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Results for “Knowledge base”

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PubMed2006

Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care.

BACKGROUND: Chiropractors must continue to learn, develop themselves professionally throughout their careers, and become self-directed and lifelong learners. Using an evidence-based approach increases the probability of optimal patient outcomes. But most chiropractors lack knowledge and interest in evidence-based approaches. The purpose of this study was to develop and measure the effectiveness of evidence-based training for chiropractic practitioners in a continuing education setting. METHODS: We developed and evaluated a continuing education workshop on evidence-based principles and methods for chiropractic practitioners. Forty-seven chiropractors participated in the training and testing. The course consisted of 12.5 hours of training in which practitioners learned to develop focused questions, search electronic data bases, critically review articles and apply information from the literature to specific clinical questions. Following the workshop, we assessed the program performance through the use of knowledge testing and anonymous presentation quality surveys. RESULTS: Eighty-five percent of the participants completed all of the test, survey and data collection items. Pretest knowledge scores (15-item test) were low (47%). Post intervention scores (15-item test) improved with an effect size of 2.0. A 59-item knowledge posttest yielded very good results (mean score 88%). The quality of presentation was rated very good, and most participants (90%) would "definitely recommend" or "recommend" the workshop to a colleague. CONCLUSION: The results of the study suggest that the continuing education course was effective in enhancing knowledge in the evidence-based approach and that the presentation was well accepted.

Journal Article↗

PubMedDate not supplied

Performance-based staff development. A baseline for clinical competence.

Changes in health-care financing, complex technological advancements, and an expanding nursing knowledge base have made it increasingly difficult for health care educators to assess and enhance the development of professional nurses. Using a set of objective evaluation methods and tools, educators assessed the competency of novice and experienced staff. This information identified learning and practice needs that formed the bases for individualized orientation and clinical educational programs.

Clinical Competence↗

PubMed1999

A general and fast scoring function for protein-ligand interactions: a simplified potential approach.

A fast, simplified potential-based approach is presented that estimates the protein-ligand binding affinity based on the given 3D structure of a protein-ligand complex. This general, knowledge-based approach exploits structural information of known protein-ligand complexes extracted from the Brookhaven Protein Data Bank and converts it into distance-dependent Helmholtz free interaction energies of protein-ligand atom pairs (potentials of mean force, PMF). The definition of an appropriate reference state and the introduction of a correction term accounting for the volume taken by the ligand were found to be crucial for deriving the relevant interaction potentials that treat solvation and entropic contributions implicitly. A significant correlation between experimental binding affinities and computed score was found for sets of diverse protein-ligand complexes and for sets of different ligands bound to the same target. For 77 protein-ligand complexes taken from the Brookhaven Protein Data Bank, the calculated score showed a standard deviation from observed binding affinities of 1.8 log Ki units and an R2 value of 0.61. The best results were obtained for the subset of 16 serine protease complexes with a standard deviation of 1.0 log Ki unit and an R2 value of 0.86. A set of 33 inhibitors modeled into a crystal structure of HIV-1 protease yielded a standard deviation of 0.8 log Ki units from measured inhibition constants and an R2 value of 0.74. In contrast to empirical scoring functions that show similar or sometimes better correlation with observed binding affinities, our method does not involve deriving specific parameters that fit the observed binding affinities of protein-ligand complexes of a given training set. We compared the performance of the PMF score, Böhm's score (LUDI), and the SMOG score for eight different test sets of protein-ligand complexes. It was found that for the majority of test sets the PMF score performs best. The strength of the new approach presented here lies in its generality as no knowledge about measured binding affinities is needed to derive atomic interaction potentials. The use of the new scoring function in docking studies is outlined.

Algorithms↗

PubMed2004

The specification of a frame-based medical terminological system in Protégé.

A medical terminological system (TS) is essentially a representation of concepts, attributes and relationships pertaining to medical terms. Although the requirements and structures of TSs have enjoyed some attention in the literature, the actual implementation of TSs consisted so far of ad-hoc approaches starting from scratch. Recently, Protégé has been suggested as a software environment for the development of knowledge-based systems. In Protégé various component types interact, and knowledge can be represented at various levels. This paper investigates how to specify a frame-based TS in Protégé and demonstrates this in a specific application in the intensive care. Our approach is characterized by the utilization of a conceptual framework for understanding TSs and mapping its components onto Protégé constructs. This results in specifications of knowledge components for the implementation of terminological systems. The significance of the work stems from the generality of the specifications, thus facilitating the principled design and development of terminological systems in various medical domains

Artificial Intelligence↗

PubMedDate not supplied

Using OncoDoc as a computer-based eligibility screening system to improve accrual onto breast cancer clinical trials.

