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At least 991 records · Page 55Linked to original sources
PubMed1991

An interactive computer simulator of the circulation for knowledge acquisition in cardio-anesthesia.

Knowledge-based decision support systems for use in cardio-anesthesia can provide online support to the anesthesiologist by generating intelligent alarms. However, the acquisition and validation of a consistent knowledge base for this application bears problems related to the transfer of clinical experiences into a rule system. An interactive simulator of the human circulation is presented that supports the process of knowledge acquisition and testing. The simulator can be controlled in realtime by an anesthesiologist during the simulation run thus providing a basis for interdisciplinary discussion of routine as well as critical situations. The output data can be transferred to a knowledge-based system for test purposes. The simulator is currently being used for the development of the Anesthesia Expert Assist System AES-2. With regard to the special application a model of the heart-function was integrated which enables the simulation of heart insufficiency. Simulation runs under various conditions are presented and discussed. The simulator was implemented on an ATARI ST personal computer.

Anesthesiology↗
PubMed2005

Protein modeling with reduced representation: statistical potentials and protein folding mechanism.

A high resolution reduced model of proteins is used in Monte Carlo dynamics studies of the folding mechanism of a small globular protein, the B1 immunoglobulin-binding domain of streptococcal protein G. It is shown that in order to reproduce the physics of the folding transition, the united atom based model requires a set of knowledge-based potentials mimicking the short-range conformational propensities and protein-like chain stiffness, a model of directional and cooperative hydrogen bonds, and properly designed knowledge-based potentials of the long-range interactions between the side groups. The folding of the model protein is cooperative and very fast. In a single trajectory, a number of folding/unfolding cycles were observed. Typically, the folding process is initiated by assembly of a native-like structure of the C-terminal hairpin. In the next stage the rest of the four-ribbon beta-sheet folds. The slowest step of this pathway is the assembly of the central helix on the scaffold of the beta-sheet.

Biophysical Phenomena↗
PubMed1997

Developing the nurse as a knowledge worker in health--learning the artistry of practice.

Nursing in the future will be a promoter of health and well-being. This paper argues that health has been inadequately conceptualised and the knowledge base required by nurses to practice as 'knowledge workers' in health gain poorly defined. An epistemology for nursing is proposed that considers knowledge to be a construction of empirical, clinical and personal ways of knowing, contextualised within the activity of the nurse as 'knower'. The difficulties nursing has in defining and developing this unique epistemology are discussed. Lastly, the implications this unique epistemology will have for nursing education are explored. The authors draws upon personal experience to explore and purpose the use of clinical supervision as a tool which can be used by lecturers to coach nurses in the artistry of reflection in action, thus developing the therapeutic skills and knowledge base necessary to promote health as a holistic, multi-dimensional, dynamic, evolving and transforming process.

Education, Nursing↗
PubMed2005

Evidence-Based Practice: a new paradigm brings new opportunities for health sciences librarians.

It is questionable whether the Evidence-Based Health Care model, whereby end users appraise all potentially pertinent information, is sustainable. A shift to an Evidence-Based Practice model, featuring a new medical knowledge base infrastructure facilitating rapid translation of clinical research into practice should be embraced. This shift would offer new opportunities for health sciences librarians. In this article, the authors: (1) review milestones in the evolution of the health sciences knowledge base; (2) review the evolution of the Evidence- Based Health Care/Practice model of health information utilization; and (3) discuss the significance and implications for health sciences librarians of trends towards an increasingly digital health information environment. The authors suggest new roles for health sciences librarians: partnering to integrate advanced information management technologies into the clinical enterprise and integration into the processes for developing these technologies.

Evidence-Based Medicine↗
PubMed1994

The relative accuracy of a variety of medical diagnostic programs.

Acute abdominal pain is one of the most widely studied applications of computer-aided diagnosis. The usual approach is to apply Bayes' theorem with the assumption of conditional independence ("independence Bayes"). We compared various approaches to designing diagnostic programs for abdominal pain of suspected gynaecological origin. The methods range from statistical to knowledge-based. All programs were evaluated using a database of 1,270 cases collected retrospectively. Our results suggest that in this application no significant improvement in accuracy can be made by taking interactions into account, either by statistical or by knowledge-based means; independence Bayes is near-optimal. As far as accuracy is concerned, there appears to be little point in pursuing knowledge-based approaches. However, the "nearest neighbours" method using a new metric appears to be at least as accurate as independence Bayes. We argue that the nearest neighbours method is more suitable than independence Bayes for clinical use because of greater accountability.

Abdominal Pain↗
PubMed2005

An algorithmic approach to understand trace elemental homeostasis in serum samples of Parkinson disease.

