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PubMed1994

Polygenic trait analysis by neural network learning.

AI techniques have been applied to the domain of DNA sequence analysis in predicting or identifying certain specialized regions, in recognizing genes, and in understanding the evolutionary relationships between sequences. This paper focuses on a kind of genetic pattern recognition, namely, the problem of identifying the gene combinations (patterns) causally related to a given trait determined by multiple genes (a so-called polygenic trait). A novel approach is presented which combines neural-network and knowledge-based techniques. The neural network is trained to predict the trait and then the knowledge embedded in the network is decoded into symbolic patterns. This hybrid approach is evaluated in the domain of identifying genes of insulin dependent diabetes mellitus. The consistency between the results with this approach and those reported in genetic literature supports the viability of this approach.

Artificial Intelligence↗

PubMed2006

Nutrition, hydration, and dysphagia in long-term care: Differing opinions on the effects of aspiration.

OBJECTIVES: This study examined the management of aspiration in skilled nursing settings, by determining speech-language pathologists' and nursing staff members' agreement about aspiration, interventions, and impact on residents' nutrition and hydration status, as determined by agreement scores on a questionnaire. DESIGN: Cross sectional descriptive. SETTING: Health care; skilled nursing facility. PARTICIPANTS: Seventy-eight speech-language pathologists (SLPs) and 83 nursing caregivers. INTERVENTION: Participants completed a survey questionnaire requesting a level of agreement with statements about aspiration and interventions for aspiration. Questionnaires also included demographic questions for analysis purposes. MEASUREMENTS: Agreement scores on a modified Likert scale. RESULTS: There were no significant differences in agreement scores for SLPs by formal training or years of experience. Nurses showed differences by experience for 2 statements, and by level of certification for 3 statements. There were significant differences between responses for nurses and SLPs for 7 of the 10 items. Both groups demonstrated content knowledge that conflicts with principles documented in the medical literature. CONCLUSION: Results suggest that both SLP and nursing training programs should include more evidence from multidisciplinary sources, specifically the medical literature, to improve the knowledge base of clinicians providing care to residents with swallowing disorders.

Aged↗

PubMed2004

Authorizing tradition: vectors of contention in Highland Maya midwifery.

In Guatemala, midwives deliver the majority of children and play an important health care role in rural areas. Maya midwives, using time-proven methods, are the chief providers of care for mothers and infants in these areas. In recent decades, however, the medical establishment has become interested in Maya midwives, and is currently engaged in training and certifying many of them. This study examines how Guatemalan health authorities have sought to change Maya midwifery, refashioning its vocational framework and retooling it in accordance with Western medical principles. I focus on the place of obligatory formal training and the use of biomedical materials in the experience of Kaqchikel Maya midwives, and consider how the health officials employ these means to undermine the midwives' knowledge base. Encounters between midwives and formal health personnel reveal an ongoing privileging of biomedical knowledge, one that preserves asymmetrical relationships between these practitioners. This creates an environment favorable to health personnel, and helps them to extend their influence through the midwives into the community. Given this, I contend that health personnel value local Maya midwives primarily for their role in furthering the goals of biomedicine.

Attitude of Health Personnel↗

PubMed2005

Family practice nurse views on barriers to immunising children.

New Zealand (NZ) has low immunisation coverage for infants and children compared to many other westernised countries. Barriers to improving uptake are multifactorial, with health professional knowledge and attitudes identified as important modifiable factors. In NZ practice nurses give most childhood vaccinations in the primary health care setting. This study explored aspects of 150 family practice nurse views, knowledge and experience about immunisation. Qualitative and quantitative text data were obtained through randomised computer assisted telephone surveys and converged using a triangulated multi-method approach. Response rate was 89.3% nurses identified parents' fear as the greatest barrier to achieving better immunisation uptake and disagreed that health professional knowledge was a barrier. However, findings showed lack of knowledge among many participants, despite many feeling confident about their knowledge base. Factors associated with lower practice coverage of infants under 2 years were poorer knowledge of contraindications to vaccination and lack of completion of vaccinator training, especially an update course. A high level of confidence, more years in practice, dedicated time to follow-ups were not associated with better coverage rates. Practice nurses may be unaware that their knowledge in some areas needs improving. A trained practice nurse appears to play a significant role in overcoming fears and maintaining high coverage rates in their practice. We conclude that strategies that focus on primary health care provider support and education are more likely to gain high coverage than those that are purely directed at overcoming access barriers.

