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PubMed2006

The knowledge-value chain: A conceptual framework for knowledge translation in health.

This article briefly discusses knowledge translation and lists the problems associated with it. Then it uses knowledge-management literature to develop and propose a knowledge-value chain framework in order to provide an integrated conceptual model of knowledge management and application in public health organizations. The knowledge-value chain is a non-linear concept and is based on the management of five dyadic capabilities: mapping and acquisition, creation and destruction, integration and sharing/transfer, replication and protection, and performance and innovation.

Biomedical Research↗
PubMed1996

The effect of writing after reading on college nursing students' factual knowledge and synthesis of knowledge.

The purpose of this experimental study was to investigate the effect of writing after reading on factual knowledge and synthesis of knowledge. College sophomore nursing students (N = 118) were randomly assigned to one of three groups: a control group which read, reviewed, but did no writing; a notetaking group; or an essay writing group. A 10-item multiple-choice test of factual knowledge was given to all subjects immediately after completing each reading and writing task and again 7 days later. At the later time, each student also wrote an essay to demonstrate synthesis of knowledge. Seven days later, students repeated the same reading and writing activities with a second text. Results of ANOVA showed that notetaking was significantly better than essay writing or no writing for recall of facts. Essay writing, on the other hand, helped students synthesize better than notetaking. However, there was no difference between essay writing and no writing on synthesis of knowledge.

Analysis of Variance↗
PubMed1994

[School children's knowledge of, need for and use of contraception before and after the AIDS campaigns. Knowledge and sources of information].

The purpose of the present paper was to investigate the influence of the AIDS-campaigns on adolescents' knowledge of contraception and pregnancy and their sources of information. All pupils in their ninth school year in the municipality of Viborg answered an identical questionnaire in 1986 and 1993, dealing with the mentioned subjects. In 1986, 539 questionnaires were included, in 1993, 391. In 1986, sexually inexperienced boys had lesser knowledge than the rest. This could not be shown in 1993. Although their knowledge was not optimal, the pupils in 1993 answered better than the 1986-pupils. They had the same informational sources, but in 1993, the school was mentioned as an important source by nearly all. The mother, on the contrary, had decreasing importance as a source of information. Two thirds were generally satisfied by the sexual information given by the school. Experienced boys were significantly more often unsatisfied. It is concluded that the condom-orientated AIDS-campaigns have not in general decreased the knowledge of contraception and pregnancy among adolescents. Their knowledge is, however, not optimal. The school is extremely important as an informational source, especially if the importance of the parents decreases. This implies that fewer of those adolescents, who have left school, have adult support in dealing with sexual problems.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The arthritis knowledge questionnaire. A test for measuring patient knowledge of arthritis and its self-management.

OBJECTIVE: To develop a questionnaire for measuring patients' knowledge about arthritis and its self-management. METHODS: An initial item pool of 175 multiple-choice questions was developed, based on the Stanford Arthritis Self-Management Program and on basic medical knowledge about arthritis and its management. A rheumatologist, psychologist, physiotherapist, and several lay individuals assessed the questions for content validity, breadth of coverage, and face validity. Patients assessed the questions for comprehensibility. Four subject groups with varying knowledge levels were recruited to answer the entire set of questions. Item analysis was undertaken to develop parallel forms of subtests so that repeated assessments could be undertaken. RESULTS: The final instrument, the Arthritis Knowledge Questionnaire, consists of 2 tests, each comprising 3 subtests: self-management (15 items), arthritis in general (15 items), and rheumatoid arthritis (11 items). CONCLUSION: We present psychometric evidence that these parallel forms provide highly reliable and valid estimates of knowledge concerning arthritis and arthritis self-management.

Arthritis↗
PubMed2005

Spatial knowledge acquisition from direct experience in the environment: individual differences in the development of metric knowledge and the integration of separately learned places.

Existing frameworks for explaining spatial knowledge acquisition in a new environment propose either stage-like or continuous development. To examine the spatial microgenesis of individuals, a longitudinal study was conducted. Twenty-four college students were individually driven along two routes in a previously unfamiliar neighborhood over 10 weekly sessions. Starting Session 4, they were also driven along a short connecting route. After each session, participants estimated spatial properties of the routes. Some participants' knowledge improved fairly continuously over the sessions, but most participants either manifested accurate metric knowledge from the first session or never manifested accurate metric knowledge. Results are discussed in light of these large individual differences, particularly with respect to the accuracy and development of integrated configurational knowledge.

Adolescent↗
PubMed2000

The use of knowledge-based systems to improve medical knowledge about urine analysis.

