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PubMed1999

[Expert systems in pulmonology].

Expert systems are software systems that can successfully compare to human experts. Their purpose is mostly advisory. Besides, they give explanation and advices to human experts when performing certain tasks. They are intelligent information systems, and are capable to explain and justify their conclusions. Knowledge systems are smaller software systems, and are usually less successful than human experts. Main reasons for expert systems development in medicine are: need for justification of decisions, need for enhancing performances in many uncertain relations; need for explaining of decision making process++ etc. One of the reasons of developing knowledge-based systems was that conventional statistic formalisms have not provided satisfactory solutions in medical decision making (MDM). Also, today, the relations between cases and conclusions are not universally valid. So, few causes can provide the same conclusion. Besides, data are not necessarily absolutely accurate. The area of applying expert systems is very wide: diagnosis, prognosis, education, managing etc. Basic structure of expert system consists of: knowledge, data base, inferring mechanism, explaining mechanism and user-interface. In this paper we presented several expert systems which are actually used in practice, especially in internal disciplines: Internist, Mycin, Onkocyn, DXplain.

Expert Systems↗

PubMed1995

[Medical expert systems].

Expert systems are software systems that can successfully compare to human experts. Their purpose is mostly advisory. Besides, they give explanation and advice to human experts when performing certain tasks. They are intelligent information systems, and are capable to explain and justify their conclusions. Knowledge systems are smaller software systems, and are usually less successful than human experts. Main reasons for expert systems development in medicine are: need for justification of decisions, need for enhancing performances in many uncertain relations; need for explaining of decision making process etc. One of the reasons of developing knowledge-based systems was that conventional statistic formalisms have not provided satisfactory solutions in medical decision making (MDM). Also, today, the relations between cases and conclusions are not universally valid. So, few causes can provide the same conclusion. Besides, data are not necessarily absolutely accurate. The area of applying expert systems is very wide: diagnosis, prognosis, self-education, directing etc. Basic structure of expert system consists of: knowledge, data base, inferring mechanism, explaining mechanism and user-interface. Though, expert systems also have certain bad features: primarily, they are not physicians i.e. they can not examine a patient. Furthermore, expert system that is good for one certain area is often not good for another one. There are some cases, when these systems can confuse a physician and make him to make a wrong decision. This occurs very often in two specific cases: when the clinical situation is urgent; and when accuracy of clinical information is not definite.

Expert Systems↗

PubMed2001

A philosophical analysis of evidence-based practice in mental health nursing.

Mental health nurses need to be aware that their knowledge base does not exist in isolation from other cultural practices. They/I/we must become more willing to engage in theoretical problem solving that directly affects clinical practice issues such as the introduction of evidence-based practice. Critical discussion of evidence-based practice should be informed by the complex issues that permeate all our socio-cultural and linguistic practices. This paper examines some of the major philosophical problems in the debate over the use of evidence-based practice in mental health nursing using both Foucault's formulation of discourse analysis and Derrida's construal of deconstruction. The conclusion reached is that postmodern philosophy offers a way to rid nursing of incessant naiive attacks on either quantitative or qualitative research methods which underpin the debate over evidence-based practice in mental health nursing.

Cultural Characteristics↗

PubMed2007

Improving paediatric nurses' knowledge and attitudes in childhood fever management.

AIM: This paper reports an evaluation of the effectiveness of a peer education programme in developing paediatric nurses' evidence-based knowledge and attitudes towards fever management and the sustainability of these changes. BACKGROUND: In general, paediatric nurses' fever management knowledge seems to be mediocre. They believe fever to be harmful, causing febrile convulsions and brain damage. Antipyretics are administered to prevent febrile convulsions and alternate antipyretics are given when temperatures are not reduced. METHOD: A quasi-experiment was conducted from August 2002 to March 2003. An experimental group of Registered Nurses received the peer education programme and peer support and education were promoted for those unable to attend the sessions. A control group continued its normal practices. Seventy-seven nurses were eligible to attend the programme; 74.0% attended at least one session, 52% two or more. Questionnaire data were collected 1 month before and 1 and 4 months after the peer education programme from 56.3% to 77.8% of eligible experimental and 40.9% to 51.6% of eligible control group nurses. FINDINGS: Interaction effects between group and time were found in overall knowledge (P = 0.01), specifically knowledge of the physiology of fever (P = 0.001), and attitudes towards evidence-based fever management (P = 0.05). In addition, experimental group nurses demonstrated statistically significantly more knowledge of general fever management principles at 4 months after the intervention than control group nurses (P = 0.01), and compared with their own knowledge at baseline (P < 0.001). CONCLUSIONS: Educational programmes targeting practice change must be theoretically based and target knowledge, attitudes and barriers to change. The programme tested here, which incorporated peer education and support and facilitated group change, is adaptable to other practices, groups and settings.