While clinical trials offer cancer patients the optimum treatment, historical accrual of such patients has not been very successful. OncoDoc is a decision support system designed to provide best therapeutic recommendations for breast cancer patients. Developed as a browsing tool of a knowledge base structured as a decision tree, OncoDoc allows physicians to control the contextual instantiation of patient characteristics to build the best formal equivalent of an actual patient. Used as a computer-based eligibility screening system, depending on whether instantiated patient parameters are matched against guideline knowledge or available clinical trial protocols, it provides either evidence-based therapeutic options or relevant patient-specific clinical trials. Implemented at the Gustave Roussy Institute and routinely used at the point of care during a 4-month period, it significantly improved physician compliance with guideline recommendations and enhanced physician awareness of open trials while increasing patient enrollment to clinical trials by 50%. But, when analyzing reasons of non-accrual of potentially eligible patients, it appeared that physicians' psychological reluctance to refer patients to clinical trials, measured during the experiment at 25%, may not be resolved by the simple dissemination of clinical trial information at the point of care.

Attitude of Health Personnel↗

PubMedDate not supplied

KBSIM/FLUIDTHERAPY: a system for optimized design of fluid resuscitation in trauma.

An application of the KBSIM (Knowledge-Based SIMulation) system to the improved design of fluid resuscitation is described. The system integrates knowledge from three domains, viz. the pathophysiology of traumatized patients represented in a quantitative biodynamic model, the heuristics of fluid resuscitation of such patients as represented in 'production rules', and some 'metaknowledge' reflected in the design of a multi-window user interface. This technique of combining numerical simulation with symbolic reasoning has obvious advantages during the design process and in training, by giving the user a possibility to evaluate his measures by direct feedback from the system. This feature of the system to assist in evaluation of alternative resuscitation procedures should also be useful as a means for decision support.

Artificial Intelligence↗

PubMed2004

Imaging of acute cervical spine injuries: review and outlook.

Advances in imaging technology have been successfully applied in the emergency trauma setting with great benefit providing early, accurate and efficient diagnoses. Gaps in the knowledge of imaging acute spinal injury remain, despite a vast wealth of useful research and publications on the role of CT and MRI. This article reviews in a balanced manner the main questions that still face the attending radiologist by embracing the current and evolving concepts to help define and provide answers to the following; Imaging techniques -- strengths and weaknesses; what are the implications of a missed cervical spine injury?; who should be imaged?; how should they be imaged?; spinal immobilisation -- help or hazard?; residual open questions; what does all this mean?; and what are the implications for the radiologist? Although there are many helpful guidelines, the residual gaps in the knowledge base result in incomplete answers to the questions posed. The identification of these gaps in knowledge however should act as the initiating stimulus for further research. All too often there is a danger that the performance and productivity of the imaging modalities is the main research focus and not enough attention is given to the two fundamental prerequisites to the assessment of any imaging technology -- the clinical selection criteria for imaging and the level of expertise of the appropriate clinician interpreting the images.

Cervical Vertebrae↗

PubMedDate not supplied

Protocols and guides, tools.

The author describes in the first part of the review the definitions and relations of the occurring concepts. In the second part a short history of the topic is overviewed. The third part is dealing with the electronic patient record based development of guidelines in addition what are the relations among guidelines, protocols, tools, knowledge-based systems, diagnosis supporting systems, expert systems, outcome analysis and artificial intelligence. A short review of what was presented in the MIE '97 in this area is finally described and the Session Chairman's conclusion.

Computer Communication Networks↗

PubMed2001

What test should I use?

Appropriate assessment of Hispanic children requires clinicians to have knowledge of the cultural and linguistic factors that influence the communication skills of these children. This knowledge base includes an understanding of variations in the social and linguistic characteristics of Hispanic subgroups. Knowledge of these characteristics provides clinicians with the framework necessary to conduct less biased assessments. Clinicians possessing this framework would be able to conduct assessments that take into consideration the child's social ecology and the impact of dialect, first and second language acquisition, and language loss on the child's communication skills.

Child↗

PubMed2006

ReadOut: structure-based calculation of direct and indirect readout energies and specificities for protein-DNA recognition.