A classical problem in neurological disorders is to understand the progression of disorder and define the trace elements (metals) which play a role in deviating a sample from normal to an abnormal state, which implies the need to create a reference knowledge base (KB) employing the control samples drawn from normal/healthy set in the context of the said neurological disorder, and in sequel to analytically understand the deviations in the cases of disorders/abnormalities/unhealthy samples. Hence building up a computational model involves mining the healthy control samples to create a suitable reference KB and designing an algorithm for estimating the deviation in case of unhealthy samples. This leads to realizing an algorithmic cognition-recognition model, where the cognition stage establishes a reference model of a normal/healthy class and the recognition stage involves discriminating whether a given test sample belongs to a normal class or not. Further if the sample belongs to a specified reference base (normal) then the requirement is to understand how strong the affiliation is, and if otherwise (abnormal) how far away the sample is from the said reference base. In this paper, an exploratory data analysis based model is proposed to carry out such estimation analysis by designing distribution and parametric models for the reference base. Further, the knowledge of the reference base in case of the distribution model is expressed in terms of zones with each zone carrying a weightage factor. Different distance measures are utilized for the subsequent affiliation analysis (City block with distribution model and Doyle's with Parametric model). Results of an experimental study based on the database of trace elemental analysis in human serum samples from control and Parkinson's neurological disorder are presented to corroborate the performance of the computational algorithm.

Algorithms↗
PubMed1997

Evaluation of a medical diagnosis system using simulator test scenarios.

This paper describes an informal but systematic method for how to test and verify a knowledge-based system in a large open-ended medical target domain. The system used is Guardian, an intelligent system for monitoring and diagnosis of post-cardiac surgery patients in an intensive-care unit. The knowledge base is tested and verified by running the system on a series of realistic test scenarios, both with an embedded simulator and with an external simulation system. The same scenarios are presented to human test subjects, making it possible to compare and analyze the performance of the knowledge-based system with that of human physicians. The use of simulators instead of clinical data also means that it is possible to test crucial scenarios which occur seldom in medical practice. Our results show that a system like Guardian might indeed be useful in medical care.

Artificial Intelligence↗
PubMed1999

Professional development in reproductive and sexual health--a pilot study from Suffolk, UK.

Staff from two neighbouring trusts working in the fields of family planning and sexual health worked together to develop joint guidelines and from this evolved a training initiative. It was acknowledged that staff were either primarily trained in family planning or in the management of sexually transmitted infections (ST1) and therefore the training would be interdisciplinary. In line with current educational thinking it was also decided to make it multiprofessional. A pilot training project was therefore set up to answer the question 'can self directed learning combined with facilitated small group study sessions provide theoretical updating for a range of health professionals within the field of reproductive and sexual health'. The project aimed to increase theoretical knowledge of contraception, sexually transmitted infections and termination of pregnancy for all relevant nursing and medical staff working within the two trusts. The stated outcome of the project was for all staff to achieve a wider core knowledge of the identified topics, regardless of whether their primary training and knowledge base was in family planning or sexually transmitted infection. The project spanned five months and offered professional development packages in hormonal contraception, non-hormonal contraception, termination of pregnancy, bacterial and minor STIs and viral STIs. The pilot project was well received and the process was shown to be an effective way of increasing the knowledge base. The knowledge shift was greatest in the opposing discipline to the primary discipline of each participant. There were added advantages in team building for staff within the same trust and networking across trusts. The strengths and weaknesses of the process were identified and used to develop ideas for future professional development initiatives.

Abortion, Induced↗
PubMed1994

High-specificity neurological localization using a connectionist model.

Most previous connectionist models for diagnosis have been developed using error backpropagation. While these systems function reasonably well, they have been limited by their need for a large database of test cases, to situations where a single disorder is present, and by the large number of connections required between fully-connected sets of processing units. Here we describe a recently developed connectionist model that overcomes these limitations. This approach can reuse existing causal knowledge bases, works well in situations where multiple disorders can occur simultaneously, and does not require fully-connected sets of processing units. We demonstrate that the accuracy of this model is comparable to that of more conventional AI programs using the same knowledge base in determining precisely the site of brain damage in a group of 50 stroke patients. These results support the conclusion that connectionist models can effectively use pre-existing causal knowledge bases from AI systems, and that they can function accurately when handling actual clinical problems.

Artificial Intelligence↗
PubMed2004

SITECON: a tool for detecting conservative conformational and physicochemical properties in transcription factor binding site alignments and for site recognition.

The local DNA conformation in the region of transcription factor binding sites, determined by context, is one of the factors underlying the specificity of DNA-protein interactions. Analysis of the local conformation of a set of functional DNA sequences may allow for determination of the conservative conformational and physicochemical parameters reflecting molecular mechanisms of interaction. The web resource SITECON is designed to detect conservative conformational and physicochemical properties in transcription factor binding sites, contains a knowledge base of conservative properties for >100 high-quality sample sites and allows for recognition of potential transcription factor binding sites based on conservative properties from both the knowledge base and the results of analysis of a sample proposed by a user. The resource SITECON is available at http://wwwmgs.bionet.nsc.ru/mgs/programs/sitecon/.