Urine protein diagnostics has developed into a routine method for screening and monitoring kidney diseases. It is based on the quantitative measurement of total protein, albumin, alpha(1)-microglobulin, immunoglobulin G and alpha(2)-macroglobulin (all related to urine creatinine), as well as a dipstick screening. The excretion pattern of the marker proteins allows differentiation of haematuria, leukocyturia and proteinuria and to assign them to prerenal, renal and postrenal causes. In order to provide the clinical partner not only with pure analytical results, but to support clinical decision making by an interpretative report, a urine protein expert system (UPES) has been developed. Based on a database containing more than 500 excretion patterns of patients with known diagnoses, a knowledge base was extracted. In its modules plausibility control, glomerular filtration rate, hematuria, leukocyturia and proteinuria, IF-THEN-rules interpret the given patterns and select matching text elements. The knowledge base has been integrated in the modern expert system shell WILAS, and the resulting interpretation system has been thoroughly verified and validated. An internal acceptance study revealed that urine protein differentiation is widely accepted as a diagnostic option and that its interpretation, provided with the help of UPES, is appreciated as a service. In an external study, the usability of UPES in routine and its knowledge representation was evaluated in 11 centres consisting of laboratories and nephrological partners. Over seven months, more than 500 cases were interpreted using UPES and documented by questionnaires. The discussion of the results at a user conference revealed that the problem of analytical standardisation as well as the common definition of diagnostic terms by laboratory staff and clinicians play a crucial role for the use of knowledge-based systems in laboratory medicine. Whereas the user interface of UPES was judged very heterogeneously, the correctness of the proposed interpretations was unanimously rated as "good". As a result of the evaluation, the user interface has been modernised. The knowledge base has been extended to address paediatric issues as well, and to take clinical information and previous findings into consideration.

Evaluation Studies as Topic↗
PubMed1991

ELDAR, a knowledge base system on microcomputer for electrolyte solutions. The factual knowledge of ELDAR.

The knowledge base system ELDAR (ELectrolyte DAta Regensburg), consisting of data base, method base, rule base, and communication manager, classifies the knowledge of electrolyte solutions into factual, algorithmic, and rule knowledge. In this paper information is given on the factual knowledge of ELDAR and the mapping of facts in Codd's relational data model with an extension of its "1st Normal Form" to repeating attributes. ELDAR offers equal user interfaces for all factual knowledge services, such as literature, data, thesaurus, module, parameter, basic data, and rule retrieval.

Artificial Intelligence↗
PubMedDate not supplied

Integrating knowledge generation with knowledge diffusion and utilization: a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health.

OBJECTIVE: Knowledge diffusion and utilization (KDU) have become a key focus in the health research community because of the limited success to date of research findings to inform health policies, programs and services. Yet, evidence indicates that successful KDU is often predicated on the early involvement of potential knowledge users in the conceptualization and conduct of the research and on the development of a "partnership culture". This study describes the integration of KDU theory with practice via a case study analysis of the Consortium for Applied Research and Evaluation in Mental Health (CAREMH). METHODS: This qualitative study, using a single-case design, included a number of data sources: proposals, meeting minutes, presentations, publications, reports and curricula vitae of CAREMH members. RESULTS: CAREMH has adopted the following operational strategies to increase KDU capacity: 1) viewing research as a means and not as an end; 2) bringing the university and researcher to the community; 3) using participatory research methods; 4) embracing transdisciplinary research and interactions; and 5) using connectors. Examples of the iterative process between researchers and potential knowledge users in their contribution to knowledge generation, diffusion and utilization are provided. CONCLUSIONS: This case study supports the importance of early and ongoing involvement of relevant potential knowledge users in research to enhance its utilization potential. It also highlights the need for re-thinking research funding approaches.

Humans↗
PubMed1995

Knowledge-acquisition tools for medical knowledge-based systems.

Knowledge-based systems (KBS) have been proposed to solve a large variety of medical problems. A strategic issue for KBS development and maintenance are the efforts required for both knowledge engineers and domain experts. The proposed solution is building efficient knowledge acquisition (KA) tools. This paper presents a set of KA tools we are developing within a European Project called GAMES II. They have been designed after the formulation of an epistemological model of medical reasoning. The main goal is that of developing a computational framework which allows knowledge engineers and domain experts to interact cooperatively in developing a medical KBS. To this aim, a set of reusable software components is highly recommended. Their design was facilitated by the development of a methodology for KBS construction. It views this process as comprising two activities: the tailoring of the epistemological model to the specific medical task to be executed and the subsequent translation of this model into a computational architecture so that the connections between computational structures and their knowledge level counterparts are maintained. The KA tools we developed are illustrated taking examples from the behavior of a KBS we are building for the management of children with acute myeloid leukemia.

