Search PubMed⌕ Search

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.

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

At least 973 records · Page 54Linked to original sources

Information technology and computer-based decision support in diabetic management.

This paper describes the application of computer-based techniques within an intelligent, knowledge-based framework to the management of diabetes. The objectives are to structure data collection and storage so that the relevant patient-specific data are collected and made accessible as needed, and to provide clinical decision support on either a day-by-day or longer timescale as appropriate; these objectives relating to both hospital clinic and general practice. For longer-term management, a prototype rule set (greater than 500 rules) has been developed (coded in Sigma PROLOG), validated and tested on patient data. The data collection programs (written in SCULPTOR) to feed the ruleset have been tested in the hospital clinic and compared with the resident data collection system for usability, and impact on the running of the clinic. Links between the data collection programs and the ruleset program have been written and tested. The computer system will also incorporate a module, combining knowledge-based advisory system and glucose/insulin model as patient simulator, that can be tested as a potential decision aid for adjusting insulin dosage on a daily basis.

Data Collection↗

Optimising assay sequence on automated coagulation instrumentation.

An embedded knowledge-based system has been developed to determine the optimum sequence for assays performed on a random access coagulation analyser. This knowledge base is in the form of a set of rules describing penalties associated with certain sequences of assays. The optimisation of assay sequences increases throughput and reduces consumption of cleaning solutions and generation of waste. A flexible design also facilitates updates to the knowledge base as assays are modified and added in the future.

Artificial Intelligence↗

Distributing knowledge maintenance for clinical decision-support systems: the "knowledge library" model.

The maintenance of knowledge-rich clinical decision-support systems is challenging, in particular in the complex setting of a large academic medical center. Distributing the maintenance tasks to the source of expertise can address scalability, accuracy and currency issues. It also helps to foster a more global sense of ownership among the system users. The knowledge maintenance model must provide processes and tools to deal with a wide range of stakeholders (resident and attending physicians, consulting specialists, other care providers, case managers, ancillary departments), with knowledge embedded in legacy departmental systems, and with the continuous evolution of the content and form of the knowledge base. We describe and illustrate the "knowledge library" model in use at Vanderbilt University Medical Center for the distributed maintenance of the integrated knowledge base that drives the WizOrder clinical decision-support, physician order entry, and notes capture system.

Artificial Intelligence↗

Knowledge-guided segmentation of colorectal histopathologic imagery.

Scene segmentation in images of sections of colorectal glands is guided by a knowledge-based system. The construction of the knowledge file, processing sequences and computation of a crowding index for adenomatous glands are described. The histologic sections were stained by hematoxylin and eosin, and the image segmentation was difficult. The knowledge-based system has to determine, on the basis of context and logic, which detected object groups belong to which histologic components. Image segmentation was followed by a reconstruction process. Acceptable segmentation was attained in approximately 85% of the glands processed.

Adenoma↗

A model for integrating image processing into decision aids for diagnostic radiology.

Advances in imaging techniques have been mirrored by advances in the use of computers to extract and interpret image data. Helping clinicians to make effective use of this superabundance of information is a key aim of medical informatics research. One approach is to incorporate digital images and image processing within a knowledge-based decision aid for radiologists. This paper describes a generic design for such aids. The work is based on an abstract model of decision-making which is used to organize the presentation of information from a knowledge base. We describe a system in which the model of decision-making is augmented to describe processes underlying image interpretation. The augmented model, implemented as a logic program, is used to control the application of image processing operators to detect and describe radiological signs. Through the use of this model we are able to combine information from image processing with information from a symbolic knowledge base. The operation of the model is illustrated by considering three different applications in the domain of breast X-rays or mammograms.

Humans↗

Physical activity and body functionality: implications for obesity prevention and treatment.

Physical activity promotes metabolic adaptations that improve body functionality and contribute to the prevention of some diseases. With respect to energy and fat balance, physical activity facilitates the equilibrium between energy intake and expenditure as well as between fat intake and fat oxidation. When combined with a healthy diet that favors satiety with a reduced energy intake, exercise can induce a substantial mass loss in obese individuals. However, even the impact of an exemplary lifestyle does not seem to have the potential to decrease body mass in obese individuals down to the mass range of lean people. Up to now, we have not been able to induce mass changes exceeding 12%-15% initial body mass in obese male subjects under tolerable exercise and dietary habits, and this moderate success was accompanied by modifications in appetite and energy expenditure susceptible to compromise subsequent mass stability. As described in this paper, many environmental factors can influence energy balance and the ability to lose body fat in response to a healthy diet and (or) physical activity program. Particular attention is given to preliminary data obtained in our laboratory that suggest that knowledge-based work does not favor the same potential mass reducing effects as physical work. In fact, the acute effects of knowledge-based work suggest that this work modality may be rather susceptible to promote a more pronounced positive energy balance compared with what we may expect from a sedentary relaxing activity. This is problematic for obesity prevention in the future since knowledge-based work now represents the main working modality in a context of modernity.

