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PubMed1996

Effects of tutor expertise on student performance in relation to prior knowledge and level of curricular structure.

PURPOSE: To test whether there are effects of tutor expertise on student performance under conditions of curricular materials that have low or high levels of structure and that are poorly or well matched to students' levels of prior knowledge. METHOD: The study was conducted in 1994-95 at the medical school of the University of Limburg. The data set used for analysis included 135 tutorial groups (with ten to 12 students per group), 119 tutors (each running only one group per unit), and 15 units in four curriculum years. The analysis was conducted at the level of tutorial groups since a tutor's level of expertise might differ for distinct units. Tutors were asked to judge their levels of expertise related to the cases discussed, based on which a distinction was made between expert and non-expert tutors. The degrees of structure of curricular materials and students' levels of prior knowledge were rated by the students. Using analyses of variance, students' scores on end-of-unit tests (each with about 150 true-false items) were compared for groups led by expert and non-expert tutors under conditions of low and high levels of structure and low and high levels of prior knowledge. RESULTS: No difference was found between the test scores of groups led by expert and non-expert tutors. The interaction effects between expertise and structure and expertise and prior knowledge also turned out to be not statistically significant. CONCLUSION: The results suggest that expert tutors do not compensate for lack of curricular structure or students' lack of prior knowledge. This finding is not consistent with that of a recent study that expert tutors do compensate for lack of structure and lack of prior knowledge. This discrepancy may be accounted for by a much smaller range within which the structuredness of the curriculum and students' levels of prior knowledge varied in the present study compared with the previous study. An implication might be that faculty should put their efforts into designing structured curricula that are well matched to students' levels of prior knowledge instead of selecting hyper-expert tutors.

Curriculum↗
PubMed1998

The effects of a managed care educational program on faculty and trainee knowledge, attitudes, and behavioral intentions.

PURPOSE: To assess the state of managed care knowledge and attitudes and to evaluate the effects of a two-day course on participants' knowledge, attitudes, and behavioral intentions. METHOD: In 1996, the University of California, Davis, Medical School invited all medical students, residents, faculty, and administrators to participate in one of two sessions of a two-day course on managed care. Participants in the first session were given both pre- and post-course questionnaires. Participants in the second session were given only post-course questionnaires. The questionnaires measured objective knowledge, attitudes, and behavioral intentions. Participants (other than administrators) who completed the questionnaires also received a follow-up questionnaire six months after the seminar. RESULTS: The two sessions were attended by 818 UC Davis medical students, residents, faculty, and administrators: after excluding 33 non-physician administrators, 428 completed survey packets (55%) were available for full analysis. Before the course, participants in the first session correctly answered on average only 46% of 32 questions about managed care knowledge. Course attendance was associated with significant gains in knowledge (to 67% correct, p < .001) and a marked increase in appreciation for the cost-control effectiveness of managed care (from 3.35 to 3.98 on a five-point scale, p < .001). Knowledge gains were greatest among medical students; changes in attitudes and behavioral intentions were least among residents. Among respondents to a follow-up survey, the changes were partially sustained six months later. CONCLUSION: Within this academic medical center, baseline levels of managed care knowledge were low among faculty as well as among trainees, and attitudes reflected a blend of negativism and wishful thinking. An intensive two-day educational program effectively increased knowledge and changed selected attitudes among critical academic constituencies. Other academic medical centers may wish to consider presenting similar programs in order to orient their faculties and trainees to the economic realities of the foreseeable future.

Academic Medical Centers↗
PubMed1986

An assessment of different components of patient medication knowledge.

Different components of drug knowledge (i.e., knowledge of the drug purpose, regimen, action if a dose is missed, and common side effects) were examined in 187 ambulatory cardiovascular patients in order to determine whether the components were similar enough to be considered interchangeable in representing drug knowledge. Patients and physicians were interviewed in a family practice setting and their responses compared for each cardiovascular drug the patient was taking. Scores were highest for knowledge of the drug regimen and purpose, fewer patients were correct about the appropriate action if a dose were missed, and only a small number could accurately identify common side effects associated with their drug therapy. The comparison of patient responses to each of the knowledge measures indicated that there was little consistency in response across the various types of knowledge. The differences in the measures were supported further by regression equations that showed different relationships between a set of independent variables and knowledge of drug purpose and regimen, respectively. The study findings suggest that a partial explanation for inconsistencies of research about drug knowledge may be the way this concept is measured.

Adult↗
PubMedDate not supplied

Knowledge, attitudes, and behaviors of healthcare providers for botanical and dietary supplement use for postmenopausal health.

