Decline of breast-feeding among New York urban poor linked to sources of information on infant feeding practices: a lesson for African countries.
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Africa↗
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[AIDS-related knowledge among nurses in Mie Prefecture, Japan].
Levels of understanding and knowledge regarding AIDS were investigated for medical personnel working at general hospitals with more than 100 beds in Mie Prefecture by means of a questionnaire during May to June, 1990. The questionnaire covered general knowledge of AIDS, psychological response, attitudes and actions taken toward infected persons, and societal countermeasures against AIDS. Responses from 1,516 nurses and assistant nurses were statistically investigated among medicare persons. Mass media was the major source of knowledge on AIDS for the nurses and assistant nurses. Level of understanding on AIDS, however, appeared to be rather low, which may be due to difficulty in obtaining accurate information on AIDS and also due to lack of motivation to study. The responses of nurses were more positive than for assistant nurses for action taken in hypothetical cases of infection to themselves, spouses or familiar persons. Similar differences were also shown in responses regarding societal countermeasures against the disease.
Acquired Immunodeficiency Syndrome↗
Evidence-based practice among Danish cardiac nurses: a national survey.
AIMS: This paper presents a survey of evidence-based practice among cardiac nurses exploring nurses' attitudes towards evidence-based practice and the types of knowledge they employ in clinical practice. BACKGROUND: Research utilization and evidence-based practice are required at hospitals around the world, although the definition of evidence-based practice is still unclear. An ongoing debate exists about the sources of knowledge and the hierarchy of research evidence in clinical practice, and nursing research has been threatened by the dominance of randomized controlled trials. Evidence-based practice has been described as a new paradigm, which promotes patient-centred care by integrating external evidence and patient preferences. METHODS: The study was a cross-sectional survey with a descriptive and comparative design, using self-administered postal questionnaires. The questionnaires were sent to 33 head nurses and 51 bedside nurses representing one or two units in each cardiac department in Denmark (n = 28). The final response rate was 81%. The study was carried out in 2004. RESULTS: Respondents had a positive attitude towards evidence-based practice, although they relied upon personal clinical experience. Head nurses were statistically significantly more familiar with the concept of evidence-based practice than bedside nurses, and read scientific journals more frequently. Introductory courses to evidence-based practice are rare and seldom mandatory, and the data suggest that respondents lacked knowledge of the finer points of evidence-based practice and equated the concept with research utilization. CONCLUSIONS: Barriers to evidence-based practice are inadequate education, unfamiliarity with English, and low organizational position. Facilitators include the implementation of guidelines, provision of continuing education, and an increase in the accountability of bedside nurses.
Adult↗
Attitudes and concerns of Canadian animal health technologists toward postoperative pain management in dogs and cats.
Three hundred and twenty-two Canadian animal health technologists (AHTs) were surveyed to determine their attitudes toward postoperative pain management in dogs and cats following 6 surgical procedures, their concerns regarding the use of opioid analgesics, and their role within veterinary practices with respect to postoperative pain control. Two hundred and sixty-four (82%) returned the questionnaire. Pain perception was defined as the average of pain rankings for dogs and cats (on a scale of 1 to 10) following abdominal surgery, or the value for dogs or cats if the AHT worked with only 1 of the 2 species. Maximum concern about the risks associated with the postoperative use of morphine or oxymorphone was defined as the highest rating assigned to any of the 6 risks evaluated in either dogs or cats. Animal health technologists reported significantly higher pain perception scores than did veterinarians who completed a similar survey 2 years previously. Higher pain perception scores were associated with decreased satisfaction with the adequacy of analgesic therapy in their practice, higher pain control goals, and attendance at continuing education within the previous 12 months. The majority of AHTs (55%) agreed that one or more risks associated with the use of morphine or oxymorphone outweighed the benefits. The 3 issues that were perceived to pose the greatest risk were respiratory depression, bradycardia, and sedation and excitement, for dogs and cats, respectively. Most AHTs (68%) considered their knowledge related to the recognition and control of pain to be adequate, compared with 24% of veterinarians who responded to a similar previous survey. As for veterinarians, experience gained while in practice was ranked as the most important source of knowledge, while the technical program attended was ranked as least important. Over 88% of the AHTs provided nursing care during the postoperative period, monitored animals for side effects of postoperative analgesic therapy, informed veterinarians when animals were in pain, recommended analgesic therapy when they believed it was warranted, reported that animals received analgesics when they believed it was warranted, administered analgesics under the instruction of a veterinarian, and believed they were part of a team working to provide adequate postoperative pain control.
