SEARCH · Search PubMed

Results for “Knowledge base”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 865 records · Page 48Linked to original sources

PubMed1998

Professional knowledge, midwifery and the role of the external examiner.

Following the move of midwifery education into institutions of higher education (IHE), professional sources have voiced some concern over the apparent 'cultural conflict' between IHE and the midwives. In order to investigate this, a 1-day conference was convened for midwife teachers and external examiners in the south of England, during which data were collected from recorded discussions and interviews. The findings confirm the existence of conflict which polarized around two issues: first, the centrality of practice for midwives and the perceived undermining of that practice by the academically orientated IHE; and second, the somewhat ambiguous role of the external examiner. These findings are explained in terms of recent work on professionalization which suggests that professional knowledge can be legitimized where the emphasis is placed on the indeterminate elements of the work and where knowledge originates from abstractions and conceptualizations derived from working practice. Such a knowledge base would be rather more resistant to undermining by the deductive, rationalist approach employed by IHE academics. It is suggested that external examiners are best placed to represent practice based knowledge to IHE examiners.

Conflict, Psychological↗

PubMed2003

Autonomy among intensive care nurses in Finland.

The purpose of this study was to describe Finnish ICU nurses' (n=172) experiences of autonomy in their work. The research was carried out as part of a project concerned with empowerment in intensive care nursing. Viewed from a psychological perspective, empowerment is understood as referring to the ability to make goal-directed decisions and to take action towards meeting the goals set out. Autonomy, then, is seen as part of empowerment. The data were collected with a structured questionnaire specially designed for this study. The random sample was drawn from 31 Finnish adult intensive care units. The respondents were registered nurses working in eight adult intensive care units. The data were analysed using statistical methods. Autonomy was defined as being composed of three bases: knowledge base (independence, right and responsibility in decision-making), action base (independence, right and responsibility in actions) and value base (independence, right and responsibility in values). The majority of the respondents felt they had more autonomy in decision-making and actions concerning patient care than in decision-making and actions concerning the intensive care unit as a whole. Autonomy usually increased with work experience. Work will be continued to study the autonomy of nurses in different health care organisations in Finland.

Adult↗

PubMed1999

Fishing in urban New Jersey: ethnicity affects information sources, perception, and compliance.

Recreational and subsistence angling are important aspects of urban culture for much of North America where people are concentrated near the coasts or major rivers. Yet there are fish and shellfish advisories for many estuaries, rivers, and lakes, and these are not always heeded. This paper examines fishing behavior, sources of information, perceptions, and compliance with fishing advisories as a function of ethnicity for people fishing in the Newark Bay Complex of the New York-New Jersey Harbor. We test the null hypothesis that there were no ethnic differences in sources of information, perceptions of the safety of fish consumption, and compliance with advisories. There were ethnic differences in consumption rates, sources of information about fishing, knowledge about the safety of the fish, awareness of fishing advisories or of the correct advisories, and knowledge about risks for increased cancer and to unborn and young children. In general, the knowledge base was much lower for Hispanics, was intermediate for blacks, and was greatest for whites. When presented with a statement about the potential risks from eating fish, there were no differences in their willingness to stop eating fish or to encourage pregnant women to stop. These results indicate a willingness to comply with advisories regardless of ethnicity, but a vast difference in the base knowledge necessary to make informed risk decisions about the safety of fish and shellfish. Although the overall median income level of the population was in the $25,000-34,999 income category, for Hispanics it was on the border between $15,000-24,999 and $25,000-34,999.

Black or African American↗

PubMed2001

125 years of public health in the USA.

The past 125 years of public health in the United States are viewed from the perspective of the most significant public health areas of the 20th century as developed by the US Centers for Disease Control and Prevention. The long-term impacts and development of the areas include: immunizations, healthier mothers and babies, family planning, safer and healthier foods, fluoridation of drinking water, control of infectious diseases, decline in deaths from heart disease and stroke, recognition of tobacco as a health hazard, motor vehicle safety, and safer workplaces. The current and future of public health in the US is encapsulated in several developing areas, including: personal lifestyle modifications, politicalization of health, evolving knowledge base, knowledge transfer and globalization.

Centers for Disease Control and Prevention, U.S.↗

PubMed2003

[The hospital perspective: disease management and integrated health care].