Algorithms↗
PubMed1998

Extracting medical knowledge for a coded problem list vocabulary from the UMLS Knowledge Sources.

INTRODUCTION: The Unified Medical Language System (UMLS) Knowledge Sources embody a rich source of medical knowledge. We sought to extract a portion of this knowledge by incorporating information about relationships between UMLS concepts into an existing problem list vocabulary. METHODS: We matched terms from the coded problem list of The Medical Record (TMR), a computer-based patient record system, with those found in the UMLS Metathesaurus. Those UMLS concepts that participate in 'parent' relationships with the matched TMR concepts were translated back into TMR codes and the relationship information was retained for integration into the coded problem list of TMR. RESULTS: Of the coded problems currently in use in TMR, 67% (1627/2436) could be matched by normalized string matches to the UMLS Knowledge Sources. Of these matched TMR concepts, 91% (1488/1627) participated in at least one UMLS-identified parent relationship but only 28% of the matched concepts (454/1627) participated in parent relationships that already matched to a TMR code. As a result, although 67% of TMR codes were matched to UMLS concepts, only 19% of our original problem list (454/2436) could be augmented by relationship information contained in UMLS without improving the rate of matches or adding additional UMLS concepts as coded problems in TMR. CONCLUSION: This study illustrates the rapid decline in overall rates of matching that result from a multiplicative effect of successive matches of terms to concepts, concepts to relationships and concepts back to entry terms. This effect will hamper any effort to extract relationship knowledge from the UMLS for incorporation into an entry vocabulary that is not already one of the source vocabularies of the UMLS Metathesaurus.

Humans↗
PubMed2002

When a little knowledge is a dangerous thing...: a study of carers' knowledge about dementia, preferred coping style and psychological distress.

OBJECTIVES: The aim of this study was to improve understanding of the relationship between carers' existing knowledge about dementia, their coping style and psychological morbidity. METHOD: Fifty carers and patients attending day services were recruited. Carers were given questionnaires to assess knowledge of dementia, preferred coping style, anxiety, depression and strain. RESULTS: The results indicated that carers who demonstrated more knowledge about the biomedical aspects of dementia were more anxious (p < 0.05). Furthermore, carers who had a preferred coping style of monitoring for threat relevant information were more anxious (p < 0.005). CONCLUSIONS: Understanding more about those factors that are associated with knowledge about dementia will help to identify profiles of carers who are in need of education and in matching individually tailored interventions to carers with specific learning needs.

Adaptation, Psychological↗
PubMed1997

Maternal knowledge and professional knowledge: co-operation and conflict in the care of sick children.

Although it is common-place to describe mothers as 'experts' about their own children there has been little examination of the nature of mothers' expertise in the assessment of their sick children. In this paper mothers' accounts of occasions when they believed that they knew that their children were unwell are reported. Mothers also described how it could be difficult to convince health professionals that their concerns were justified. These accounts were obtained during a qualitative study of the experiences of parents of 24 children hospitalised on a surgical ward. The nature of maternal and professional knowledge is considered and it is suggested that conflicts arise from the different nature of maternal knowledge, which develops in the 'private' domain of intimate contact and professional knowledge which is based in the 'public' domain of the world of work. These differences are illustrated by problems experienced by mothers and nurses in the integration of their different knowledge in assessments of children's pain. Implications for practitioners involved in the care of sick children are considered.

Adult↗
PubMed1999

The Genetic Knowledge Index: developing a standard measure of genetic knowledge.

This paper reports on the development of a unidimensional genetic knowledge index that has been tested and validated in a general population sample. The Index is intended to provide the basis for a standard measure of basic genetic knowledge that can be applied across diverse populations and research settings. The study group was composed of 330 European Americans selected randomly in the Louisville, KY, metropolitan area. The final version of the Genetic Knowledge Index (GKI) consisted of five items identified by principle components analysis, correlation coefficients, and the alpha measure of internal consistency. Construct validity of the GKI was determined by appropriate statistical correlations with educational attainment and attitudes toward genetic discrimination. The Index provides a numerical ranking of subjects' knowledge of practical genetics. Implications for research are discussed.

Data Interpretation, Statistical↗
PubMed1999

The Crohn's and Colitis Knowledge Score: a test for measuring patient knowledge in inflammatory bowel disease.

