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Medical literature as a potential source of new knowledge.

Specialized biomedical literatures have been found that are implicitly linked by arguments that they respectively contain, but which nonetheless do not cite or refer to each other. The combined arguments lead to new inferences and conclusions that cannot be drawn from the separate literatures. One such analysis identified one set of articles showing that dietary fish oils lead to certain blood and vascular changes, and a second set containing evidence that similar changes might benefit patients with Raynaud's syndrome. Yet these two literatures had no articles in common and had never before been cited together; neither literature mentioned the other or suggested that dietary fish oil might benefit Raynaud patients. Two years after publication of that analysis, the first clinical trial demonstrating such a beneficial effect was reported independently by others. A second example of literature synthesis, based on eleven indirect connections, led to an inference that magnesium deficiency might be a causal factor in migraine headache. A third example calls attention to implicit connections between arginine intake and blood levels of somatomedins, a potentially fruitful but neglected area of research with implications for the decline with age of thymic function and protein synthesis. A model and an online search strategy to aid in identifying other logically related noninteractive literatures is described. Such structures are probably not rare and may provide the foundation for a literature-based approach to scientific discovery.

Abstracting and Indexing

Poliomyelitis and the sources of useful knowledge.

Dr. Richard Ross during his introduction observed that Dr. Bodian made three contributions to the study of poliomyelitis which laid the groundwork essential to the ultimate triumph over the disease by immunization. The first was the identification of three types of poliovirus. This was absolutely basic to the development of a vaccine. The second was the identification of the viremia which occurred before the paralysis began and thus, indicated how it would be possible for an immune response to be effective. The third important contribution was the demonstration that immunity could be developed in primates with very low antibody levels.

Animals

Oral health knowledge and habits of senior elementary school students.

Despite improvements in children's dental health, and significant resource allocation to health education programs, few recent studies have investigated the associations of oral health knowledge, behaviors, and status. This study of 11-year-old children (N = 6,329) in northeastern Ontario used a supervised self-complete questionnaire and a clinical examination to gather baseline data on, and test associations of, caries and periodontal knowledge, self-reported oral health behaviors and source of knowledge, and oral health status. Results show the children had poor knowledge of caries preventive measures such as water fluoridation, dental sealants, and choice of snack foods. Periodontal knowledge was better, but children confused plaque and calculus. Respondents claimed good oral health habits, with 73 percent claiming to brush at least twice daily, 88 percent claiming to use toothpaste, 42 percent claim to floss at least twice weekly, and 84 percent claiming an annual dental visit. Children with the best knowledge claimed dentist and school as the sources. High knowledge was associated with good oral health habits (P less than .001) and low DMFT score (P less than .001). Good habits were not related to DMFT score (P = .1095). Logistic regression showed high knowledge was associated with English cultural status, urban school area, good habits, having a dental sealant, and attending a fluoride-rinse school (P less than .05). Findings suggest a need to reinforce caries preventive teaching, to investigate the effect of cultural status, dental experience, and residence status on oral health knowledge, and to further test the efficacy of different oral health education programs delivered by different sources.

Analysis of Variance

Use of prior knowledge in brain electromagnetic source analysis.

Using multichannel measurements of EEG and/or MEG, macroscopic source activities can be estimated in the human brain using brain electric source analysis (BESA, Scherg 1990). If a discrete number of brain areas is active, functional brain images which depict the locations and orientations of equivalent dipole sources as well as the dynamics of the local macroscopic currents can be obtained from such data--in principle--without external knowledge. However, given a certain number of sources or 'neural masses' (Freeman 1975) which contribute to an event related response (ERP), it can be difficult to find the correct solution due to background noise in the data and distortions from the head model. Prior knowledge based on anatomy and physiology can be useful to constrain spatial or temporal parameters of the model and to define better cost functions for fitting locations and orientations. An analysis of the auditory evoked N100 complex and of the auditory mismatch negativity (MMN) is presented which illustrates the use of spatial constraints. Also, the use of a modified cost function is demonstrated which limits source currents in certain time intervals.