Disease Management is a transsectoral, population-based form of health care, which addresses groups of patients with particular clinical entities and risk factors. It refers both to an evidence-based knowledge base and corresponding guidelines, evaluates outcome as a continuous quality improvement process and usually includes active participation of patients. In Germany, the implementation of disease management is associated with financial transactions for risk adjustment between health care assurances [para. 137 f, Book V of Social Code (SGB V)] and represents the second kind of transsectoral care, besides a program designed as integrated health care according to para. 140 a ff f of Book V of Social Code. While in the USA and other countries disease management programs are made available by several institutions involved in health care, in Germany these programs are offered by health care insurers. Assessment of disease management from the hospital perspective will have to consider three questions: How large is the risk to compensate inadequate quality in outpatient care? Are there synergies in internal organisational development? Can the risk of inadequate funding of the global "integrated" budget be tolerated? Transsectoral quality assurance by valid performance indicators and implementation of a quality improvement process are essential. Internal organisational changes can be supported, particularly in the case of DRG introduction. The economic risk and financial output depends on the kind of disease being focussed by the disease management program. In assessing the underlying scientific evidence of their cost effectiveness, societal costs will have to be precisely differentiated from hospital-associated costs.

Disease Management↗

PubMed2004

Knowledge sharing and information integration in healthcare using ontologies and deductive databases.

This paper describes a method for using Semantic Web technologies for sharing knowledge in healthcare. It combines deductive databases and ontologies, so that it is possible to extract knowledge that has not been explicitly declared within the database. A representation of the UMLS (Unified Medical Language System) Semantic Network and Metathesaurus was created using the RDF standard, in order to represent the basic medical ontology. The inference over the knowledge base is done by the TRI-DEDALO System, a deductive data-base created to query and update RDF based knowledge sources as well as conventional relational databases. Finally, an ontology was created for the Brazilian National Health Card data interchange format, a standard to capture and transmit health encounter information throughout the country. This paper demonstrates how this approach can be used to integrate heterogeneous information and to answer complex queries in a real world environment.

Brazil↗

PubMed1992

Breast-feeding the smallest consumer.

Breast-feeding has numerous advantages, yet the trend to breast-feed is declining. Nurses, as well as patients, can benefit from increasing their knowledge base about breast-feeding. Nurses have an important role to play in supporting breast-feeding mothers with current research-based knowledge. More importantly, nurses also serve as patient advocates for the neonate. The use of appropriate nursing diagnoses may facilitate an optimal breast-feeding experience for our smallest consumer, the neonate.

Breast Feeding↗

PubMed1996

A decision support system for prevention and treatment of pressure ulcers based on AHCPR guidelines.

We have developed a Pressure Ulcer Prevention and Management System to assist clinicians with patient-specific decision making. The system captures coded data about assessment, diagnosis and interventions using a point-and-click interface. Guideline-based knowledge is imbedded into the system, and is accessible in several ways: 1) via hypertext links from the data entry screens; 2) via explicit entry into an indexed version of the guideline; 3) via imbedded knowledge-based rules that critique the diagnosis and offer guidance for treatment; and 4) via explicit entry into interactive algorithms. The system has been implemented experimentally on one care unit at our hospital, where its impact will be assessed in comparison with a control unit. Preliminary usage data are provided. Issues with rendering guideline material useful for patient-specific decision support are discussed. In our setting, these issues had to do with a) incongruity with local standards; b) insufficient specificity; and 3) insufficient comprehensiveness. Issues of use and dissemination in the context of today's health care environment are also addressed.

Aged↗

PubMed1993

Desperately seeking data: knowledge base-database links.

Linking a knowledge-based system (KBS) to a clinical database is a difficult task, but critical if such systems are to achieve widespread use. The Columbia-Presbyterian Medical Center's clinical event monitor provides alerts, interpretations, research screening, and quality assurance functions for the center. Its knowledge base consists of Arden Syntax Medical Logic Modules (MLMs). The knowledge base was analyzed in order to quantify the use and impact of KBS-database links. The MLM data slot, which contains the definition of these links, had almost as many statements (5.8 vs. 8.8, ns with p = 0.15) and more tokens (122 vs. 76, p = 0.037) than the logic slot, which contains the actual medical knowledge. The data slot underwent about twice as many modifications over time as the logic slot (3.0 vs. 1.6 modifications/version, p = 0.010). Database queries and updates accounted for 97.2% of the MLM's total elapsed execution time. Thus, KBS-database links consume substantial resources in an MLM knowledge base, in terms of coding, maintenance, and performance.

Academic Medical Centers↗

PubMed1999

Traditional research and psychotherapy practice.

Practitioners of psychotherapy hold different assumptions about the predictability and constancy of human actions than those required by the inferential logic employed in traditional research. Psychotherapy requires the use of judgment by therapists that goes beyond the direct application of generalized knowledge. Judgment is sensitive to the particular, contextual, and changing situation characteristic of therapy practice. Therapists decisions about what to do and say are informed by, but go beyond, that which is available in their knowledge bases. Therapists' knowledge bases include their own, as well as vicarious, experiences. Therapists can parse traditional research into descriptive and inferential components, and by treating the descriptive component as vicarious experiences, they can incorporate it into their knowledge base.