Animal Technicians↗
A knowledge-based architecture for protein sequence analysis and structure prediction.
Methods for analyzing the amino-acid sequence of a protein for the purposes of predicting its three-dimensional structure were systematically analyzed using knowledge engineering techniques. The resulting entities (data) and relations (processing methods and constraints) have been represented within a generalized dependency network consisting of 29 nodes and over 100 links. It is argued that such a representation meets the requirements of knowledge-based systems in molecular biology. This network is used as the architecture for a prototype knowledge-based system that simulates logically the processes used in protein structure prediction. Although developed specifically for applications in protein structure prediction, the network architecture provides a strategy for tackling the general problem of orchestrating and integrating the diverse sources of knowledge that are characteristic of many areas of science.
Amino Acid Sequence↗
Knowledge, personal risk and experiences of HIV/AIDS among people with disabilities in Swaziland.
Although there has been research focused on the disabling consequences of HIV/AIDS, there has been very little documented information about HIV/AIDS for individuals with disability prior to infection. There is evidence to suggest that people with disabilities face inequalities in accessing health information and services. The aim of this study was to explore whether disabled and non-disabled young adults in Swaziland perceive HIV/AIDS similarly. A qualitative study using focus-group discussions was conducted. Four focus groups were conducted with a total of 56 non-disabled adults (aged 16-29 years) and four focus groups were conducted with a total of 32 adults with either a physical or hearing disability (aged 18-32 years). The focus-group schedule explored knowledge about HIV/AIDS, personal risk and experiences of health-seeking practices. Information and awareness about HIV/AIDS was good in both rural and urban areas among the non-disabled participants, who obtained their information from a wide range of sources. In contrast, participants with disability, who obtained information about HIV/AIDS from a limited range of sources, lacked knowledge about HIV/AIDS and were misinformed about modes of transmission. Women with disabilities described experiences of sexual exploitation and abuse, which was perceived to be higher among disabled women than their non-disabled peers; they felt this was because disabled women were perceived to be 'free' from the HIV virus by non-disabled men. Further research is necessary to enable HIV/AIDS programmes to address the specific needs of people with disabilities.
Acquired Immunodeficiency Syndrome↗
Israeli youth and AIDS: knowledge and attitude changes among high school students following an AIDS education program.
A pilot project conducted in three Jerusalem schools in 1990-91 demonstrated that medical students who had received extensive training in teaching about AIDS and its prevention were able to influence the level of knowledge and attitudes on this subject among high school students. Research findings showed moderate to low knowledge levels in a sample group of 241 Jerusalem high school students on all AIDS-related questions. The average score was (mean +/- SD) 68.9 +/- 15.4, with significant differences (P < 0.01) between boys 77.2 +/- 8.6 and girls 65.9 +/- 16.4. The principal source of knowledge on AIDS among the sample population was the electronic media, 47% stating that their knowledge of HIV/AIDS came from television. After a series of four lessons in the "The Immune System and AIDS" program, there was a significant improvement in the students' knowledge. The average score rose to 78.8 +/- 13.9 with an improvement of up to 23% in the answers to the various subgroups of questions. The program succeeded in clarifying for the students the degree of personal risk from contracting HIV, but did not affect their fear of the disease--70% of the students stated that they were afraid of being ill with AIDS. The study did not examine the students' behavioral patterns.
Acquired Immunodeficiency Syndrome↗
Role of information sources and socio-demographic factors on knowledge about AIDS in female adolescents.