Adult↗

PubMed2003

Evaluation of an Internet-based database on infectious disorders during pregnancy: INFPREG.

OBJECTIVE: To evaluate the use of an Internet-based information system on infectious disorders (INFPREG) in antenatal care in Sweden. METHODS: A postal questionnaire was sent to all antenatal clinics in Sweden in 2000 (n = 515) and 2002 (n = 503). The questionnaire consisted of sections covering use of computers, availability of Internet connections and the use of INFPREG in patient care. RESULTS: We received 404 completed questionnaires in 2000 and 501 in 2002. In 2000, 81% of the midwives had access to computers at their antenatal clinics, and this number had increased to 93% in 2002. Sixty-eight percent and 88% in 2000 and 2002, respectively, had computers with an Internet connection. Of the responding midwives, 74% in 2000 and 84% in 2002 had received information concerning INFPREG. In 2000, 29% of the midwives had visited INFPREG and this figure had increased to 58% in 2002. Of the midwives that had used INFPREG, 67% in 2000 and 81% in 2002 reported that the information obtained from the site was implemented in the patient care. Of the responders, 45% in 2000 and 43% in 2002 claimed that they needed more information on how to use INFPREG. CONCLUSIONS: A majority of midwives at antenatal clinics in Sweden have access to the Internet and are confident in using an Internet-based knowledge center on infectious disorders in pregnancy. The present study indicates a rapid acceptance among health care providers in antenatal care in Sweden of this new method for dissemination of information and guidelines. However, many midwives still want more information and knowledge on how to use an Internet-based information system.

Databases, Factual↗

PubMed2004

Promoting informed decision making: evaluating a community-based prostate health awareness program.

BACKGROUND: For health educators, the controversy surrounding routine prostate cancer screening provides curriculum development and delivery challenges. The purpose of this study was to evaluate a community-based prostate health awareness program. METHODS: Using a pretest-posttest design, participants were recruited from community-based organizations to assess the effectiveness of the program in the areas of knowledge gain, short-term intentions, and changing prostate health behaviors. RESULTS: Many of the participants reported having been tested for prostate cancer, yet there was a lower than expected pretest knowledge base. There were significant increases in knowledge on the posttest and some impact on short-term intentions and behavior. DISCUSSION: A community-based prostate health awareness program prior to the patient-physician encounter can assist health-care professionals in the education process and give men the tools to make an informed decision.

Adult↗

PubMed2005

Mining a clinical data warehouse to discover disease-finding associations using co-occurrence statistics.

This paper applies co-occurrence statistics to discover disease-finding associations in a clinical data warehouse. We used two methods, chi2 statistics and the proportion confidence interval (PCI) method, to measure the dependence of pairs of diseases and findings, and then used heuristic cutoff values for association selection. An intrinsic evaluation showed that 94 percent of disease-finding associations obtained by chi2 statistics and 76.8 percent obtained by the PCI method were true associations. The selected associations were used to construct knowledge bases of disease-finding relations (KB-chi2, KB-PCI). An extrinsic evaluation showed that both KB-chi2 and KB-PCI could assist in eliminating clinically non-informative and redundant findings from problem lists generated by our automated problem list summarization system.

Chi-Square Distribution↗

PubMed2005

Improving override rates for computerized prescribing alerts in ambulatory care.

Computerized drug prescribing alerts can improve patient safety, but are often overridden because of poor specificity and alert overload. We developed a selective knowledge base of only clinically significant drug alerts and designated only critical-high severity alerts to be interruptive to clinician workflow (a tiered approach). Using this approach, we were able to achieve a 67% clinician accept rate for ambulatory computerized prescribing alerts.

Ambulatory Care Information Systems↗

PubMed2005

The effect of feature representation on MEDLINE document classification.