Child↗

PubMed2001

Computer-assisted drug development (CADD): an emerging technology for designing first-time-in-man and proof-of-concept studies from preclinical experiments.

Computer-assisted drug development (CADD) is an emerging technology for accelerating drug development based on the integration of mathematical modelling and simulation. This methodology provides a knowledge-based decisional tool on alternative development strategies based on the evaluation of potential risks on drug safety, and the definition of experimental design of new trials with expected power and probability of success. An example of CADD implementation is presented to design the first-time-in-man (FTIM) and the proof-of-concept (PoC) study of a new CNS compound. The final objective of the example presented is not necessarily to supply a success story of a correct prediction of human data from animal studies but to define a credible strategy suitable to design FTIM and PoC studies using preclinical data without the support of any human in vivo information. Rhesus monkey and human PK were initially estimated using allometric scaling on data collected in dogs, cynomolgus monkeys and rats. A PK/PD model was derived from a study conducted in rodent and validated by comparing the model predicted response to the one observed in a PET experiment conducted in rhesus monkey. The final PK/PD model, incorporating potential variability and uncertainty on scaled human prediction together with a receptor affinity adjustment derived from in vitro binding studies, was used to design the first-time-in-man and the proof-of-concept study.

Animals↗

PubMed2003

On the evolution of primitive genetic codes.

The primordial genetic code probably has been a drastically simplified ancestor of the canonical code that is used by contemporary cells. In order to understand how the present-day code came about we first need to explain how the language of the building plan can change without destroying the encoded information. In this work we introduce a minimal organism model that is based on biophysically reasonable descriptions of RNA and protein, namely secondary structure folding and knowledge based potentials. The evolution of a population of such organism under competition for a common resource is simulated explicitly at the level of individual replication events. Starting with very simple codes, and hence greatly reduced amino acid alphabets, we observe a diversification of the codes in most simulation runs. The driving force behind this effect is the possibility to produce fitter proteins when the repertoire of amino acids is enlarged.

Amino Acid Sequence↗

PubMedDate not supplied

Assessment of professional nursing students' knowledge and attitudes about patients of diverse cultures.

This study examined personal attitudes of 152 Bachelors of Science in Nursing (BSN), registered nurse (RN) to BSN, and master's students enrolled in a school of nursing in the southwestern United States toward culturally diverse patients and their perceived knowledge of specific cultural practices and culture-specific skills. Three instruments were used to collect data: the Ethnic Attitude Scale-Part I, the Transcultural Questionnaire, and a demographic survey. Findings reveal that students in all three programs had a relatively low knowledge base about specific cultural groups. The only statistically significant difference found in attitudes, perceived knowledge of cultural patterns, or perceived cultural skills by program was the slightly higher perceived ability of generic BSN students to distinguish between concepts such as ethnocentrism and discrimination, intra- and intercultural diversity, and ethnicity and culture. Similar to other studies of measurement of provider attitudes and perceived cultural knowledge, the results of this study reinforce the struggle experienced by educators and the challenges faced by health care administrators grappling with teaching and delivering culturally competent care. The findings imply that nurse educators need to examine alternate models and teaching strategies to move students along the continuum of cultural learning.

Adult↗

PubMed1988

The introduction of expert systems in animal husbandry.

