and self-assembly in all viable prokaryotic and eukaryotic expression systems, hepatitis B core (HBc) protein has been favored over other proposed particulate carriers. Structurally, the unusual alpha-helical organization of HBc dimeric units allows introduction of foreign peptide sequences into several areas of HBc shells, including their most protruding spikes. Progress toward full resolution of the spatial structure as well as accumulation of chimeric HBc-based structures has brought closer the knowledge-based design of future vaccines, gene therapy tools and other artificial particulate objects.

Animals↗

PubMed2006

Educating diabetic patients about insulin use: changes over time in certainty and correctness of knowledge.

AIM: Diabetic patients should understand their disease correctly and be sure of what they know, but certainty is rarely considered by educators. Furthermore little is known about how certainty changes with time after an educational intervention. To clarify this, in 38 patients with type 1 diabetes (0.3-36 years duration) we analysed the effect of a course on insulin use by administering a questionnaire before the course, after the course and 1 and 3 years later. METHODS: Answers, accompanied by a subjective estimate of the degree of certainty, were assigned to mastered knowledge (certainty>or=90%, correctness>or=90%), hazardous knowledge (certainty>or=90%, correctness or=90%) and residual knowledge (total-[mastered+hazardous+uncertain]). Answers were then counted and changes in distribution among areas were analysed by the chi2 test. We also followed the fate of wrong answers. RESULTS: The course increased mastered knowledge, while other types of knowledge decreased. With time mastered knowledge decreased, patients losing both correctness and certainty. The loss affected declarative knowledge, based purely on theory, more than procedural knowledge, which concerns the way things are done. Wrong answers, mostly given with high degree of certainty, were heterogeneous since some became correct after the course, some remained wrong, some became wrong after the course, some became mistaken after having been corrected earlier. CONCLUSIONS: The analysis of certainty helps in evaluating patient's knowledge; programmes tending to improve procedural knowledge are more likely to have long lasting effects; wrong answers need to be considered on a individual basis.

Diabetes Mellitus, Type 1↗

PubMed1997

A diagnostic support system in general practice: is it feasible?

A medical diagnostic decision support system (DDSS) has been developed for and tested in general practice. Two major issues have been addressed: diagnostic support and usefulness. The diagnostic support pertains to the ability of the system to generate diagnostic hypotheses from a set of patient data. The usefulness is approached by creating a computer system which can be used simultaneously with the doctor-patient consultation. The support function operates by matching symptoms from the patient data base with symptom configurations contained in the knowledge base. The support is presented as a list of diagnostic hypotheses ranked by degree of concordance. A user-friendly interface has been constructed with a comprehensive set of clinical terms within which the doctor can locate a desired symptom and store it with a single keystroke. With another keystroke the doctor can check the stored data and ask for support at any moment during the process. The overall purpose is to invite the doctor to rethink and re-examine his steps and to reconsider possible alternatives in the light of the presented diagnostic information. In our view it has to be the doctor who makes the final judgement. A test with the system in general practice revealed good performance of the system and an astonishing proficiency of the participating doctors in its use during the consultation. Twenty doctors solved five patient cases, entering 2000 clinical items within acceptable limits of consultation time. In 96% of the cases the correct diagnosis appeared in the differential diagnosis list. The doctors' diagnostic accuracy was 43%. The use of standardised terminology as an option for further development is discussed. The role of the doctor in computer-aided diagnostics remains open to debate. A computer-aided diagnostic support system in general practice appears to be feasible.

Adult↗

PubMed1998

Participation of expectant mothers in decision making in maternity care: results of a population-based survey.

The purpose of the study was to acquire knowledge of the opportunities that expectant mothers had to participate in decision making regarding their care in maternity clinics during their last pregnancy. The study is a part of a larger national survey 'Family planning services in Finland' carried out by the National Research and Development Centre for Welfare and Health. The rationale for the study were the known benefits of participation in one's care and its emphasis in health policy documents. The subjects were a random sample of women aged between 18 and 44. The response rate was 73% (n = 1289). The data were gathered by a mailed questionnaire and analysed statistically. According to the results mothers had fairly good opportunities to participate in decision making. However, there were statistically significant differences in opportunities between the women. The mothers who were most satisfied were aged 25-29 years, lived in a permanent relationship, had 12 years of basic education and had three children. Opportunities to participate in care have improved from the 1970s to the 1990s. The results have many implications for the development of nursing practice in maternity clinics and the deepening of the knowledge base in nursing education. The study, being the first national survey on this topic, also gives suggestions for further studies.

Adolescent↗

PubMed1997

Toward a strategy for healthy adolescent development.

Mel Sabshin and I worked closely together during the 1950s, and his influence on me-as on so many others-has persisted ever since. I have never ceased to be deeply impressed by his intellectual curiosity, his strong sense of social responsibility, his integrative capacity across disciplines, and his constructive problem-solving orientation. One of his pioneering and enduring interests over several decades has been in the study of normality. Within that frame-work, he has devoted special attention to adolescent development. In this article I pick up on this strand of his interest. During much of my career, and especially during the past 14 years at the Carnegie Corporation, I have sought ways to build the knowledge base on adolescent development and put that knowledge to use in preventing lifelong casualties.