Animals↗

Are nurses knowledgeable in regards to latex allergy?

Lack of knowledge concerning latex allergy may lead to a life-threatening adverse reaction to natural rubber latex. Registered nurses need a latex allergy knowledge base to provide latex-safe health care to clients and to create a latex-safe environment. This research explored the current knowledge base of registered nurses as related to (1) the care of clients at risk for latex allergy, or diagnosed with latex allergy, and (2) the provision of a latex-safe environment for all populations. This article describes this research and its implications for nurses. A copy of the Latex Allergy Knowledge Base Self-Assessment Questionnaire is included at the conclusion of the article.

Educational Measurement↗

Use of toxicological information in drug design.

This paper is an extension of the keynote address and another talk at the Symposium on the Use of Toxiciological Information in Drug Design. The symposium was organized by American Chemical Society's Chemical Information Division at the 220th National Meeting of the American Chemical Society in Washington, DC, August 20-24, 2000. We outline an approach for meeting the scientific information needs of the U.S. Food and Drug Administration (FDA). Ready access to scientific information is critical to support safety-related regulatory decisions and is especially valuable in situations where available experimental information from in vivo/in vitro studies are inadequate or unavailable. This approach also has applications for lead selection in drug discovery. A pilot electronic toxicology/safety knowledge base and computational toxicology initiative is underway in the FDA Center for Drug Evaluation and Research (CDER) that may be a prototype for an FDA knowledge base. The objectives of this effort are: (i) to strengthen and broaden the scientific basis of regulatory decisions, (ii) to provide the Agency with an electronic scientific institutional memory, (iii) to create a scientific resource for regulatory and applied research, and (iv) to establish an internal Web-based support service that can provide decision support information for regulators that will facilitate the review process and improve consistency and uniformity. An essential component of this scientific knowledge base is the creation of a comprehensive electronic inventory of CDER-regulated substances that permit identification of clusters of substances having similar chemical, pharmacological or toxicological activities, and molecular structure/substructures. Furthermore, the inventory acts as a pointer and link to other databases and critical non-clinical and clinical pharmacology/toxicology studies and reviews in FDA archives. Clusters of related substances are identified through the use of: (i) an extensive index of alternative names for each substance, (ii) a molecular structure key field consisting of a rudimentary or core structure represented as an ISIS.mol-file, (iii) global search terms (molecular group, chemical class, clinical indication, or pharmacologic activity), and (iv) molecular clustering using structure/sub-structure similarity indices. The information contained in a toxicology knowledge database has limited value unless means are available to extract information, identify relationships, and create and test hypotheses. One such means is computational toxicology, also called in silico toxicology, ComTox, or e-TOX. Computational toxicology is the application of computer technology and information processing (informatics) to analyze, model, and estimate chemical toxicity based upon structure activity relationships (SAR). A computational toxicology software package, MCASE, has been evaluated and successfully improved by CDER through the incorporation of data from FDA archives and concomitant alterations of the logic used in the interpretation of the results to reflect the data analysis and hazard identification practices and priorities of the Center. Our modifications and uses of the MCASE program are discussed in detail.

Databases, Factual↗

DIAMED: a probabilistic diagnostic aid system on the web.

DIAMED is a system to assist the physicians in the diagnostic process using probabilistic networks as knowledge representation. These networks make it possible to reason on medical data by applying Bayesian methods and to take into account uncertainties of the facts in the resolution of the clinical cases. The proposed model re-uses knowledge contained in an existing knowledge base (ADM). An interface of DIAMED developed on a Web server remotely assists the experts of each medical specialty in updating and validating the knowledge base. Most of the data processing is automated while being based on information preexistent in the ADM base : Constitution of lexicons starting from the existing dictionaries of the ADM system, are then used to work out the requests for selection and update of the knowledge base. One of its assets resides in its pseudo-segmented structure in several layers. The propagation of information is thus limited to only one part of the probabilistic network and calculations are therefore limited.