This work explores the effect of text representation techniques on the overall performance of medical text classification. To accomplish this goal, we developed a text classification system that supports the very basic word representation (bag-of-words) and the more complex medical phrase representation (bag-of-phrases). We also combined word and phrase representations (hybrid) for further analysis. Our system extracts medical phrases from text by incorporating a medical knowledge base and natural language processing techniques. We conducted experiments to evaluate the effects of different representations by measuring the change in classification performance with MEDLINE documents from the OHSUMED dataset. We measured classification performance with information retrieval metrics; precision (p), recall (r), and F1-score (F1). In our experiments, we achieved better classification performance with the hybrid approach (p=0.87, r=0.46, F1=0.60) compared to the bag-of-words approach (p=0.85, r=0.44, F1=0.58) and the bag-of-phrases approach (p=0.87, r=0.42, F1=0.57).

Abstracting and Indexing↗

PubMed2006

NeuroScholar's electronic laboratory notebook and its application to neuroendocrinology.

Scientists continually relate information from the published literature to their current research. The challenge of this essential and time-consuming activity increases as the body of scientific literature continues to grow. In an attempt to lessen the challenge, we have developed an Electronic Laboratory Notebook (ELN) application. Our ELN functions as a component of another application we have developed, an open-source knowledge management system for the neuroscientific literature called NeuroScholar (http://www. neuroscholar. org/). Scanned notebook pages, images, and data files are entered into the ELN, where they can be annotated, organized, and linked to similarly annotated excerpts from the published literature within Neuroscholar. Associations between these knowledge constructs are created within a dynamic node-and-edge user interface. To produce an interactive, adaptable knowledge base. We demonstrate the ELN's utility by using it to organize data and literature related to our studies of the neuroendocrine hypothalamic paraventricular nucleus (PVH). We also discuss how the ELN could be applied to model other neuroendocrine systems; as an example we look at the role of PVH stressor-responsive neurons in the context of their involvement in the suppression of reproductive function. We present this application to the community as open-source software and invite contributions to its development.

Animals↗

PubMed2005

The victor/FRST function for model quality estimation.

Scoring functions are widely used in the final step of model selection in protein structure prediction. This is of interest both for comparative modeling targets, where it is important to select the best model among a set of many good, "correct" ones, as well as for other (fold recognition or novel fold) targets, where the set may contain many incorrect models. A novel combination of four knowledge-based potentials recognizing different features of native protein structures is introduced and tested. The pairwise, solvation, hydrogen bond, and torsion angle potentials contain largely orthogonal information. Of these, the torsion angle potential is found to show the strongest correlation with model quality. Combining these features with a linear weighting function, it was possible to construct a robust energy function capable of discriminating native-like structures on several benchmarking sets. In a recent blind test (CAFASP-4 MQAP), the scoring function ranked consistently well and was able to reliably distinguish the correct template from an ensemble of high quality decoys in 52 of 70 cases (33 of 34 for comparative modeling). An executable version of the Victor/FRST function for Linux PCs is available for download from the URL http://protein.cribi.unipd.it/frst/.

Computational Biology↗

PubMed2002

Preparing medical students to teach.