Protein-DNA interactions play a central role in regulatory processes at the genetic level. DNA-binding proteins recognize their targets by direct base-amino acid interactions and indirect conformational energy contribution from DNA deformations and elasticity. Knowledge-based approach based on the statistical analysis of protein-DNA complex structures has been successfully used to calculate interaction energies and specificities of direct and indirect readouts in protein-DNA recognition. Here, we have implemented the method as a webserver, which calculates direct and indirect readout energies and Z-scores, as a measure of specificity, using atomic coordinates of protein-DNA complexes. This server is freely available at http://gibk26.bse.kyutech.ac.jp/jouhou/readout/. The only input to this webserver is the Protein Data Bank (PDB) style coordinate data of atoms or the PDB code itself. The server returns total energy Z-scores, which estimate the degree of sequence specificity of the protein-DNA complex. This webserver is expected to be useful for estimating interaction energy and DNA conformation energy, and relative contributions to the specificity from direct and indirect readout. It may also be useful for checking the quality of protein-DNA complex structures, and for engineering proteins and target DNAs.

DNA↗

PubMed2006

The acquisition of tacit knowledge in medical education: learning by doing.

AIM: This study was designed to assess medical school teachers' tacit knowledge of basic pedagogic principles and to explore the specific character of the knowledge base. METHODS: We developed a 50-item, multiple-choice question test based on important pedagogic principles, and classified all questions as requiring either declarative or procedural knowledge. A total of 72 medical teachers representing 5 different groups of clinicians and educators agreed to sit the test. RESULTS: Teachers in all 5 groups performed well on the test of tacit pedagogic knowledge but those with advanced education degrees, or local recognition as experts, performed best. All test takers performed best on questions requiring procedural knowledge. CONCLUSION: Medical teachers possess tacit knowledge of basic pedagogic principles. Superior test performance on questions requiring procedural knowledge is consistent with their working in a clinical environment characterised by repeated procedural activities.

Education, Medical↗

PubMed1989

Nursing practice. Developing a philosophy.

The application of nursing models has been a recent theme in British nursing. Part of this process is the development of a nursing philosophy which underpins the model. Nurses at clinical level are often required to define their philosophy to meet clinical, educational and managerial objectives. The first part of this two-part article explores the significance of nursing philosophy to practice. In the second part, a case study is used to illustrate how clinical nurses can set about defining a philosophy of nursing for themselves. Dickoff et al (1) indicate that a philosophy is significant in the generation of theory. By identifying the nature of practice, theoretical relationships become apparent. It is also significant as Johnson (2) states in nursing's development as a profession. Johnson further asserts that nurses should use their beliefs to build a conceptual system of the person to be served and an abstract model for practice which allows such purpose to be fulfilled. However a nurse's beliefs and values about nursing may have no theoretical substance to them. They may be purely intuitive in nature. Writing a philosophy legitimates intuition. Kitson (3) considers that nurse theorists who believe that only developing a knowledge base through a scientific approach are at risk of throwing away the intuitive sources of knowledge within nursing. Yet gut reactions have been shown to be critical in the development of excellence in nursing (4). Kitson believes that intuitions can lead to developing 'grassroots standards of care' and a clearer definition of what nursing is.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed1989

Effectiveness of an AIDS education program on knowledge, attitudes, and practices of state employees.

While the number of companies employing HIV infected workers has more than tripled since 1985, only 10% of American corporations have policies for dealing with persons infected with HIV. The occupational health nurse is in a unique position to influence the attitudes, knowledge, and behaviors of workers in promoting a safe and productive work environment and reducing high risk activities. While the number of all individuals with AIDS has increased 4,000% in the last 6 years, there has been no reported increase in the percentage of HIV infected health care workers as compared with other occupations. An evaluation of an AIDS educational program revealed that while knowledge base was fairly high, statistically significant improvements were noted from pretest to retest in specific knowledge, attitude, and practice items.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Transferring knowledge from one system to another.

Although knowledge is contained in many systems, moving it from one system to another is not an easy task because each system is tailored in its own unique way and because knowledge configurations are usually copyrighted. To populate our FRAMEMED knowledge base we turned to the NLM Metathesaurus as a readily-available open source of knowledge. We were disappointed by the greatly variable granularity of the concepts and the lack of definitions that could be borrowed. Some reference books in electronic form seem attractive but reformatting will require excessive human intervention and copyright negotiation.

Artificial Intelligence↗

PubMed1995

A conceptual graphs modeling of UMLS components.

The Unified Medical Language System (UMLS) of the U.S. National Library of Medicine is a complex collection of terms, concepts, and relationships derived from standard classifications. Potential applications would benefit from a high level representation of its components. This paper proposes a conceptual representation of both the Metathesaurus and the Semantic Network of the UMLS based on conceptual graphs. It shows that the addition of a dictionary of concepts to the UMLS knowledge base allows the capability to exploit it pertinently. This dictionary defines more precisely the core concepts and adds constraints on their use. Constraints are dedicated to guide an "intelligent" browsing of the UMLS knowledge sources.