OBJECTIVE: To identify the knowledge, attitudes, and behaviors of health care providers (physicians and nurses) regarding the use of botanical dietary supplements (BDS) for peri- and postmenopausal women. DESIGN: Health care providers (physicians and nurse practitioners/nurse midwives) completed a questionnaire to assess knowledge, attitudes, and behaviors regarding botanical dietary supplement use for peri- and postmenopausal women. A total of 62 providers were included in the final analysis. RESULTS: Two thirds of providers reported that they had limited or no knowledge about botanical dietary supplements. By far, the majority of providers had no formal training nor had they studied these supplements on their own. Although knowledge was limited, a majority of providers wanted additional training predominantly because of growing patient awareness and use and were open to using these therapies for their patients either in combination with conventional Western medicine or as the only support for relief of peri- and postmenopausal symptoms. However, only 25% of providers regularly asked their peri- and postmenopausal patients about use of botanical dietary supplements. Providers who had practiced longer (> or =11 y) were more likely to be knowledgeable about dietary supplements and to have studied on their own (P < 0.01), to believe that botanicals are part of evidence-based medicine (P < 0.05), and to have talked to their patients (P < 0.05) about use of these therapies. Increased knowledge also appeared to predict a more positive attitude on the part of providers toward their patients who use BDS (P < 0.001) as well as more proactive behavior related to referring and recommending these therapies as treatment (P < 0.01). CONCLUSIONS: Our findings suggest that knowledge about botanical therapies among health care providers caring for peri- and postmenopausal women is quite low, but they are open to learning more about these modalities and using them for treatment, if appropriate. Our results suggest that increased years in practice is related to increased knowledge, more positive attitudes, and more proactive behaviors related to botanical dietary supplements.

Adult↗
PubMed2001

All together now: when dissociations between knowledge and action disappear.

Why do people sometimes seem to know things but fail to act appropriately on the basis of this knowledge? Such dissociations between knowledge and action often occur in infants and children, and in adults following brain damage. These dissociations have supported inferences about the organization of cognitive processes (e.g., separable knowledge and action systems) and their development (e.g., knowledge systems develop before action systems). The current study tested the basis for knowledge-action dissociations in a card-sorting task in which children typically correctly answer questions about sorting rules while sorting cards incorrectly. When questions and sorting measures were more closely equated for the amount of conflict that needed to be resolved for a correct response, children showed no systematic dissociation between knowledge and action. The results challenge standard interpretations of knowledge-action dissociations and support an alternative account based on graded knowledge representations.

Child, Preschool↗
PubMed1992

Tacit nursing knowledge: an untapped resource or a methodological headache?

Nursing education in the United Kingdom currently draws heavily upon Schön's concept of the reflective practitioner, and Benner's concept of the expert. It is claimed that experienced practitioners are unable to articulate all they know, and that their knowledge is of a qualitatively different type from that learned by beginners. Schön states that professional education gives privileged status to systematic, preferably scientific, knowledge, that technical knowledge drives out the artistry and competence of skillful practice, and that knowing that takes precedence over knowing how. In the first part of this paper, various writers on the subject of expert, tacit knowledge are discussed. Second, the paper examines the implications of expert knowledge for nursing research. Certainly it may be considered a methodological headache, since if expert knowledge is tacit it cannot be researched by exclusively verbal methods such as questionnaires; open-ended discussion may be appropriate, or perhaps participant observation. Nor will the findings be neat and easily analysed. But tacit knowledge is also an untapped resource for co-operative enquiry between researcher and practitioner, and nursing research has an important role in enhancing the knowledge creation capacity of practitioners.

Education, Nursing↗
PubMed1994

Specialized Travel Consultation Part II: Acquiring Knowledge.