Humans↗

PubMed2004

An analysis of independence and interactions of brain substrates that subserve multiple attributes, memory systems, and underlying processes.

It is proposed that memory is organized into event-based, knowledge-based, and rule-based memory systems. Furthermore, each system is composed of the same set of multiple attributes and characterized by a set of process oriented operating characteristics that are mapped onto multiple neural regions and interconnected neural circuits. Based on this theoretical model of memory, it is possible to investigate the independence and interaction among brain regions between any two systems for any of the proposed attributes or processes. This applies also to the investigation of independence and interactions between any two attributes within a system and between processes associated with a system for any of the proposed attributes. In this article, research evidence is presented to suggest that there are both dissociations and interactions between the hippocampus and caudate nucleus in mediating spatial and response attributes within the event-based memory system, between the hippocampus and the parietal cortex in subserving the spatial attribute within the event-based and knowledge-based memory systems, and between the hippocampus and the prefrontal cortex in subserving the spatial attribute within the event-based and rule-based memory systems.

Animals↗

PubMed2004

Toward Alzheimer therapies based on genetic knowledge.

Genetic analysis has allowed the dissection of the pathogenic pathway that leads to Alzheimer's disease. It has also been integral to the development of earlier and more accurate diagnostic practices. This analysis has identified many potential therapeutic targets, and clinical trials aimed at these targets are now under way. If these approaches are successful, it will be a spectacular validation of genetic-knowledge-based treatment strategies; if they are not, researchers will need to re-evaluate this approach toward understanding and developing strategies for treating complex diseases.

Alzheimer Disease↗

PubMedDate not supplied

The competency of internists in holistic global care to support healthy Indonesia 2010.

All patients are entitled to good standards of practice and care from their doctors. The improved health of all peoples is the main goal of medical education, including for the education of internal medicine registrars. The future development of the direction and goal of education, the level of competence of internal medicine specialists, and the process of learning will be related to preparing the internal medicine specialist to have global competitive advantage. Identification of general competencies is the first step in a long-term effort designed to emphasize educational outcome, for assessment in residency programs, and in the accreditation process. To achieve that competence, a variety of learning opportunities need to be provided in order that the resident can achieve the necessary knowledge, skills, attitude, and behaviors. Identification of the role and function of internal medicine specialists is needed prior to the development of the general competencies. As educational objectives, the competencies fall into two main categories: knowledge-based and performance-based. Knowledge-based competency has two components, medical knowledge (bio-science and clinical medicine) and contextual knowledge (epidemiology, health service organization, and human behavior). The performance base has two components, intellectual skills and the interpersonal skills. Besides the two main categories of educational objectives, there are behavioral objectives that residents must achieve through the educational program, to ensure that residents are able to deal with a range of prescribed clinical situations effectively, safely, humanely, and economically. The achievement of behavioral objectives will ensure, at least in part, that the doctor will implement good medical practice. The index clinical/community situations (ICS) on which the educational objectives will be based are taken from diseases and illnesses that occur in clinical and community settings. No resident can master all medicine there is to know, as there are no limits to what can be known about medicine. It is important to make choices in selecting what residents should learn by analyzing the ICS.

Clinical Competence↗

PubMed1988

Intelligent systems for human resources.

An intelligent system contains knowledge about some domain; it has sophisticated decision-making processes and the ability to explain its actions. The most important aspect of an intelligent system is its ability to effectively interact with humans to teach or assist complex information processing. Two intelligent systems are Intelligent Tutoring Systems (ITs) and Expert Systems. The ITSs provide instruction to a student similar to a human tutor. The ITSs capture individual performance and tutor deficiencies. These systems consist of an expert module, which contains the knowledge or material to be taught; the student module, which contains a representation of the knowledge the student knows and does not know about the domain; and the instructional or teaching module, which selects specific knowledge to teach, the instructional strategy, and provides assistance to the student to tutor deficiencies. Expert systems contain an expert's knowledge about some domain and perform specialized tasks or aid a novice in the performance of certain tasks. The most important part of an expert system is the knowledge base. This knowledge base contains all the specialized and technical knowledge an expert possesses. For an expert system to interact effectively with humans, it must have the ability to explain its actions. Use of intelligent systems can have a profound effect on human resources. The ITSs can provide better training by tutoring on an individual basis, and the expert systems can make better use of human resources through job aiding and performing complex tasks. With increasing training requirements and "doing more with less," intelligent systems can have a positive effect on human resources.

Artificial Intelligence↗

PubMed1986

[Testing an expert system for hypertension].