OBJECTIVE: Residents do a significant amount of teaching. Therefore, as medical students prepare for the clinical aspects of their residency, it is also important for them to prepare for their role of physician as teacher. With the goal of offering fourth-year students an opportunity to enhance their teaching skills, an elective was designed that presented them with an opportunity to expand their knowledge base in education, and then apply and practice this new set of knowledge. A week-long elective, Physician as Teacher, was designed to encompass core educational information such as needs assessment of learners, establishing goals and objectives, teaching methods, and evaluation and feedback. This core information was then applied and enriched during an end-of-course teaching presentation. Aside from this course, there is no forum during their undergraduate medical training for the students to acquire knowledge and skills about how to be teachers. DESCRIPTION: The course was developed with the appreciation that application of knowledge is a rich source of learning. The course began with interactive classroom teaching sessions designed to facilitate acquisition of core educational knowledge. Sessions topics included assessment of learner needs, methods of teaching, learning styles, microprecepting, and feedback. Also incorporated were sessions on facilitating small groups, and teaching and learning how to use technology. Those classroom sessions were then enhanced by a complement of sessions that asked the students to apply their new knowledge to clinical situations. Those more application-based sessions included observation and follow-up discussion of clinical teaching and small-group teaching sessions with the goal of developing the students' skills with respect to the teaching and learning process. An end-of-course teaching presentation by each student provided them with a capstone experience of applying the knowledge and skills learned throughout the week. The topic of the teaching presentation was of their choosing, and could incorporate technology. Each student's teaching presentation was videotaped, immediately viewed by the student, and discussed using a structured format of facilitated feedback. DISCUSSION: Students reported that the end-of-course teaching presentation was a rich source of their learning, and an important vehicle for helping them apply and synthesize the new knowledge. Fifteen percent of fourth-year students enrolled in and completed the elective. Seventy-one percent of those students "strongly agreed" and 29% "agreed" that the course provided useful knowledge and skills. Seventy-nine percent "strongly agreed" and 21% "agreed" that their teaching would be better because of the course. Based on comments, the students appeared to feel that the experience of presenting a teaching session at the end of the course was a rich source of their learning, and helped them to apply and synthesize the new knowledge. Students noted, "the teaching project was an excellent idea to see how much we have learned; I never realized what a responsibility we have as residents to teach our peers; I have been enlightened this past week and will now consciously make an effort to share what little information I currently have; I will be a better teacher because I have been given the appropriate tools."

Education, Medical, Undergraduate↗

PubMed2006

Information-seeking behaviors and reflective practice.

INTRODUCTION: As they care for patients, physicians raise questions, but they pursue only a portion of them. Without the best information and evidence, care and patient safety may be compromised. Understanding when and why problems prompt physicians to look for information and integrate results into their knowledge base is critical and shapes one part of reflection about care. This study explores the role of the Internet in gathering medical information as one step in that reflective practice, the barriers to its use, and changes in utilization over time. METHODS: A questionnaire with 18 items adapted from previous studies was sent by facsimile to a randomly selected sample of U.S. physicians in all specialties and active in practice. RESULTS: Specific patient problems and latest research in a specific topic most often prompt physicians to search on the Internet. Younger physicians and female physicians were most likely to seek information on a specific patient problem. Only 9% of all respondents (n = 2,500) searched for information during a patient encounter. When unsure about diagnostic and management issues for a complex case, 41.3% chose to consult with a colleague or read from a text (22.8%). Searching most often occurred at home after work (38.2%) or during breaks in the day (35.7%). Most (68.7%) found the information they were looking for more than 51% of the time. Searching was facilitated by knowing preferred sites and access in the clinical setting. The greatest barriers to answering clinical questions included a lack of specific information and too much information to scan. DISCUSSION: Although physicians are increasingly successful and confident in their Internet searching to answer questions raised in patient care, few choose to seek medical information during a patient encounter. Internet information access may facilitate overall reflection on practice; physicians do not yet use this access in a just-in-time manner for immediately solving difficult patient problems but instead continue to rely on consultation with colleagues. Professional association Web sites and point-of-care databases are helpful. From physicians' use of the Internet, professionals in continuing medical education must learn which search engines and sites are trusted and preferred.

Attitude of Health Personnel↗

PubMed1990

Medicinal chemistry: a support or a driving force in drug research?

The foregoing has demonstrated most emphatically the significant and central role which chemistry plays in modern and future drug research. It does not mean to diminish the important role of biology but it does serve to show that chemistry is not merely a support for the needs of biology but is a powerful driving force in itself. The two disciplines are essentially interdependent and each relies on the other for success in drug design, discovery and eventual delivery of a useful medicament to the patient. Finally, the medicinal chemist today is faced with as many if not more formidable challenges in medicinal research as his counterpart of a generation ago. The sciences of genetics, molecular biology, neuro-pharmacology and electrophysiology have expanded the knowledge base of cellular function many fold. This new knowledge when coupled with the fundamental role of biochemistry in outlining in chemical terms both normal and abnormal cellular events offers the researcher a much more sophisticated appreciation of the cause of disease states. Knowing which enzymes or receptors are involved is a crucial step towards correcting the malfunctioning cellular conditions. With powerful new methods for determining the three-dimensional structure of molecules and computer graphics which give insight on rational drug design and modification, the medicinal chemist can explore with greater confidence than ever before the road to new drugs. The new biology, the new physical methodology and the computer have enhanced the role of chemistry in modern drug research and have given the medicinal chemist a more profound grasp of cellular aberrations leading to disease. This knowledge is a golden rod in the hands of an imaginative chemist in the search of innovative drugs.