OBJECTIVE: To assess the role of information sources and socio-demographic factors on knowledge about AIDS in female adolescents. DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Three different girls colleges of Lahore. Study was conducted from September 1999 to November 1999. PATIENTS AND METHODS: The sample of 600 students was divided into various colleges according to the total strength of students in the college. The students filled a semi structured questionnaire anonymously. To assess the overall knowledge of students a scale with a range of 0-49 score was developed for 49 items inquired to assess knowledge about AIDS. On the basis of this score students were divided into satisfactory and unsatisfactory knowledge groups by using the 50th percentile as the cut off point. RESULTS: Eighty percent of those students whose mothers and 58% of those students whose fathers had postgraduate qualifications had satisfactory knowledge of AIDS as compared to those students whose parents were graduate and undergraduate (p <0.0001). Similarly, significantly higher knowledge of AIDS (p <0.0001) was observed in those students whose mothers were working as compared to those students whose mothers were housewives, as well as those whose parents' monthly income exceeded Rs 10,000. Those students who read the editorial, columns and magazine section of newspapers had satisfactory knowledge about AIDS as compared to those students who read the political and sports section of the newspapers. Access to television, satellite channels and Internet had a statistically significant effect on knowledge about AIDS (p<0.0001). Significant higher knowledge of AIDS was observed among those students who discussed AIDS with their sisters and friends (p <0.05) as compared to those students who discussed AIDS with their parents and teachers. CONCLUSION: Those students who belonged to higher socioeconomic group and had educated parents had satisfactory knowledge about AIDS. The newspaper and electronic media also have an important role in transmitting knowledge about AIDS. Family members, friends and teachers can prove to be a potential source for dissemination of information about AIDS.
Acquired Immunodeficiency Syndrome↗
Herbal therapy use in a pediatric emergency department population: expect the unexpected.
BACKGROUND: In recent years investigators have reported widespread use of alternative medicine. Some herbal therapies have potentially harmful side effects as well as adverse interactions with medications. Data are lacking on the use in children and caregiver understanding of these products. OBJECTIVES: To determine the reported use of herbal products among a pediatric emergency department population and to evaluate the caregivers' understanding and source of information concerning these products. DESIGN/METHODS: A convenience sampling of pediatric emergency department patients and their caregivers occurred during a 3-month period in 2001. The interview consisted of 18 questions regarding the types of non-Food and Drug Administration-regulated herbal products and home remedies used, general product knowledge and sources of information used by the child's caregiver (including discussions with their child's primary physician). RESULTS: One hundred forty-two (93%) of 153 families approached participated in the study. The mean patient age was 5.3 years (range: 3 weeks-18 years). Forty-five percent of caregivers reported giving their child an herbal product, and 88% of these caregivers had at least 1 year of college education. Of the children receiving these therapies, 53% had been given 1 type and 27% were given 3 or more in the past year. The most common therapies reportedly used were aloe plant/juice (44%), echinacea (33%), and sweet oil (25%). The most dangerous potential herbal and prescription medication combination reported was ephedra and albuterol in an adolescent with asthma. The most unusual products reportedly used included turpentine, pine needles, and cowchips. Of all people interviewed, 77% did not believe or were uncertain if herbal products had any side effects and only 27% could name a potential side effect. Sixty-six percent were unsure or thought that herbal products did not interact with other medications and only 2 people correctly named a drug interaction. Of the people who used these therapies, 80% reported either friends or relatives as their primary source of information. Only 45% of those giving their children herbal products report discussing the use with their child's primary health care provider. CONCLUSION: Herbal and home therapies are commonly used in this pediatric population. An unexpectedly wide variety of products were reportedly given to this patient population. Caregivers reported limited knowledge regarding potential adverse medication interactions and side effects. Limited discussions with the child's primary health care provider were reported. It is therefore important for health care providers to have knowledge about herbal medications, to inquire about their use and to educate families about the risk/benefit as well as potential interactions these products may have with over-the-counter and prescription medications.