An Expert System (ES) has been connected to a database management system for the management and follow-up of hypertensive patients. The patient data base, called Artemis, contains approximately 18,000 medical records. About 90% of the initial informations used by the ES is contained in the medical records of the Artemis data base. The knowledge base consists of 870 rules. A first group of rules allows the description of knowledge structures (hierachies, graphs and mutual exclusions). The second group consists of production rules which describe the dynamic reasoning of the expert. The inference engine uses a combination of forward and backward chaining. The ES produce diagnostic hypotheses (possible causes of hypertension) and therapeutic suggestions before and after requiring additional information (patient supplementary interrogation, biological or radiological investigations). The evaluation of the diagnostic performance of the ES was made on 40 confirmed cases of secondary hypertension (SH) and 40 cases of essential hypertension (EH). The initial initial diagnosis, just after the forward chaining step, was correct in 17 cases of SH and 32 cases of EH. The final diagnosis proposed after several steps of forward and backward chaining was correct in 37 cases (92%) of SH and 36 (90%) of EH. Averages of 5 (EH) and 8 (SH) questions were formulated by the ES to reach the final diagnosis. The integration of the ES to the database is expected to facilitate the validation of the knowledge base and to enhance its overall acceptability. Whether or not such an integration will be useful and accepted as a complementary tool by physicians remains however an open question.

Decision Making, Computer-Assisted↗

PubMed1992

Expert systems and expert behavior.

Iliad 4.0 and QMR 2.03 are computer-based diagnostic knowledge bases that can play many roles in decision support and other areas of medical practice, but neither appears ready to assume the role of an expert diagnostic consultant. In contrast to human experts, these programs have problems related to recognition of their own limitations, interpretation of continuous data, recognition of dependent findings, selection of tests, and description of the impact of certain tests. Suggestions to improve these aspects of knowledge bases are offered.

Artificial Intelligence↗

PubMed1995

Protocol care for hypertension supported by an expert system.

1. PURPOSE. Hypertension if one of the major prevalent diseases that influences the prognosis of chronic diseases. Primary care should attract much attention in the management of hypertension. The management of hypertension includes not only the use of antihypertensiove drugs, but also the modification of unhealthy lifestyles. Multi-dimensional approaches are required for the management of hypertensive patients. This system supports the standard protocol care for hypertensive patients and the database for clinical epidemiology. 2. DESIGN CONSIDERATIONS. This system has several functions that support the appropriate management of hypertensive patients. The first one is clinical database management. The second is the evaluation of the clinical conditions in hypertension. The third is the decision support system for the selection of treatments for hypertension. 3. SYSTEM DESCRIPTION. This system administers the clinical database, which includes symptoms and signs, laboratory data, and prescriptions. The database deals with the temporal course of the patient's status. The system that evaluates the patient's condition and the decision support system have some knowledge bases. The knowledge bases consist of the evaluation of the patient's condition, the appropriate selection of laboratory examinations, and suggestions for treatments, which involve a life-style modification and the proper prescription of medication. 4. STATUS REPORTS. The relational database was developed for handling the patient's records. These records were displayed on the terminal according to the temporal sequence. The graphical representations of the medical data were displayed in order to understand the patient's status. 5. LESSON LEARNED. This kind of protocol care system is expected to support the proper medical care of patients. Excess medications and laboratory examinations will be excluded under the protocol care, thus reducing unnecessary medical expense. The system will enhance the randomized clinical trials that verify the effects of the treatments. Violation of the protocol care is treated according to the several levels. 6. FUTURE PLANS. This system will be introduced to the occupational health care fields. The efficacy of improving the clinical quantity, and the effect of reducing the medical budget concerning hypertension will be verified.

Clinical Protocols↗

PubMed1997

Combining tabular, rule-based, and procedural knowledge in computer-based guidelines for childhood immunization.

IMM/Serve is a computer program which implements the clinical guidelines for childhood immunization. IMM/Serve accepts as input a child's immunization history. It then indicates which vaccinations are due and which vaccinations should be scheduled next. The clinical guidelines for immunization are quite complex and are modified quite frequently. As a result, it is important that IMM/Serve's knowledge be represented in a format that facilitates the maintenance of that knowledge as the field evolves over time. To achieve this goal, IMM/Serve uses four representations for different parts of its knowledge base: (1) Immunization forecasting parameters that specify the minimum ages and wait-intervals for each dose are stored in tabular form. (2) The clinical logic that determines which set of forecasting parameters applies for a particular patient in each vaccine series is represented using if-then rules. (3) The temporal logic that combines dates, ages, and intervals to calculate recommended dates, is expressed procedurally. (4) The screening logic that checks each previous dose for validity is performed using a decision table that combines minimum ages and wait intervals with a small amount of clinical logic. A knowledge maintenance tool, IMM/Def, has been developed to help maintain the rule-based logic. The paper describes the design of IMM/Serve and the rationale and role of the different forms of knowledge used.

Age Factors↗