With an increase in travel to tropical countries, the need to improve the disease-risk perceptions of travelers who are either naive or given inappropriate or ineffective advice is becoming increasingly important. More widely available, specialized centers that can provide advice on tropical or travel-related diseases have been established, but their efficacy on travelers' knowledge and health has not been verified. Therefore, this study was undertaken to evaluate the impact of the service provided by a routine travel consultation at the Hospital for Tropical Diseases Travel Clinic, London, England. Self-administered questionnaires were given to 161 preconsultation and 144 postconsultation clients. The consultation included an interview covering travel plans and immunization and medical history, and advice was given on the journey, necessary immunizations, and prophylaxis. Data were analyzed using the Statistical Analytic System software and the mean differences in knowledge between pre- and postconsultation scores were correlated using the nonparametric Mann-Whitney procedure. The control of mutually confounding factors was maintained by multiple regression using the Mantel-Haenszel summary chi-square and the General Linear Model procedures. Comparison of the entry and exit scores showed a significantly improved overall knowledge of travel-related diseases in the exit, postconsultation group. Subanalysis revealed that this difference was due to an increased knowledge of malaria and its prevention and perceived risk of cholera. Knowledge about the management of diarrhea or fever, however, was not significantly improved by a consultation. Inexperienced travelers taking packaged or organized trips, and those from socioeconomic groups I and II showed the largest increase in knowledge following consultation. Our results show that a face-to-face interview for an average of 18 minutes by trained staff is an effective way of improving travelers' knowledge on certain topics. The slight improvements overall are explained by the levels of experience of travel and previously acquired knowledge of the clients in our study. Effective advice on malaria prevention and some health risks is given during an average consultation; however, there is still a need for improvement in giving information on the management of diarrhea, fever, and other travel diseases.

Journal Article↗
PubMedDate not supplied

From data to knowledge through concept-oriented terminologies: experience with the Medical Entities Dictionary.

Knowledge representation involves enumeration of conceptual symbols and arrangement of these symbols into some meaningful structure. Medical knowledge representation has traditionally focused more on the structure than the symbols. Several significant efforts are under way, at local, national, and international levels, to address the representation of the symbols though the creation of high-quality terminologies that are themselves knowledge based. This paper reviews these efforts, including the Medical Entities Dictionary (MED) in use at Columbia University and the New York Presbyterian Hospital. A decade's experience with the MED is summarized to serve as a proof-of-concept that knowledge-based terminologies can support the use of coded patient data for a variety of knowledge-based activities, including the improved understanding of patient data, the access of information sources relevant to specific patient care problems, the application of expert systems directly to the care of patients, and the discovery of new medical knowledge. The terminological knowledge in the MED has also been used successfully to support clinical application development and maintenance, including that of the MED itself. On the basis of this experience, current efforts to create standard knowledge-based terminologies appear to be justified.

Artificial Intelligence↗
PubMedDate not supplied

Knowledge about hypoglycemia in young women with type I diabetes and their supportive others.

Hypoglycemia is a common stressful occurrence for people with type I diabetes, is disruptive to daily activities, and is a source of embarrassment, fear, and anxiety. Adequate knowledge about hypoglycemia is needed to recognize, treat, and prevent this condition. Families and friends also need adequate knowledge about hypoglycemia to provide helpful support. In this study, the Hypoglycemia Knowledge Questionnaire was used to measure knowledge about hypoglycemia in a convenience sample of 94 young women with type I diabetes and 94 supportive others. Knowledge about hypoglycemia was significantly higher for the young women with diabetes than for their supportive others, although knowledge deficits were evident for the young women on selected questionnaire items. Because normalization of blood glucose is associated with an increased risk of hypoglycemia, comprehensive evaluation of knowledge about hypoglycemia is critical to self-care. Additional studies are needed to validate the reliability and evaluate the usefulness of the Hypoglycemia Knowledge Questionnaire in clinical and research applications.

Adult↗
PubMedDate not supplied

Knowledge acquisition and verification tools for medical expert systems.

Expert systems require large amounts of domain knowledge for non-trivial problem solving. Experience in developing such systems has shown that the processes of acquiring domain knowledge (knowledge acquisition) and of determining whether the knowledge is consistent, complete, and correct (knowledge verification) are major problems. This paper discusses various tools developed to assist in these two processes. These tools bring additional knowledge to bear, or provide better interfaces between a knowledge engineer and the expert system's knowledge.

Artificial Intelligence↗
PubMed2003

Relationship between patients' warfarin knowledge and anticoagulation control.