OBJECTIVE: The aim of this study was to develop a valid and reliable questionnaire assessing patient knowledge of inflammatory bowel disease (IBD) and its treatment--the Crohn's and Colitis Knowledge (CCKNOW) Score. METHODS: A total of 30 multiple choice questions were constructed into a draft questionnaire. This was piloted on a random selection of participants with differing IBD knowledge levels; junior doctors, nurses, and ward clerks. Factor analysis eliminated questions with poor discriminant ability. The resulting 24-item questionnaire (CCKNOW score) was retested on the three groups, and a Kruskal-Wallis test determined the questionnaire's ability to discriminate between the groups. Reliability and readability were tested using Cronbach's a and the Flesch Kincaid reading score. The validated CCKNOW was then tested on patients from the Leicestershire IBD database. RESULTS: CCKNOW scores differed significantly across the groups of doctors, nurses, and ward clerks (median 22, 16, and five, respectively) T = 40.35, p < 0.0001. The reliability was very good with a Cronbach's alpha of 0.95 and the readability was also high. The median score on the CCKNOW for IBD patients was 10, with no significant difference between ulcerative colitis and Crohn's disease. Patients who are members of NACC (National Association of Crohn's and Colitis) achieve statistically significantly higher scores than do nonmembers (difference in medians 4, 95% confidence interval 4-6, p < 0.0001). CONCLUSIONS: The CCKNOW score provides a valuable index of overall knowledge. It is self-administered and psychometric tests show it to be valid, reliable, and readable. It may be used in the future as a tool to evaluate patient education programs.

Adult↗
PubMed2006

Knowledge mapping as a technique to support knowledge translation.

This paper explores the possibility of integrating knowledge mapping into a conceptual framework that could serve as a tool for understanding the many complex processes, resources and people involved in a health system, and for identifying potential gaps within knowledge translation processes in order to address them. After defining knowledge mapping, this paper presents various examples of the application of this process in health, before looking at the steps that need to be taken to identify potential gaps, to determine to what extent these gaps affect the knowledge translation process and to establish their cause. This is followed by proposals for interventions aimed at strengthening the overall process. Finally, potential limitations on the application of this framework at the country level are addressed.

Biomedical Research↗
PubMed2004

Knowledge translation and indigenous knowledge.

OBJECTIVE: We wanted to evaluate the interface between knowledge translation theory and Indigenous knowledge. DESIGN: Literature review supplemented by expert opinion was carried out. METHOD: Thematic analysis to identify gaps and convergences between the two domains was done. RESULTS: The theoretical and epistemological frameworks underlying Western scientific and Indigenous knowledge systems were shown to have fundamental differences. CONCLUSION: Knowledge translation methods for health sciences research need to be specifically developed and evaluated within the context of Aboriginal communities.

Canada↗
PubMed2006

[In the consultation room, ready knowledge is more important than knowledge that must be looked up].

Ready knowledge rules the consultation room--there is no time to look things up. The doctor attempts to find the diagnosis on the basis of a network of ready knowledge. The quality of this knowledge network determines the quality of the resultant diagnosis and of the subsequent treatment. The doctor must continually test and maintain his or her knowledge network.

Continuity of Patient Care↗
PubMedDate not supplied

Brazil Patient Knowledge Questionnaire (PKQ) and evaluation of disease-specific knowledge in patients with rheumatoid arthritis.

OBJECTIVE: To create a Brazilian version of the Patient Knowledge Questionnaire--PKQ, an instrument for measuring the knowledge of patients with rheumatoid arthritis (RA) as regards their disease, and through the use of this instrument, also measure the knowledge of RA patients from reference hospitals in the city of São Paulo. METHODS: Two teachers of English translated the PKQ into Portuguese in order to obtain a single version, which was then translated back into English to evaluate its equivalence to the original version (back translation). The final version in Portuguese was applied to 20 patients with RA for adaptation to cultural issues, and questions not understood by 20% or more patients were subsequently modified. Inter- and intraobserver reliability and the constructive validity of the PKQ were tested. The questionnaire was then applied to 100 RA patients, selected in four outpatient clinics at reference hospitals in the city of São Paulo. RESULTS: Three of the PKQ questions were modified to adapt to cultural issues. Intraclass correlation coefficients used for the reliability and validity of the PKQ were between were between 0.62 and 0.94, therefore, statistically significant (p< 0.05). The mean PKQ score was 12.96 and the mean test application time was 10.3 minutes, for the 100 patients assessed. The lowest scores were observed in the domains of medications and joint protection/energy conservation. PKQ scores showed a positive correlation with the level of education (r=0.40) and a negative correlation with the patients' age (r= -0.32) and with HAQ (r= -0.28). CONCLUSION: The Brazilian version of the PKQ that was created and proved to be a reliable and valid instrument. Patients' knowledge of RA is poor, particularly in the domains regarding medications and joint protection/energy conservation.

Adolescent↗