Adolescent↗
Constructing biological knowledge bases by extracting information from text sources.
Recently, there has been much effort in making databases for molecular biology more accessible and interoperable. However, information in text form, such as MEDLINE records, remains a greatly underutilized source of biological information. We have begun a research effort aimed at automatically mapping information from text sources into structured representations, such as knowledge bases. Our approach to this task is to use machine-learning methods to induce routines for extracting facts from text. We describe two learning methods that we have applied to this task--a statistical text classification method, and a relational learning method--and our initial experiments in learning such information-extraction routines. We also present an approach to decreasing the cost of learning information-extraction routines by learning from "weakly" labeled training data.
Artificial Intelligence↗
Whose evidence counts? An exploration of health professionals' perceptions of evidence-based practice, focusing on the maternity services.
OBJECTIVES: to gain an insight into how health professionals in the maternity services define evidence and how they perceive different types of evidence are valued in maternity care. DESIGN: using a qualitative approach data were collected by semi-structured interviews: the content of each was analysed thematically. SETTING: England. PARTICIPANTS: a purposeful sample of ten midwives, two obstetricians and one research nurse. FINDINGS: definitions of evidence vary widely among health practitioners. These definitions are affected by individuals' own beliefs and give rise to a hierarchy in which some types of evidence are valued above others. All the participants made direct or indirect reference to cultural beliefs inherent within the health service, and indicated that these beliefs determine the extent to which different types of evidence are seen as legitimate. IMPLICATIONS FOR PRACTICE: the concept of evidence-based practice is not value-free. Evidence that reinforces notions of authoritative knowledge may be transposed into clinical practice quickly and easily. Conversely, health practitioners may have difficulty putting evidence into practice that challenges the cultural norms of the profession. There is a need for further work to make explicit the values that underpin different sources of knowledge and expose the hierarchies of evidence that exist.
Anecdotes as Topic↗
Enteral nutrition in intensive care nurses' perceptions and bedside observations.
The aims of this descriptive study were to examine (1) nurses' perceptions of responsibility, knowledge and documentation focusing on enteral nutrition and (2) nursing practice regarding enteral feeding in the intensive care unit. Forty-four nurses in three intensive care units responded to a questionnaire (response rate 70%) and 40 bedside observations were performed. The nurses' primary source of knowledge was consultation with colleagues. Regarding responsibility, knowledge and documentation, the focus was more on planning, implementation and prevention than on the assessing phase of the nursing process. Gastric residual volumes were almost never checked, and none of the tubes were labelled. Seven out of 40 bedside observations revealed a backrest elevation of 30 degrees or more. Mean backrest elevation was 20.7 degrees. Comparisons between nurses in the three hospitals revealed significant differences. This study indicates that enteral nutritional nursing care within intensive care has its strength in planning, implementation and prevention of complications. Regarding nutritional assessment, the registered nurses (RNs) scored low. There are gaps between recommended nursing care and nursing practice regarding enteral nutrition. Knowledge and awareness of responsibilities in combination with a systematic documentation could increase the optimal nutritional care of the intensive care patient.
Adult↗
The perception of menopause among women in Taiwan.