The intensive nature of modern animal husbandry has changed the environmental conditions, so that protection against diseases, especially those caused by secondary pathogenic organisms, becomes an increasing concern. Production inefficiencies become more and more important. Because of their complex nature, many associated problems cannot be solved by farmers alone. With the introduction of information technology in the form of expert systems, new possibilities emerge for maximal productivity and animal health. Expert systems are a new type of computer programmes which are able to handle problems in limited domains at an expert level, using expert knowledge and reasoning processes, within strictly defined problem limits. Expert systems as they presently exist have the following components: a knowledge base (rule- and data-base), inference engine (deductive mechanism), user-interface (explanatory facilities, etc.). The application of knowledge engineering in animal husbandry may result in improvements in the general health and productivity of the herd and the financial returns of the farm, derived from the improved managerial control. At the same time the use of knowledge engineering may lead to greater understanding of the various epidemiological factors that influence farm results, either positively or negatively.

Animal Husbandry↗

PubMed1998

Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations.

Beginning in 1992, the Agency for Health Care Policy and Research and the National Institute of Mental Health funded the Schizophrenia Patient Outcomes Research Team (PORT) to develop and disseminate recommendations for the treatment of schizophrenia based on existing scientific evidence. These Treatment Recommendations, presented here in final form for the first time, are based on exhaustive reviews of the treatment outcomes literature (previously published in Schizophrenia Bulletin, Vol. 21, No. 4, 1995) and focus on those treatments for which there is substantial evidence of efficacy. The recommendations address antipsychotic agents, adjunctive pharmacotherapies, electroconvulsive therapy, psychological interventions, family interventions, vocational rehabilitation, and assertive community treatment/intensive case management. Support for each recommendation is referenced to the previous PORT literature reviews, and the recommendations are rated according to the level of supporting evidence. The PORT Treatment Recommendations provide a basis for moving toward "evidence-based" practice for schizophrenia and identify both the strengths and limitations in our current knowledge base.

Combined Modality Therapy↗

PubMed2004

Approaches to target class combinatorial library design.

The wealth of information available from the solution of the human genome has dramatically altered the nature of combinatorial library design. While single-target-focused library design remains an important objective, creation of libraries directed toward families of receptors such as GPCRs, kinases, nuclear hormone receptors, and proteases, has replaced the generation of libraries based primarily on diversity. Although diversity-based design still plays a role for receptors with no known ligands, more knowledge-based approaches are required for target class design. This chapter discusses some of the possible design methods and presents examples where they are available.

Amino Acid Sequence↗

PubMed2003

Periodontal referral patterns, 1980 versus 2000: a preliminary study.

BACKGROUND: A review of the periodontal literature offers little information concerning trends in referral patterns of patients for periodontal therapy. Over the last 2 decades, there has been a significant increase in the knowledge base concerning inflammatory periodontal disease. It might be assumed that the collective advances in knowledge have impacted periodontal referral patterns. Thus, the purpose of this study was to examine the differences in periodontal referral patterns in the same offices separated by a 20-year interval (i.e., 1980 and 2000). METHODS: A retrospective chart analysis was conducted on a total of 782 patient charts from three conveniently selected periodontal practices. Charts were randomly selected from two time periods: 1980-1981 and 2000-2001. The following information was obtained from each patient record: gender, age at time of initial examination, tobacco smoking status at time of initial examination, periodontal case type, number of missing teeth at initial examination (not including third molars), and number of teeth scheduled for extraction per periodontal treatment plan. Descriptive data were analyzed using frequency distributions, measures of central tendency, and measures of dispersion. Non-parametric statistics were used to examine the relationship of disease severity as a function of site, time period, and patient age. RESULTS: The following trends were noted: 1) an increase in the average age of patients at the time of the initial examination; 2) a decrease in the percentage of patients using tobacco at the time of the initial interview; 3) an increase in the percentage of periodontal Case Type IV patients with a concomitant decrease in the number of periodontal Case Type II patients; 4) an increase in the average number of missing teeth per patient at the initial examination; and 5) an increase in the average number of teeth scheduled for extraction per periodontal treatment plan. CONCLUSIONS: Characteristics of patients referred in 1980 compared to those referred in the year 2000 indicate that, although fewer patients used tobacco, there were several noteworthy trends. At referral, patients exhibited a greater loss of teeth, had more severe disease, and required extraction of a greater number of teeth in 2000 compared to 1980. Possible reasons for these trends are discussed.