Brain

Training in developmental pediatrics. How practitioners perceive the gap.

Ninety-seven randomly selected, board-certified pediatricians in five New England states were interviewed by two physicians to explore attitudes toward previous training and current sources of knowledge in developmental pediatrics. Formal training in development was rated as inadequate by 79%, of residency experience was viewed as highly valuable by only 30%, and 47% rated medical school as having no value. Although clinical experience was reported as a valuable source of knowledge by 99% of the sample, almost two thirds did not regard it as an adequate substitute for formal training. Frequent interdisciplinary communication was reported, and professional contacts were described as a highly valuable ongoing source of knowledge. Social class and size of practice did not correlate with differences in consultation patterns. A part-time longitudinal clinical experience for further education was preferred by 97%. Improved training with greater interdisciplinary content is needed.

Child

West Texas teenagers and AIDS: a survey of their knowledge, attitudes, behavioral changes, and information sources.

We conducted this study to determine the knowledge, attitudes, behaviors, and sources of AIDS information among teenagers in West Texas. We also examined differences by gender, ethnicity, and rural/urban status. Results were divided into the following categories: general knowledge of AIDS, AIDS-related attitudes, behavior changes caused by AIDS, and AIDS information sources. The 289 ninth-grade students revealed a greater knowledge of AIDS than had been shown in studies in other states. However, there were group differences with Anglo students exhibiting greater knowledge of AIDS. There were also some differences between rural and urban students, with urban students scoring higher on knowledge. Finally, doctors were regarded as the most reliable source of AIDS information. There were many implications related to AIDS education from these results and from the other findings in this study.

Acquired Immunodeficiency Syndrome

Philosophic analysis of a theory of clinical nursing.

Knowledge in nursing requires development of theories that address both the science and art of the professional practice discipline. "A Theory of Clinical Nursing" was analyzed to explicate the epistemologic dimensions within an historic perspective. Epistemologic dimensions defined by the philosophy of science--approaches to theory development, sources of knowledge, and methodology--were characterized from two perspectives, scientific inquiry and historicism. The major perspectives in the scientific mode, namely, mechanism, empiricism, logical positivism, and logical empiricism, were analyzed along the three dimensions of theory development, sources of knowledge, and methodology. Trends in theoretical developments in nursing were related to the scientific and historic perspectives and to the epistemologic dimensions. Juxtaposing the diversity of knowledge required for nursing science and practice, and the values systems of the practitioners, revealed the inadequacy of the scientific model. Nursing knowledge explication required several modes of inquiry to articulate the scientific basis of the discipline and the art of delivery of the practice. The historicist approach framed scientific work with the prevailing World View. The Rubin theory was located within the matrix of approaches to inquiry and perspectives in nursing science. Labeled by the theorist as both a nursing research and a nursing care model, "A Theory of Clinical Nursing" represented a transition model of nursing, undergirded by the major conceptualizations and methodologies of field, psychoanalytic, and social behaviorist traditions, but implicitly coalescing the art with the science of nursing. The theory addressed core concepts of person, situation, and nursing care, as well as major process themes of change and interaction. Nursing theories of a more narrow range, such as maternal role attainment and maternal identity, nested within the theory, while subsequent theoretical clarifications and expansions have been constructed by students of the theorist. In the hierarchy of knowledge conceptualizations, Rubin's theory represents a disciplinary matrix: ordering theories, methods, and exemplars; giving direction to the development of theories of nursing that address empirical problems of the discipline; and cohering to the metaparadigm of nursing. Philosophic analysis of theories of nursing can yield an articulated, clearly depicted framework of concepts and their relationships from which new understandings may emerge.

Cognition

Sexually transmitted diseases--knowledge and attitudes among young people. Developments in Sweden between 1986 and 1988.