Biochemical Phenomena↗

PubMed2005

CADB-2.0: Conformation Angles Database.

The Conformation Angles Data Base (CADB) is a comprehensive, authoritative and timely knowledge base with a powerful query engine developed to facilitate the retrieval of information related to the conformational angles (main chain and side chain) of the amino-acid residues present in non-redundant (both 25 and 90%) data sets. The updated version has improved options for determining the dependency of the conformation angles of a particular residue upon the flanking residues, doublet analysis, triplet analysis and analysis of a particular protein structure. It is worth mentioning that for all options a user-friendly and convenient Java graphical user interface (GUI) has been provided to display the output on the client machine. The database is accessible at the URL http://cluster.physics.iisc.ernet.in/cadb/ or http://144.16.71.148/cadb/.

Amino Acids↗

PubMed1994

Pathophysiologic assessment of data from a stroke data bank.

Stroke data banks have been instrumental in helping us to clarify stroke etiology and in the investigation of clinical-topographic correlations. For these purposes they have relied upon results from noninvasive vascular and cardiac methods, including extra- and transcranial Doppler sonography and echocardiography, as well as from procedures such as cranial computed tomography and magnetic resonance imaging. Conventional database concepts have also been used to assess pathophysiologic aspects of stroke. Although such applications have made important contributions in this multidiscipline area of investigation, they are limited by a lack of explicit representation of pathophysiologic knowledge for data interpretation. Recent results from artificial intelligence research suggest exciting new frontiers for medical database design with concepts stemming from second generation expert systems. We propose an extended concept for stroke data banks to include a knowledge-based system which incorporates current patient data, heuristic knowledge relating clinical features to functional impairment, and pathophysiologic models of neurological disease.

Cerebrovascular Disorders↗

PubMed2002

Health and society in Finland: public health nurses' daily practice.

The role of public health nursing in Europe is changing as an ageing population and increasing social exclusion make new demands on health and social services. The purpose of this study was to describe how Finnish public health nurses (PHNs) practise in their daily work in order to meet the needs of this changing society. The knowledge base of the PHNs' work strongly emphasised experiential knowledge. However, on a theoretical level, medical knowledge dominated their work. The target of the PHNs' work was most frequently an individual, and perspectives of population or community were less common. The methods used in interactions with clients were participatory and empowered individuals to enhance their own health, and multiprofessional collaboration focused on joint decision-making and working towards the shared health goals of the client. However, PHNs need to employ a more reflective approach to their daily practice and take a more active role as an influential person in community and policy level.

Finland↗

PubMed1999

A comparative study of nurses' and elderly patients' ratings of pain and pain tolerance.

The purpose of this study was to compare elderly patients' and nurses' ratings of pain and pain tolerance. Data were collected through structured interviews with the patients. The attending nurses completed a questionnaire after conducting a pain assessment. Independent of each other, patients and nurses were asked to rate on a VAS when pain should be treated (pain tolerance) and pain intensity. The VAS has been used both by patients and nurses. The initial selection consisted of 43 patients; however, 9% (n = 4) were unable to complete the VAS. These patients were not significantly older than those who completed the study (n = 39). The results shows that nurses tend to overestimate mild pain and underestimate severe pain. Nurses rated pain tolerance significantly lower than patients. The results also suggest that nurses with training beyond basic nursing education tend to assess patients' pain more accurately than those without additional training. For patients who reported that they had pain prior to hospitalization, the nurses' pain ratings showed a higher agreement than for those who reported that they did not have pain before being hospitalized. At the time of the interviews, 21% (n = 8) of patients felt that their pain was so great they needed treatment. Those patients also were recognized by the attending nurses as being in pain. To improve elderly patients' pain management, practicing nurses must collaborate with researchers to develop specific empirical research nursing knowledge within geriatric pain management. This research-based knowledge should be incorporated into nurses' clinical practice regarding pain management. Specific guidelines must be developed for the assessment, treatment, and documentation of elderly patients' pain.

Aged↗