Artificial Intelligence↗

A unified approach to the design of clinical reporting systems.

Computer-based Clinical Reporting Systems (CRS) for diagnostic departments that use structured data entry have a number of functional and structural affinities suggesting that a common software architecture for CRS may be defined. Such an architecture should allow easy expandability and reusability of a CRS. We report the development methodology and the architecture of SISCOPE, a CRS originally designed for gastrointestinal endoscopy that is expandable and reusable. Its main components are a patient database, a knowledge base, a reports base, and screen and reporting engines. The knowledge base contains the description of the controlled vocabulary and all the information necessary to control the menu system, and is easily accessed and modified with a conventional text editor. The structure of the controlled vocabulary is formally presented as an entity-relationship diagram. The screen engine drives a dynamic user interface and the reporting engine automatically creates a medical report; both engines operate by following a set of rules and the information contained in the knowledge base. Clinical experience has shown this architecture to be highly flexible and to allow frequent modifications of both the vocabulary and the menu system. This structure provided increased collaboration among development teams, insulating the domain expert from the details of the database, and enabling him to modify the system as necessary and to test the changes immediately. The system has also been reused in several different domains.

Artificial Intelligence↗

Hawaii veterinarians' bioterrorism preparedness needs assessment survey.

The purpose of this study was to assess the objective bioterrorism-related knowledge base and the perceived response readiness of veterinarians in Hawaii to a bioterrorism event, and also to identify variables associated with knowledge-based test performance. An anonymous survey instrument was mailed to all licensed veterinarians residing in Hawaii (N = 229) up to three times during June and July 2004, using numeric identifiers to track non-respondents. The response rate for deliverable surveys was 59% (125 of 212). Only 12% (15 of 123) of respondents reported having had prior training on bioterrorism. Forty-four percent (55 of 125) reported being able to identify a bioterrorism event in animal populations; however, only 17% (21 of 125) felt able to recognize a bioterrorism event in human populations. Only 16% (20 of 123) felt they were able to respond effectively to a bioterrorist attack. Over 90% (106 of 116) expressed their willingness to provide assistance to the state in its response to a bioterrorist event. Veterinarians scored a mean of 70% correct (5.6 out of 8 questions) on the objective knowledge-based questions. Additional bioterrorism preparedness training should be made available, both in the form of continuing educational offerings for practicing veterinarians and as a component of the curriculum in veterinary schools.

Adult↗

Evaluation of KNAVE-II: a tool for intelligent query and exploration of patient data.

We present the results of a preliminary evaluation of KNAVE-II, a distributed knowledge-based computational framework for visualization, interpretation, and exploration of longitudinal clinical data and of multiple levels of concepts derivable from these data. KNAVE-II uses a distributed architecture to access at run-time clinical time-oriented data, a domain-specific knowledge base containing properties of the clinical data, and a knowledge-based problem-solving method for computing on-the-fly interpretations of these data. The purpose of the evaluation was to compare efficiency and user satisfaction when answering clinical queries of variable complexity about clinical time-oriented data using KNAVE-II, versus using methods available in standard clinical settings: paper chart or electronic spreadsheet (ESS). Subjects answered high-complexity queries significantly faster using KNAVE-II than when using paper or ESS. User satisfaction with KNAVE-II was significantly superior compared to satisfaction using paper or ESS, based on a standard usability scale. Users also explicitly ranked KNAVE-II as superior to paper and the ESS.

Artificial Intelligence↗

Problem solving in undergraduate medical students.

In recent years the systematic development of the skill of clinical reasoning has come to assume a high priority as an explicit aim of medical education. Clinical reasoning, it is contended, is the application of general reasoning and problem-solving skills to the specific knowledge base of medicine. The results presented in this paper constitute a preliminary study designed to investigate the ability of first-year medical undergraduates to solve abstract problems using a simple nonmedical knowledge base. Further studies are being carried out and will continue to extend this into the specific medical knowledge base area. The potential implications for medical education and the development of clinical reasoning are discussed.

Clinical Competence↗

Research and the cumulation of knowledge in Physical Therapy.