OBJECTIVES: Hormone replacement therapy (HRT) has become a popular topic and the subject of many newspaper and magazine health articles in the last 5 years in Taiwan, so a great deal of knowledge about the menopause has been introduced to Taiwanese women. With this massive change, we wanted to know the current perception of the menopause among women in Taiwan and also evaluate the prevalence of various acute menopausal symptoms and women's attitudes toward receiving hormone replacement therapy. METHODS: We designed a cross-sectional study, using structured questionnaires, targeting women who attended the health information seminar on the menopause and HRT, held in an urban area in Taiwan. The audience was asked to fill out the questionnaire before the seminar began. More than 2000 questionnaires were collected, but only 386 women completed all items of the questionnaire and were included in this study. Among them, 161 women were postmenopausal and their answers to questions regarding acute menopausal symptoms were collected for statistical analysis. The other 225 women were non-menopausal and their perception of menopausal symptoms was also collected for analysis. Qualitative data, in the form of transcripts, were interpreted using text-based content analysis. RESULTS: Among these women, 375/386 (97%) had previously heard of the menopause, but only 207/386 (53%) knew the definition of the term. The most commonly indicated source of knowledge on the menopause was reading material, such as newspapers and magazines 283/386 (43%); less common sources of information were friends 141/386 (22%), medical personnel 114/386 (18%) and family members 49/386 (8%). Among these women, 276 (71%) thought they should receive therapy. The most common acute menopausal symptoms in postmenopausal women and perception of menopausal symptoms in non-menopausal women, respectively, were insomnia 68/161 (42%); 111/225 (49%), hot flushes 61/161 (38%); 115/225 (51%), heart palpitation 55/161 (34%); 103/225 (46%), an irritable temper 54/161 (34%); 138/225 (61%), dyspareunia 52/161 (32%); 100/225 (44%), headaches or dizziness 45/161 (28%); 74/225 (33%), a lack of energy 42/161 (26%); 73/225 (32%), depression 32/161 (20%); 114/225 (51%), night sweating 29/161 (18%); 61/225 (27%), and loss of bladder control 26/161 (16%); 37/225 (16%). CONCLUSIONS: According to this study, Taiwanese women have a much higher percentage of awareness of the menopause than other Asian women, as reported previously and a greater willingness to receive treatment. We also found that most of their knowledge of the menopause was obtained from reading material (43%) or friends (22%). Furthermore, the percentage of recognition of menopausal symptoms, especially of vasomotor symptoms, is lower than that of Western women and higher than that of women in Hong Kong and Southern China.
Adult↗
Expertise in practice: an ethnographic study exploring acquisition and use of knowledge in anaesthesia.
BACKGROUND: Expert professional practice in any field is known to rely on both explicit (formal) and tacit (personal) forms of knowledge. Current anaesthetic training programmes appear to favour explicit knowledge and measurable competencies. We aimed to describe and explore the way different types of knowledge are learned and used in anaesthetic practice. METHOD: Qualitative approach using non-participant observation of, and semi-structured interviews with, anaesthetic staff in two English hospitals. RESULTS: The development of expertise in anaesthesia rests on the ability to reconcile and interpret many sources of knowledge--clinical, social, electronic, and experiential--and formal theoretical learning. Experts have mastered technical skills but are also able to understand the dynamic and uncertain condition of the anaesthetized patient and respond to changes in it. This expertise is acquired by working with colleagues, and, importantly, by working independently, to develop personal routines. Routines mark the successful incorporation of new knowledge but also function as a defence against the inherent uncertainty of anaesthetic practice. The habits seen in experts' routines are preferred ways of working chosen from a larger repertoire of techniques which can also be mobilized as changing circumstances demand. CONCLUSIONS: Opportunities for developing expertise are linked to the independent development of personal routines. Evidence-based approaches to professional practice may obscure the role played by the interpretation of knowledge. We suggest that the restriction of apprenticeship-style training threatens the acquisition of anaesthetic expertise as defined in this paper.
Anesthesia↗
An expert system for the analysis and interpretation of evoked potentials based on fuzzy classification: application to brainstem auditory evoked potentials.
EPEXS is an expert system for evoked potential analysis and interpretation (a medical examination performed in clinical neurophysiology laboratories), working from available clinical records and numerical data extracted from evoked potential traces. EPEXS integrates two formalisms of knowledge representation: rules and structured objects. The rules represent the elementary concepts (shallow knowledge) and include a model of possibility based on the Dubois and Prade default reasoning and possibility theory. The structured objects (prototypes) are organized as hierarchical taxonomies (underlying knowledge). These allow the description of both the objects and their relationships. The heuristics used to interpret knowledge are based on two hypotheses: the unicity of the pathological process leading to several given symptoms and the progression from the general to the specific, leading to the adoption or rejection of a class of diagnoses. This avoids the problem of the differential diagnosis. These sources of knowledge are used in a dynamical way that could be described as a four-step process: acquisition of clinical data in order to define the nosological frame of the pathology, production of hypotheses about the nature and topography of lesions, interpretation of data in accordance with these hypotheses, and finally evaluation of their likelihood. The validation shows that EPEXS topographic diagnoses were correct in 100% of cases and 92% of it nosologic diagnoses were correct, and no pathological record was interpreted as normal. When examined on a given pathology basis EPEXS was not significantly different from human experts as regards to performance, specificity, and sensitivity.