Adolescent↗

PubMed1993

PEIRS: a pathologist-maintained expert system for the interpretation of chemical pathology reports.

Provision of a comprehensive interpretative service is an important challenge facing chemical pathologists. Attempts to automate report interpretation using expert systems have been limited in the past by the difficulties of rule base maintenance. We have applied a novel knowledge acquisition technique, ripple down rules, in the development of PEIRS (Pathology Expert Interpretative Reporting System), a user-maintained expert system for automating chemical pathology report interpretation. We created over 950 rules for thyroid function tests, arterial blood gases and other test sub-groups in 9 mths of operation. A staff pathologist performed all maintenance tasks as part of his routine duties without any need for computer programming skills. No clerical staff involvement was required. Duplication of rule addition for reports requiring multiple comments was the only limitation to coverage of other high volume test groups. PEIRS is the first expert system for the automated interpretation of a range of chemical pathology reports which operates in routine use without extra staffing requirements. PEIRS does not require "knowledge engineering" expertise. Thus, the knowledge base is flexible and can be easily maintained and updated by the pathologist. Expert systems based on ripple down rules should enable pathologists to provide a comprehensive automated interpretative service within the context of the total testing process.

Chemistry, Clinical↗

PubMed1990

Reminiscence: an independent nursing intervention for the elderly.

The nursing literature states that reminiscence is an independent nursing intervention for elderly clients and patients. This paper is about the use of reminiscence by nurses in all settings. Nurses have not to date built a firm knowledge base. The paper discusses the need for knowledge about the phenomenon and life review versus reminiscence. The uses of reminiscence therapy in one-to-one interaction, in the group modality, and as a research tool are all important applications of the concept. In contrast to other disciplines, reminiscence therapy, as studied by nurses, focuses on interventions. Reminiscence is a fascinating, elusive, and complex phenomenon, but although nursing textbooks tout its usefulness, the research findings are less optimistic.

Aged↗

PubMedDate not supplied

A system for computer-aided diagnosis.

MEDICIS is an integrated environment for computer-aided diagnosis. It consists of two subsystems: a module used by the expert to build knowledge bases and a consultation module to exploit those bases. MEDICIS uses a framed representation of knowledge. The inference engine performs logical reasoning without recourse to certainty factors. This phase is followed by a multicriteria analysis.

Diagnosis, Computer-Assisted↗

PubMed2004

Nitrogen removal influence factors in A/O process and decision trees for nitrification/denitrification system.

In order to improve nitrogen removal in anoxic/oxic(A/O) process effectively for treating domestic wastewaters, the influence factors, DO(dissolved oxygen), nitrate recirculation, sludge recycle, SRT(solids residence time), influent COD/TN and HRT(hydraulic retention time) were studied. Results indicated that it was possible to increase nitrogen removal by using corresponding control strategies, such as, adjusting the DO set point according to effluent ammonia concentration; manipulating nitrate recirculation flow according to nitrate concentration at the end of anoxic zone. Based on the experiments results, a knowledge-based approach for supervision of the nitrogen removal problems was considered, and decision trees for diagnosing nitrification and denitrification problems were built and successfully applied to A/O process.

Decision Trees↗

PubMed1990

A method for the acquisition of formalized knowledge in pathology.

A tool is introduced for the acquisition of pathology knowledge in a formalized form, directly by the expert. Formalization of the knowledge is intended to make descriptive pathology knowledge more suitable for computerized diagnostic support since a formal representation of knowledge allows more extensive indexing, hence more flexible access. The knowledge acquisition (KA) tool also provides a useful research instrument to investigate to what extent pathology knowledge can be made explicit, to what degree ambiguity is present, in what way experts differ when formalizing knowledge, and whether it is feasible to incrementally acquire decision criteria on the basis of the formalized descriptive knowledge. Crucial in the design of the KA tool is the incorporated meta-knowledge, which is reflected by the knowledge-base structure and is used to elicit knowledge from the expert. Knowledge is acquired from the expert via a menu-driven user interface, which follows the general steps of the pathologist when describing a case. The paper discusses the considerations underlying the design, the implementation of the KA tool, and the research goals.

Diagnosis, Computer-Assisted↗

PubMedDate not supplied

Microcomputer-aided diagnosis in cardiology. An expert system based on clinical and phono-mechanocardiographic data.

A knowledge-based consultation system capable of making multiple diagnoses in noninvasive cardiology is presented here. The system, expressly designed for a personal computer, is able to provide assistance in the diagnosis of 49 disease-entities. When tested in 52 retrospective cases (33 patients with one disease-entity, 17 with two, 2 with three), it made 39 correct diagnoses (75%). The average score of the actually present disease-entities was 94 +/- 3.2 (mean +/- standard error of the mean), significantly higher than the highest score obtained by the incorrect diagnoses (87.2 +/- 3.1) (p less than 0.001). The system was able to correctly perform 1 triple diagnosis and 9 double diagnoses. The results obtained, comparable with those of well-known expert systems (MYCIN, INTERNIST-1), demonstrate the reliability of a microcomputer-based expert system for medical diagnosis in cardiology.