Binding Sites↗
PubMed1997

Computer assisted medical diagnosis using the Web.

The ADM (Aide au diagnostic Medical) project was started 15 years ago and was the first telematic project for physicians in France using the MINITEL terminal. The knowledge base contains information on more than 10000 diseases from all pathological fields, using more than 100000 signs or symptoms. The ADM system has two main functionalities for physicians: consultation of diseases descriptions and list of diseases containing one or more symptoms. The ADM knowledge base is supported by a relational database management system (DBMS ORACLE) and we developed a Web interface using the Perl language to produce HTML pages for the web server. We will describe our experience on redesigning a large existing medical knowledge base for diffusion on the web Internet.

Artificial Intelligence↗
PubMed2001

Information needs of clinical teams: analysis of questions received by the Clinical Informatics Consult Service.

OBJECTIVES: To examine the types of questions received by Clinical Informatics Consult Service (CICS) librarians from clinicians on rounds and to analyze the number of clearly differentiated viewpoints provided in response. DESIGN: Questions were retrieved from an internal database, the CICS Knowledge Base, and analyzed for redundancy by subject analysis. The unique questions were classified into ten categories by subject. Treatment-related questions were analyzed for the number of viewpoints represented in the librarian's response. RESULTS: The CICS Knowledge Base contained 476 unique questions and 71 redundant questions. Among the unique queries, the top two categories accounted for 67%: treatment (36%) and disease description (31%). Within the treatment-related subset, 138 questions (59%) required representation of more than one viewpoint in the librarian's response. DISCUSSION: Questions generated by clinicians frequently require comprehensive, critical appraisal of the medical literature, a need that can be filled by librarians trained in such techniques. This study demonstrates that many questions require representation of more than one viewpoint to answer completely. Moreover, the redundancy rate underscores the need for resources like the CICS Knowledge Base. By critically analyzing the medical literature, CICS librarians are providing a time-saving and valuable service for clinicians and charting new territory for librarians.

Artificial Intelligence↗
PubMed1998

Isomeric differentiation of asparagine-linked oligosaccharides by matrix-assisted laser desorption-ionization postsource decay time-of-flight mass spectrometry.

Matrix-assisted laser desorption-ionization (MALDI)-postsource decay (PSD) was used to differentiate glycoprotein-released N-linked oligosaccharide isomers directly from aliquots of glycosidase digests and peak fractions collected from high-pH anion exchange chromatography (HPAEC) with minimal sample handling and material. With the implementation of instrumental tuning and acquisition controls, MALDI-PSD of NMR-characterized high-mannose, hybrid, and complex standards resulted in spectra with reproducible fragment ion peak intensity ratios which correlated well to the respective oligosaccharide branching patterns. A "knowledge-based" strategy was utilized to characterize unknown isomeric N-glycan structures in which specific fragment ion types and their distributions in the unknown PSD spectrum were compared to those in PSD spectra of standards possessing similar structural features. This PSD knowledge-based isomeric differentiation strategy was applied to distinguishing recombinant glycoprotein-derived Man7 D1 versus D2/D3 isomers directly from a PNGaseF digest aliquot of high-mannose N-glycans based on branching differences. A precursor ion selection device was employed to isolate the component of interest from the mass profile without additional chromatographic isolation steps. MALDI-MS signal-to-background was maximized for direct PSD with on-the-probe sample clean-up methods. The asialo complex N-glycan PSD knowledge base was used to differentiate HPAEC peak fractions containing the tri- and tri'-antennary branching isomers and two tetraantennary isomers with antennal versus core fucose locations. Although the particular asialo complex N-glycan isomers here were well separated by HPAEC, MALDI-MS alerted us to their presence using m/z-derived monosaccharide compositions and PSD fragmentation allowed us to differentiate these structures using the HPAEC elution positions as guides.

Asparagine↗
PubMed1991

Pre- and post-testing of students in surgery: do medical rotations help?

A prospective multiple choice question (MCQ) study developed to pre- and post-test fifth year medical students at the University of Queensland, was undertaken during 1990. We investigated whether there was a significant gain in their surgical knowledge base resulting from non-surgical rotations during the same year. We have previously reported a retrospective study suggesting that there was such a gain. Comparable clinical surgical pre- and post-tests were adapted from a fresh question bank, and were presented prospectively to four groups of fifth year medical students at the beginning and end of each 7 week General Surgical term. In contrast to our retrospective study, we found there was no significant increment in surgical knowledge using non-parametric Notched Box and Whisker Plot analysis of data. We conclude that this is either because students are compartmentalizing their factual knowledge base between one speciality and the next, or that indeed there is no benefit to Surgical knowledge base from prior non-surgical rotations. Assuming the former, a combined Medical and Surgical Objective Structured Clinical Examination (OSCE) at the end of the fourth year could serve to broaden the student's horizons and reduce factual dissociation during the fifth year.