OBJECTIVE: To evaluate patients' knowledge of warfarin and its relationship to anticoagulation control. METHODS: From January to March 1999, 122 patients attending the warfarin clinic of the Prince of Wales Hospital in Hong Kong were interviewed. Their knowledge of warfarin therapy and adherence to medical advice were tested by 9 questions. A score (maximum 1.0) was calculated for each patient. The number of international normalized ratios (INRs) that was within the target range in the 4 most recent clinic visits was noted. RESULTS: Fifty-six men and 66 women participated in the study (mean +/- SD age 58.0 +/- 13.0, duration of treatment 43.1 +/- 39.8 mo). Patients' warfarin knowledge was poor, with an overall score of 0.48 +/- 0.18. Participants generally knew the colors of their warfarin tablets and took them regularly. They almost always informed their physicians and dentists of their warfarin therapy. Only 40-45% of patients knew the strengths of their warfarin tablets, the reason for taking warfarin, and its effect on the body. Their deficiencies in knowledge were even more obvious with respect to the possible consequences of under- or over-anticoagulation, drugs and medicated oils that might interact with warfarin, and management of a missed dose. Knowledge was related to age (r -0.43; p < 0.001) and duration of therapy (r 0.18; p = 0.044). Sixty patients (49.2%) had read the information booklet on warfarin and had better knowledge than those who had not (0.53 +/- 0.20 vs. 0.42 +/- 0.20; p < 0.001). Illiteracy was the main reason for not reading the booklet. There was a positive correlation between patients' warfarin knowledge and the number of INR values that was within the target range in the 4 most recent clinic visits (r 0.20; p = 0.024). CONCLUSIONS: Patients' warfarin knowledge, a determinant of anticoagulation control, was generally poor. More attention should be given to the education of elderly and illiterate patients.

Adult↗
PubMed1989

Perceived and actual level of knowledge of diabetes mellitus among nurses.

The purpose of this study was to survey staff nurses on their perceived and actual level of knowledge of diabetes mellitus. A convenience sample of 184 professional staff nurses from both inpatient and outpatient settings of a large research-teaching hospital was surveyed. The Diabetes Self-Report Tool (Cronbach's alpha = .91) was used to assess staff nurses' perceptions of knowledge of diabetes mellitus. The Diabetes: Basic Knowledge Test (DBKT; Cronbach's alpha = .79) was used to measure the actual level of knowledge of diabetes mellitus. The data were analyzed with Pearson's correlation coefficients. A moderately low negative correlation (r = -.36, P less than .001) indicated that the staff nurses' perceived knowledge of diabetes mellitus was inversely related to actual knowledge. Subjects were found to have a mean score of 64% on the DBKT. Study findings raise questions as to the adequacy of staff nurse knowledge of diabetes and the ability of staff nurses to assess themselves for knowledge deficits.

Diabetes Mellitus↗
PubMedDate not supplied

Terminology support for development of sharable knowledge modules.

Lack of an agreed infrastructure for terminology is identified as one of the major barriers to interchange of knowledge modules and integration of knowledge bases with other clinical information systems. The goal of the GALEN project is to bridge this gap between different terminology systems through the construction of a terminology server, which is based on a rich conceptual model with mapping facilities to natural language expressions and coding schemas. The long term goal is to support communication between medical information systems. Arden Syntax is a standard format for the creation of knowledge modules, with sharability as one of the main objectives. Since Arden Syntax is based on a data-driven approach, the data items used need to be adapted to locally available terminology. The GALEN approach appears to be complementary to Arden Syntax and to the development of sharable knowledge modules. The major theme of this paper is utilization of the GALEN terminology server for knowledge module authoring. Two systems are presented, a knowledge base manager and a client to the terminology server, allowing the user to navigate in the semantic network and to import concept definitions and terms into the knowledge modules. The benefit of the terminology server, allowing the user to navigate in the semantic network and to import concept definitions and terms into the knowledge modules. The benefit of the terminology services is discussed.

Artificial Intelligence↗
PubMed1995

A knowledge-based system for diagnosis of mastitis problems at the herd level. 2. Machine milking.

A knowledge-based system for the diagnosis of mastitis problems at the herd level must search for possible causes, including malfunctioning milking machines or incorrect milking technique. A knowledge-based system on general mechanisms of mastitis infection, using hierarchical conditional causal models, was extended. Model building entailed extensive cooperation between the knowledge engineer and a domain expert. The extended knowledge-based system contains 12 submodels underlying the overview models. Nine submodels were concerned with mastitis problems arising from machine milking. These models are briefly described. The knowledge-based system has been validated by other experts after which the models were adjusted slightly. The final knowledge-based system was validated to data collected at 17 commercial dairy farms with high SCC in the bulk milk. Reports containing the farm data were accompanied by recommendations made by a dairy farm advisor. This validation showed good agreement between the knowledge-based system and the dairy farm advisors. The described knowledge-based system is a good tool for dairy farm advisors to solve herd mastitis problems caused by a malfunctioning milking machine or incorrect milking technique.

Animals↗
PubMed1994

Establishing partnerships with family caregivers. Local and cosmopolitan knowledge.