Diagnosis, Computer-Assisted↗

PubMed1987

Integrating management and expertise in a computerised system for hypertensive patients.

An expert system has been integrated to the data management system of the ARTEMIS programme for hypertensive patients. The patient database, which has been used since 1975, contains the medical records of about 20,000 patients. Information is interactively entered by physicians, nurses and secretaries on video display units. The computerised medical record has replaced the traditional handwritten medical record. The database management system is used to produce different summary reports (inpatient and outpatient care) and personalized recall letters which are mailed to the patients before their appointments. Suggestions provided by the expert system include additional information to be obtained (complementary patient interrogation, biological or radiological investigations, etc.), possible causes of hypertension, and medical prescriptions. The information base allows the description of both static knowledge (in the form of a semantic network) and dynamic knowledge (in the form of production rules). The inference system sequentially uses a combination of forward and backward chaining and performs both exact and approximate reasoning. The diagnostic performance of the expert system was evaluated in 100 cases of hypertension (50 of essential hypertension and 50 of secondary hypertension. Concordance between the diagnosis proposed by the expert system and the one proposed by the specialist was achieved in 92% of secondary hypertension cases and 88% of essential hypertension cases. It is suggested that the integration of data and knowledge management might enhance the overall acceptance by medical staff of a computerised system, and facilitate the validation of a knowledge base.

Database Management Systems↗

PubMed1994

The role of the nursing home in nursing research of the elderly.

The greatest repository of knowledge of the elderly lies in the nursing home setting. Nurses who work in nursing homes acknowledge that the knowledge base that directs their practice is gerontological knowledge and over time they have evolved the most sophisticated care for older persons. Much of this care has evolved in trial and error response to needs. Many of the interventions have not been tested in rigorous research and therefore are difficult to justify in an atmosphere of cost cutting. Nursing home nurses have, therefore, a responsibility to be forerunners in the generation, testing and dissemination of the body of gerontological nursing knowledge to guide effective and efficient nursing practice with older persons. In a time of decreased resources this is no small challenge. To suggest approaches to encourage long term care research this article will explore the literature in this area, relate knowledge gained from the teaching nursing home projects and share the experience of a Director of Nursing in fostering research in a teaching nursing home setting without outside funding.

Aged↗

PubMed1995

Real time monitoring in the control theory paradigm.

Monitoring patients hospitalized in hemato-oncology departments to undergo clinical protocols of therapy is a complex task. The main difficulty arises in the follow-up of the oncology protocol and in the management of critical episodes of acute illness which frequently occur due to the high toxicity of the antimitotics used. This problem can be conceptualized within the control theory paradigm as the task of controlling a process whose state can deviate unacceptably from a normal range. Following the control theory analogy at the level of knowledge bases design, we have modeled the medical knowledge as control information to represent the medical actions, and state information is used as a feedback control to readjust the command.

Aged↗

PubMed1998

[Resources in medical research].

The biennial national statistical surveys of research and development expenditure, based on OECD guidelines, contribute to the knowledge base for Norwegian research policy. This article outlines the resources for research and development in the medical sciences, with emphasis on the higher education sector. This sector, which includes university hospitals, performs about 75% of medical research in Norway (medical research in industry not included) while the remaining 25% is performed in research institutes in the institute sector. In 1995, current expenditure for medical research amounted to 1,240 million Norwegian kroner, 930 million in the higher education sector and 310 million in the institute sector. From 1993 to 1995, there was a small increase in real terms in resources for medical research in universities and colleges paid for over institutional budgets, while there was no growth in externally funded research. Over the 25-year period 1970-1995, the growth in expenditures for medical research was higher than for the natural sciences, but lower than for the humanities and the social sciences. Comparisons between the Nordic countries show that investments in medical research in Norway is much lower than in Denmark or Sweden.

Norway↗

PubMed2003

An advanced artificial intelligence tool for menu design.

The computer-assisted menu design still remains a difficult task. Usually knowledge that aids in menu design by a computer is hard-coded and because of that a computerised menu planner cannot handle the menu design problem for an unanticipated client. To address this problem we developed a menu design tool, MIKAS (menu construction using incremental knowledge acquisition system), an artificial intelligence system that allows the incremental development of a knowledge-base for menu design. We allow an incremental knowledge acquisition process in which the expert is only required to provide hints to the system in the context of actual problem instances during menu design using menus stored in a so-called Case Base. Our system incorporates Case-Based Reasoning (CBR), an Artificial Intelligence (AI) technique developed to mimic human problem solving behaviour. Ripple Down Rules (RDR) are a proven technique for the acquisition of classification knowledge from expert directly while they are using the system, which complement CBR in a very fruitful way. This combination allows the incremental improvement of the menu design system while it is already in routine use. We believe MIKAS allows better dietary practice by leveraging a dietitian's skills and expertise. As such MIKAS has the potential to be helpful for any institution where dietary advice is practised.

Artificial Intelligence↗