BACKGROUND AND PURPOSE: Published research contributes to the knowledge base that distinguishes one discipline from another. More research is now published in the physical therapy journals, but concerns with the profession's knowledge base continue. SUBJECTS: The study examined citations from 78 clinical articles published and indexed on three thematic areas in Physical Therapy between 1951 and 1990. METHODS: Unique items and multiple-cited items were identified and counted and their sources ascertained. Linkages among multiple-cited items in each thematic area were identified and described. RESULTS: Most cited items were unique and not from the physical therapy literature. Few linkages were identified among the clinical articles. CONCLUSION AND DISCUSSION: The lack of evidence of cumulation or of coherence among the articles examined and the extent of reliance on non-physical therapy sources suggest that concerns with the knowledge base of the profession are well founded.

Forecasting↗

Genetic-based fuzzy image filter and its application to image processing.

In this paper, we propose a Genetic-based Fuzzy Image Filter (GFIF) to remove additive identical independent distribution (i.i.d.) impulse noise from highly corrupted images. The proposed filter consists of a fuzzy number construction process, a fuzz filtering process, a genetic learning process, and an image knowledge base. First, the fuzzy number construction process receives sample images or the noise-free image and then constructs an image knowledge base for the fuzzy filtering process. Second, the fuzzy filtering process contains a parallel fuzzy inference mechanism, a fuzzy mean process, and a fuzzy decision process to perform the task of noise removal. Finally, based on the genetic algorithm, the genetic learning process adjusts the parameters of the image knowledge base. By the experimental results, GFIF achieves a better performance than the state-of-the-art filters based on the criteria of Peak-Signal-to-Noise-Ratio (PSNR), Mean-Square-Error (MSE), and Mean-Absolute-Error (MAE). On the subjective evaluation of those filtered images, GFIF also results in a higher quality of global restoration.

Algorithms↗

Primary care and health care reform: the need to reflect before reforming.

The system of primary care in the UK National Health Service appears to have become popular amongst policy makers worldwide. This is surprising given the poor knowledge base regarding the care provided and its cost effectiveness. It is necessary for policy makers to identify which health care interventions are effective and cost effective, and develop knowledge about how behaviour can be changed and cost effective interventions adopted in routine medical practice. Trials of pharmaceuticals in primary care therapeutic areas reveal a poor knowledge base about clinical effectiveness and often fail to include economic aspects. Initiatives such as the UK general practice fundholding scheme, the general practitioner contract and the Health of the Nation targets were not based on empirical evidence and have not been subject to adequate evaluation. If health care reforms elsewhere are to include emphasis on primary care, policy goals must be clearly articulated and the knowledge base informing efficient delivery of primary care must be improved.

Cost-Benefit Analysis↗

An analysis of Part II of the National Board of Medical Examiners Test with regard to questions in emergency medicine.

We conducted a study to determine the number of items and successful response rate to questions specific to emergency medicine on the National Board of Medical Examiners Test, Part II (NBME-II). The 1979 and 1983 NBME-II examinations were reviewed by a subcommittee of the Society of Teachers of Emergency Medicine. Items pertaining directly to the core content knowledge base were selected and classified by core content topic and NBME subspecialty. Overall, 14.7% of the 892 items on the 1983 examination pertained to emergency medicine. The successful response rate was 73.3% for the emergency medicine questions. When looked at by sub-specialty categories, the percentage of items pertaining to emergency medicine varied from 1.3% in obstetrics/gynecology to 27.2% of the items in surgery. On the 1979 examination, 13.8% of the questions pertained to emergency medicine, with a successful response rate of 67.1%. Analysis of the data by core content topic showed that some areas (orientation to emergency medicine, ophthalmologic diseases, environmental emergencies, and behavioral emergencies) had two items or fewer on both examinations. Other topics, such as trauma, showed a consistent pattern of questions on both examinations. Our study emphasizes the difficulty of attempting to test competency in the clinical knowledge base of medicine within the artificiality of knowledge base departmental boundaries.

Certification↗

Pre-compiling medical logic modules into C++ in building medical decision support systems.

Development of medical knowledge bases is a time-consuming process, and no single medical institution can develop medical knowledge bases covering all areas of medicine. The use of medical knowledge representation standards such as the Arden Syntax is an attempt to enhance the writability and readability of computer-stored knowledge and facilitate transfer and sharing among institutions. A method for the realisation of decision support systems based on knowledge formulated according to the Arden Syntax is presented. An essential tool in this process is a medical logic module (MLM) pre-compiler, translating MLMs into an object-oriented programming language, C++. Advantages of the C++ approach compared with other alternatives are discussed.

Artificial Intelligence↗