Computer Simulation↗
The perception of fluent speech.
The perception of fluent speech involves both acoustic-driven and knowledge-driven sources of information. Acoustic sources that directly convey information about higher-order linguistic characteristics include the suprasegmental aspects of speech, associated with the acoustic cues of fundamental frequency, duration, and intensity. From the standpoint of cochlear prostheses, interest in listeners' perception of these suprasegmentals is heightened by the fact that these properties are typically among the best preserved sources of speech information in the sensorineural hearing-impaired. Studies with normal listeners indicate that suprasegmentals provide cues to such linguistic factors as word stress, syntactic structure, and semantic interpretation. In addition, they supply information about many nonlinguistic characteristics of the speaker. Research on knowledge-driven processes indicates that normal listeners utilize knowledge of lexical, syntactic, and semantic constraints of the language to guide the segmentation of speech into word-like units and to select among candidate word choices. These findings are related to research with hearing-impaired listeners and prosthesis testing.
Cochlear Implants↗
Promoting evidence-based practice: an organizational approach.
AIM: To examine factors influencing the achievement of evidence-based practice. BACKGROUND: This paper reports on the approach taken by a large teaching hospital in England to promote evidence-based practice. A summary of initiatives spanning a 5 year period is presented in order to set the scene for a recent survey of nurses to review progress made. Consideration is given to how the findings from the survey have been used to inform policy and practice. METHODS: A survey by self-completed questionnaire was undertaken with a sample of clinical nurses (n = 330). The questionnaire examined the extent to which nurses utilised different sources of knowledge to inform their practice; perceived barriers to accessing evidence-based information and effecting change in practice; and a self-assessment of core skills necessary to underpin evidence-based practice. FINDINGS: Nurses relied most heavily on experiential knowledge gained through their interactions with nursing colleagues, medical staff and patients to inform their practice. Organisational information in the form of policies and audit reports was drawn upon more frequently than research reports. Lack of time, resources and perceived authority to change practice influenced the extent to which nurses utilised formal sources of evidence. Whereas nurses were relatively well skilled at accessing and reviewing research evidence, they were less confident about their ability to change practice. CONCLUSION: Health care organisations need to consider multiple strategies to facilitate and promote evidence-based practice. Managerial support, facilitation, and a culture that is receptive to change are essential.
Attitude of Health Personnel↗
Basic Gene Grammars and DNA-ChartParser for language processing of Escherichia coli promoter DNA sequences.
MOTIVATION: The field of 'DNA linguistics' has emerged from pioneering work in computational linguistics and molecular biology. Most formal grammars in this field are expressed using Definite Clause Grammars but these have computational limitations which must be overcome. The present study provides a new DNA parsing system, comprising a logic grammar formalism called Basic Gene Grammars and a bidirectional chart parser DNA-ChartParser. RESULTS: The use of Basic Gene Grammars is demonstrated in representing many formulations of the knowledge of Escherichia coli promoters, including knowledge acquired from human experts, consensus sequences, statistics (weight matrices), symbolic learning, and neural network learning. The DNA-ChartParser provides bidirectional parsing facilities for BGGs in handling overlapping categories, gap categories, approximate pattern matching, and constraints. Basic Gene Grammars and the DNA-ChartParser allowed different sources of knowledge for recognizing E.coli promoters to be combined to achieve better accuracy as assessed by parsing these DNA sequences in real-world data sets.
DNA, Bacterial↗