Dictionaries as Topic↗

PubMed1989

Immune system function. Implications for critical care nursing practice.

The purpose of the immune system is to protect the body from invasion from microorganisms. Natural defenses encompassing epithelial surfaces and secretions, nonspecific phagocytosis and inflammatory process, and the acquired defenses of humoral and cell-mediated immunity work together to defend the internal environment of the body. If microorganisms penetrate the external surfaces and enter the body, the inflammatory process is triggered. During phagocytosis by monocytes/macrophages, the invading antigen is identified as nonself. The antigen is presented to the T4-lymphocyte. This cell line orchestrates the activation of B-lymphocytes and a humoral response of antibody or Ig production and initiates the cytotoxic cell-mediated T cell response. Following an appropriate level of response, T8 cells suppress immune system response to the antigen, but not before memory B and T cells have formed. These memory cells protect the body against future exposure to the antigen, thus creating immunity. As concepts of immunology are identified and validated by future research, the knowledge base of immune system function and dysfunction will continue to grow. Critical care nurses must incorporate new knowledge related to immune system function into their practice, as patients in the ICU are at risk for immunocompromise from their underlying disease state and the therapeutic interventions used in their treatment. Nurses must expand their physiologic data base to include a nursing assessment of the immune system. A framework for organizing the data collection process would include: (1) a survey of factors affecting immune system function in each patient, (2) assessment of the cells and structures of the immune system, (3) monitoring of the status of first line defenses, (4) observing for activity of nonspecific defenses, and (5) evidence of specific acquired immune responses. After complete immune system assessment has identified areas of risk for compromise or the presence of immunocompromise, specific individualized nursing care plans can be developed to provide nursing support to maintain and enhance the patient's defenses.

Critical Care↗

PubMed2006

Knowledge content of advance practice nurse and physician experts: A cognitive evaluation of clinical practice guideline comprehension.

Clinical practice guidelines (CPGs) are intended to provide evidence based knowledge for decision making for patient care. However, these guidelines have been poorly adopted by healthcare providers. One reason for this may be the static paper-based formats, isolated from the point of care. Biomedical informatics has provided a solution to this limitation through Computer Interpretable Guidelines (CIGs). An essential component of this process is CPG translation to a computer interpretable model. From the guideline modeling literature, the translators of CPGs typically are physicians. It is not known if other healthcare providers (i.e., Advance Practice Nurses [APNs]) comprehend CPGs similarly. This descriptive study utilized novice and expert APN and physician participants (varied by level of expertise) in a CPG comprehension task. Demographic data, verbal protocols, and recall model drawings were obtained and analyzed by description, protocol analysis, discourse analysis, and content analysis. The findings of this study indicate similar comprehension by the expert APNs and physicians suggesting that either type of expert may be utilized for modeling CPGs.

Comprehension↗

PubMed2004

Levels and correlates of knowledge about cancer risk factors among 13,293 public school students in Morelos, Mexico.

BACKGROUND: Data on young people's knowledge about cancer prevention are not currently available for many populations, including Mexican young people, although cancer is the second most common cause of death among the Mexican population. METHODS: A questionnaire was applied to 13,293 public school students aged 11-24 years in Morelos, Mexico. A knowledge-based scale was constructed from survey answers about risk factors for cancer. Data were analyzed using multivariate logistic multinomial models. RESULTS: Knowledge levels were low: 78% of male and 74% of female students had only wrong answers to questions about risk factors for cancer. A significant dose-response gradient was observed between age and knowledge of cancer risk factors (P < 0.001), with a higher prevalence in young women at all ages (female students OR 4.6, 95% CI 3.81-5.66). Students 18 years old and older knew more than 13-year-olds (OR = 2.39; 95% CI 1.89-3.01). Sexually active students (OR 2.10; 95% CI 1.70-2.58), especially those who consistently used condoms (OR 2.84; 95% CI 1.00-8.07), knew more about cancer prevention. Tobacco smoking was the most frequently recognized cancer risk factor, and smokers also recognized this as an important cause of cancer (OR 1.37; 95% CI 1.44-2.52). CONCLUSIONS: Our results reveal a poor level of knowledge about cancer prevention among adolescents. These data are the first step in the development of an intervention based on empirical findings that will be susceptible to evaluation.

Adolescent↗