Adult↗

PubMed1993

The ongoing development of a problem-based surgery clerkship: year three.

The third-year clerkship at one college of medicine was modified to reflect an emphasis on adult learning principles and life-long learning habits. Problem-based learning was selected as the educational method, and the development of a cognitive knowledge base, clinical problem-solving skills, and appropriate clinical skills was stressed. At a yearly faculty education retreat, strengths and weaknesses of the clerkship were discussed. As a result of this meeting, several changes were made in the clerkship, including additional stress on students' usage of the medical library and computerized databases, a tutor development program, the addition of expert resource sessions, and more emphasis on students' development of clinical skills through a preceptor program. A comprehensive evaluation program designed to support the educational goals of the clerkship is in place. The major challenge of the program remains the proper synchronization of curricular, clinical, and student self-study activities essential for an ideal learning experience.

Clinical Clerkship↗

PubMed2003

Automatic section segmentation of medical reports.

Automated segmentation of medical reports can significantly enhance the productivity of the healthcare departments. While many algorithms have been developed for document summarization, passage retrieval, and story segmentation of news feeds, much less effort has been devoted to parsing of medical documents. We present an algorithm specifically developed for medical applications. The algorithm consists of two components. First, a rule-based algorithm is used to detect the sections that contain labels. It utilizes a knowledge base of commonly employed heading labels and linguistic cues seen within training examples. The second part of the algorithm handles the detection of unlabeled sections. It uses a combination of lexical pattern recognition and a classifier based on an expectation model for a particular class of medical reports. The proposed method was evaluated on three test corpora containing a total of 129,303 report sections. The detection rates for labeled and unlabeled sections for individual corpus ranged from 97.4% to 99.4% and from 96.5% to 99.0%, respectively. The rule-based approach is particularly effective for medical reports due to inherently structured nature of these documents.

Algorithms↗

PubMed2004

[Evidence-based medicine from the office-based physicians' point of view: a representative survey on its acceptance and demand for continuous medical education].

In 2002 a curriculum on evidence-based medicine (EbM) has been developed and published in Germany on behalf of the national statutory health care administrations. Planning and guiding medical education in EbM requires an empirically-based knowledge of the level of awareness and acceptance of EbM as well as specific educational needs and organisational preferences. In Germany, there is no such systematic knowledge, particularly in regard to general practitioners. A random sample of 900 office-based physicians in the German state of Schleswig-Holstein, stratified by medical specialties, was surveyed by means of a postal questionnaire. After two reminders the response rate was 65.6%. Respondents mainly welcomed EbM, in terms of their own daily work, for the benefit of the patient and the healthcare system as a whole. Integrating EbM into their daily practice and possible restrictions to therapeutic freedom were considered the most serious problems of EbM. 46.8% of the respondents were interested in EbM training. They preferred a rather low-cost 2-day weekend seminar. Office-based physicians were found to be sufficiently motivated to participate in EbM courses, which is in marked contrast to the actual participation rate being rather low in Schleswig-Holstein. The training should primarily focus on integrating EbM into daily routines. In public presentations efforts should be directed towards promoting the way in which EbM enhances professional autonomy and therapeutic freedom.

Curriculum↗

PubMed1995

A client/server system for remote diagnosis of cardiac arrhythmias.