Clinical Clerkship↗
PubMed1994

Knowledge data base system for twins study.

The medical research on twins, carried out at the Gregor Mendel Institute for Medical Genetics and Twin Study in Rome over the past four decades, has resulted in a vast collection of clinical paper records. A challenge was presented by the need for a more secure method of storage to preserve this enormously valuable historical and scientific patrimony and to render its contents more easily accessible for research purposes. We met the challenge by planning and developing the computerization of this material. New concepts, currently being explored in biomedical informatics, were applied to build a Knowledge Data Base System, using a fourth-generation language (SQL). This architecturally innovative computer system enables its users to manipulate data supplied, rather than just simply storing it. Based on heuristic relational criteria between variables and parameters, the system is employed to solve problems of sibling design analysis typically arising from twins' records, but is also equipped to meet future data base requirements. Another feature of the system is its users' ability to pull off data in the form of regular automated reports, which are distributed through a Local Area Network (LAN). Through a Bulletin Board System (BBS) and modem, any scientist (outside as well as within the Institute) is thus able to access data and exchange scientific information.

Data Collection↗
PubMedDate not supplied

Using the Roper-Logan-Tierney model in neonatal transport.

In recent years approaches to nursing practice have changed. Nursing theorists have advocated the need for nursing practice to be carried out using a systematic rather than an intuitive approach. A process of nursing has been developed as a method of organizing and delivering nursing care. This change in nursing practice has resulted in the need to establish a knowledge base that relates specifically to nursing. Conceptual models of nursing, advocated by nursing theorists, have come into use in Ireland, the UK and the USA. These models aim to promote greater understanding of people and their nursing needs. They advocate a certain approach to nursing and attempt to define nursing as a role independent from other health care roles. The need to develop a knowledge base specific to nursing remains a central tenet of the profession (Aggleton and Chalmers, 2000). Nursing models serve to provide this knowledge base through the description of the nature of people, health, environment and nursing. The aim of this article is to explore the use of the Roper-Logan-Tierney (RLT) nursing model in a neonatal transport setting. The first section provides an overview of the model. The second section describes the background information on a selected patient, followed by a detailed assessment of this patient using the activities of living. The final section evaluates the use of the model in this clinical situation with reference to literature on the topic.

Activities of Daily Living↗
PubMed2001

How to be a gray box: dynamic semi-physical modeling.

A general methodology for gray-box, or semi-physical, modeling is presented. This technique is intended to combine the best of two worlds: knowledge-based modeling, whereby mathematical equations are derived in order to describe a process, based on a physical (or chemical, biological, etc.) analysis, and black-box modeling, whereby a parameterized model is designed, whose parameters are estimated solely from measurements made on the process. The gray-box modeling technique is very valuable whenever a knowledge-based model exists, but is not fully satisfactory and cannot be improved by further analysis (or can only be improved at a very large computational cost). We describe the design methodology of a gray-box model, and illustrate it on a didactic example. We emphasize the importance of the choice of the discretization scheme used for transforming the differential equations of the knowledge-based model into a set of discrete-time recurrent equations. Finally, an application to a real, complex industrial process is presented.

Algorithms↗
PubMed2001

Finnish occupational health nurses' work and expertise: the clients' perspective.

AIMS: The aims of this study were to describe Finnish occupational health nurses' functions, characteristics, prerequisites, consequences, changes, development areas and expertise from the point of view of clients. METHODS: The background literature of this study is based on public health nursing models, Finnish social and health report, arguments of special education for occupational health nurses, and earlier studies concerning occupational health nurses' work. The data were collected from volunteer clients (n=26) by interviews. RESULTS: According to the qualitative content analysis, occupational health nurses' activities include health promotion and secondary health care among workers and at workplaces. The main work characteristics are holism, client-orientation, interaction and co-operation. Occupational health nurses need an extensive knowledge base and practical skills, client-orientation, courteous behaviour and a healthy and clean appearance. The outcomes of their work for clients are better health, healthier life habits and healthier working conditions. Nowadays, nurses are more client-orientated than 20 years ago. They are expected to develop their practical and interaction skills and expand their knowledge base. The expertise of occupational health nurses consists of an extensive knowledge base with practical skills, working experience and confidence, and it appeared when advising clients and answering their questions. CONCLUSIONS: It is important to arrange continuing education for occupational health nurses to ensure that they are always up to date in order to be able to respond to specific clients' needs. This study provides a foundation for further investigations into, for example, occupational health nurses' work from the point of view of employers, students of occupational health nursing and other occupational health experts and co-operative partners.

Adult↗