Pupils aged 18 to 19 years at colleges and technical schools in a small town and a rural area filled in questionnaires concerning sexually transmitted diseases (STD) in May 1986 and May 1988. The questions covered knowledge and sources of information about STD. The influence of knowledge on attitudes and actual behavior was studied. Knowledge about STD was fairly good and increased between the two study periods. Schoolteachers and the media were important sources of information. Girls knew more than boys, and more often discussed STD with adults and friends. Small differences emerged between the urban and rural areas and between pupils attending theoretical and practical courses. Attitudes seemed to change with time but it is not clear whether this has resulted in changes in actual behavior.

Adolescent

Sexual behaviour, contraceptive practice and knowledge of reproductive biology among adolescent secondary school girls in Nairobi, Kenya.

One thousand seven hundred and fifty one adolescent secondary school girls aged between 12 and 19 years were interviewed by means of self-administered questionnaire to determine their knowledge on reproductive biology, sexual behaviour and its relationship to contraceptive practice in late 1986. 23.8% of all the girls had been or were sexually active at the time of the study. 94.5% of the sexually active girls had not or were not using any method of contraception; while the rest, i.e. 5.5% were using mainly unreliable or risky methods of contraception. 1.7% of the sexually active girls admitted to have been pregnant at one time and had sought abortion. Majority of the girls displayed profound ignorance and misinformation regarding their reproductive biology and contraception. Their mothers played a very minor role in imparting this knowledge, their sources of information being fairly unreliable. While 77.8% of the girls were against school girls having sexual relationships, 90.7% of them felt that all women (including school girls) should be given contraceptives to protect themselves from unwanted pregnancies.

Adolescent

How sources of health information relate to knowledge and use of cancer screening exams.

Utilization of many screening procedures to detect cancer in early stages remains low. In order to design more effective strategies to increase utilization of these tests, we assessed the role and relative importance of different information sources on knowledge and use of cancer screening exams. Where individuals get useful information about disease prevention, and the relationship of information sources to cancer screening knowledge and behavior are reported using data from the 1987 National Health Interview Survey. Results indicate that physicians are perceived as important sources of information on how to prevent illness. However, persons who use print media as their most useful source of information are significantly more likely to have heard of cancer screening procedures than those who rely on the doctor as the source. Those who rely on electronic media tend to be less knowledgeable of all screening procedures examined. A strong and consistent association between doctor as the most useful source of information and actually having received the procedure was found. These results suggest that knowledge may not necessarily be a prerequisite to screening and indicate that reliance on the physician to recommend cancer screening may be critical in utilization of these services.

Family

Introducing hypertext in primary health care: a study on the feasibility of decision support for practitioners.

A study on the feasibility of the introduction of hypertext systems for communication of medical knowledge in primary care is described. Shortliffe's constraints on areas for application of decision support are evaluated (i.e., theoretical barriers, observable and recognized needs among users, sources of usable knowledge, available system development method). Considering the barriers derived from the knowledge types and forms used by practitioners, hypertext was found suitable as support at 'breakdowns' in practice routines, to generate 'alarms', as well as for continued medical education. A survey of the a priori acceptance of decision support systems by general practitioners showed that 84% would use the computer support if it was available today and that full-text databases, such as hypertext, were given highest priority for introduction. Local specialist physicians were identified as knowledge sources for therapy advice. Implementation of prototype systems envisioned use of hypertext in primary care as the introduction of a communication medium for co-operative health care decision making. A model for the introduction into the work environment is described.

Attitude to Computers

Information needs in office practice: are they being met?

We studied the self-reported information needs of 47 physicians during a half day of typical office practice. The physicians raised 269 questions about patient management. Questions related to all medical specialties and were highly specific to the individual patient's problem. Subspecialists most frequently asked questions related to other subspecialties. Only 30% of physicians' information needs were met during the patient visit, usually by another physician or other health professional. Reasons print sources were not used included the age of textbooks in the office, poor organization of journal articles, inadequate indexing of books and drug information sources, lack of knowledge of an appropriate source, and the time required to find the desired information. Better methods are needed to provide answers to questions that arise in office practice.

Adult

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