Health care practitioners are often faced with the task of interpreting complex heart rhythms from electrocardiograms (ECGs) produced by 12-lead ECG machines, ambulatory (Holter) monitoring systems, and intensive-care unit monitors. Usually, the practitioner caring for the patient does not have specialized training in cardiology or in ECG interpretation; and commercial programs that interpret 12-lead ECGs have been well-documented in the medical literature to perform poorly at analyzing cardiac rhythm. We believe that a system capable of providing comprehensive ECG interpretation as well as access to online consultations will be beneficial to the health care system. We hypothesized that we could develop a client-server based telemedicine system capable of providing access to (1) an on-line knowledge-based system for remote diagnosis of cardiac arrhythmias and (2) an on-line cardiologist for real-time interactive consultation using readily available resources on the Internet. Furthermore, we hypothesized that Macintosh and Microsoft Windows-based personal computers running an X server could function as the delivery platform for the developed system. Although we were successful in developing such a system that will run efficiently on a UNIX-based work-station, current personal computer X server software are not capable of running the system efficiently.

Arrhythmias, Cardiac↗

PubMed1998

Automated knowledge extraction from the UMLS.

This paper presents our work in extracting disease-chemical relationship knowledge from the UMLS Co-occurrence table (MRCOC) using an automated method. We evaluated the quality of the knowledge from UMLS MRCOC by comparing it with knowledge from other sources: For disease-lab chemical relationships, knowledge was obtained from a decision support system (DXplain) and our own knowledge base of medical terminology (MED) through automated processes. For disease-drug chemical relationships, knowledge was manually acquired from the medical literature. Evaluations showed that the UMLS MRCOC knowledge has good sensitivity, especially regarding disease-drug relationships. We are using this knowledge to produce disease-specific views of patients' electronic patient record.

Decision Support Systems, Clinical↗

PubMed2006

Research to practice in The Journal of Continuing Education in the Health Professions: a thematic analysis of volumes 1 through 24.

INTRODUCTION: Authors have stressed the importance of the broader contextual influences on practice improvement and learning and have expressed concern about gaps between research and practice. This implies a potential expansion of the knowledge base for continuing education in the health professions (CEHP) and an increased emphasis on research evidence for that knowledge. How has the content of The Journal of Continuing Education in the Health Professions (JCEHP) reflected those changes? What are the implications for CEHP practitioners? METHODS: Based on all abstracts, tables of contents, and editorials, a thematic analysis was completed for volumes 1 through 24 of JCEHP. All texts were downloaded into qualitative analysis software and coded. Main code categories included demographics of articles, concepts relating to CEHP as a discipline, knowledge translation and outcomes-oriented continuing education, and theories and frameworks. Key themes were identified. RESULTS: Key themes include categories of topics included in JCEHP over the years, the increased prominence of research in JCEHP, a dual research evidence-to-practice gap, the professionalization of continuing education providers, and interdisciplinarity and the links with broader frameworks that have been proposed for CEHP. DISCUSSION: Two sets of research-to-practice gaps are portrayed in the journal: the gap between clinical research and practice and the gap between research and practice in CEHP. To close the first gap, authors have asserted that the second gap must be addressed, ensuring that CEHP practices themselves are evidence based, driven by theory-based research. This is a variation on prior debates regarding the need to define CEHP as a discipline, which uses the language of professionalization. The increased focus of continuing education on the contexts of health care providers' practices has multiplied the topics that are potentially relevant to CEHP practice.

Education, Medical, Continuing↗

PubMed2003

Testing alternative decision approaches for identifying cleanup priorities at contaminated sites.

This exploratory study compares two approaches for involving nonexpert stakeholders in difficult policy choices. Both approaches have as their goal informing members of the public about contaminated sites and involving them in decisions regarding their cleanup. The first approach focuses on technical information and seeks to improve the available knowledge base so that participants can make choices informed by detailed scientific data. This approach is similar in intent to many of the science-based initiatives in public involvement now being undertaken by EPA, DOE, and other federal or state agencies. The second approach, in contrast, focuses on values-oriented information and seeks to improve stakeholders' ability to make difficult choices in light of required tradeoffs across a variety of technical and nontechnical concerns. The results demonstrate that although both approaches help to increase participants' knowledge level, a values-based approach is more successful in terms of helping nonexpert participants to make decisions aboutwhat have historically been viewed as primarily technical problems.

Decision Making↗