1. The concepts of local and cosmopolitan knowledge may be used by gerontological nurses in creating partnerships with family caregivers to frail older people. 2. Local knowledge is the understanding and skills that the family brings to the caregiving situation; cosmopolitan knowledge is the understanding and skills that the gerontological nurse brings to the situation. 3. Four nursing interventions are guided by the conceptualization of local and cosmopolitan knowledge: acknowledging and affirming local knowledge when it is adequate; developing or enhancing local knowledge when it is inadequate; assisting family caregivers to apply local knowledge to problem solving; and blending local and cosmopolitan knowledge.

Aged↗
PubMed1997

The WISECARE Project and the impact of information technology on nursing knowledge.

The European Union retained the WISECARE project "Work flow Information Systems for European nursing CARE" for funding. The project focuses on the use of telematics technology for clinical and resource management in oncology care in hospitals. This paper outlines the impact of introducing this kind of advanced nursing informatics application on the management of nursing knowledge. Three shift in knowledge management that will get high attention in WISECARE, are identified. The first is the shift from knowledge dissemination to knowledge sharing. The second is the shift from individual knowledge to organisational knowledge. The third is the shift from deductive, prescriptive knowledge as seen in guidelines, protocols to more inductive, experience based knowledge. The paper emphasizes that the real impact of information technology is not in the automation of existing processes but on the discovery of new ways of organisation and living.

Diffusion of Innovation↗
PubMed1999

The effect of a special nurse on patients' knowledge of epilepsy and their emotional state. Epilepsy Evaluation Care Group.

BACKGROUND: People with epilepsy often report being given insufficient information and support. However, there is little evidence from general practice about how much they know and how they feel. AIM: To describe social differences in the knowledge of epilepsy of people with the condition and test the potential effect of a nurse intervention in general practice on patients' knowledge and depression levels. METHOD: A questionnaire that included measures of knowledge, anxiety, and depression was sent to people with epilepsy aged over 15 years who were registered with 37 general practitioners. Responders were randomized to a controlled trial, offering either two appointments with an epilepsy nurse or usual care. Six months later they were reassessed. RESULTS: Two hundred and fifty-one out of 283 (89%) of the patients with epilepsy completed questionnaires and entered the study at Stage 1. One hundred and ninety-six out of 232 (84%) of those who entered the study, who remained in the practices and were eligible, returned questionnaires at Stage 2. The average duration of epilepsy was 23 years (range 2-79 years). There were significant differences in patients' levels of knowledge of epilepsy at Stage 1. Younger people, those who had left school after 16 years of age, those with GCSEs, and people who belonged to self-help groups had higher knowledge levels, and these were independent effects. Older people and those with a recent epilepsy attack had significantly higher depression scores. Knowledge scores did not differ significantly after the nurse intervention (Stage 2). At Stage 2, the risk of depression was less in the group randomized to be offered nurse input; the effect was mainly in a subgroup of patients with no recent epilepsy attack; their risk of depression was a third of the risk in the control group. CONCLUSIONS: Knowledge of epilepsy differs significantly, with social factors and self-help group membership having independent effects. A nurse-run clinic reduced the risk of depression for people with no recent epilepsy attack, but knowledge levels were not affected. This does not exclude the potential for patients learning more about epilepsy; it may be useful to suggest that patients join self-help groups early on.

Adolescent↗
PubMedDate not supplied

[Knowledge of AIDS of the medical students from three Mexican universities].

BACKGROUND: The Hegemonic Medical Model is discussed and is articulated with the postulates of the sociology of the professions. The information takes Aids as a specific topic, because it involves the aspects of recent scientific development, of clinical and epidemiological importance and due to the research which is being done for its treatment and the production of immunizations. METHOD: This is a case study of students enrolled in different years of study for medical degrees at the three main universities in México City. A closed-question questionnaire was handed out, checked and corrected, the variables of which were related to three types of knowledge, that is, basic, technical and general. RESULTS: The students were revealed to master this subject to only a minor extent the extensions of the knowledge of the disciplines of the profession however being applied to new cases without the suitable accuracy. A certain degree of dissociation was found to exist among the different types of knowledge which were researched, the professional know-how having been noted to clearly conform within specialized, segmented, curative logic of the Hegemonic Medical Model. CONCLUSIONS: The technical, problem-solving knowledge employed in clinical use prevails over the systematic, abstract knowledge of the general knowledge of medicine. A clear notion of the processes based on the dominant medical pattern is revealed in the single-causal relations of the disease. There is an extension of the basic knowledge a the resolving of clinical problems. The medical students are oriented toward taking in knowledge which will be useful to them in clinical practice.

Acquired Immunodeficiency Syndrome↗