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At least 1,135 records · Page 63Linked to original sources
PubMed1998

[Knowledge about drugs used by adult patients with asthma for self-treatment].

OBJECTIVE: To assess the knowledge of adult asthmatics about medication for self-treatment. DESIGN: Descriptive. SETTING: Department of Pulmonary Diseases, Medisch Spectrum Twente, Enschede, the Netherlands. METHODS: As a part of a larger project aimed at improvement of self-management and self-treatment, all adults aged 18-65 years in Enschede (population 146,000) reported by the city pharmacists as using medication for asthma or chronic obstructive pulmonary disease, in 1994 were sent a questionnaire including 7 items pertaining to knowledge about lung medication. From among those who failed to respond after a written reminder and an appeal in local papers, a random group of 9% were interviewed by telephone. Of the responders who reported that according to their GPs they had asthma and who had answered the questions on medication, the number of questions answered correctly was counted; in addition, the question was investigated whether their level of knowledge was related to sex, education, use of (inhalation) corticosteroids and the form of explanation received. RESULTS: A total of 4563 questionnaires were sent out: 2259 (50%) usable forms were returned. The responders were better educated than the 192 non-responders interviewed, but did not differ as to age or sex. Of the responders, 1262 (56%) reported that their GPs had told them they had asthma. On average they had answered 2.4 (range: 0-7) out of 7 questions correctly. Previous instruction, number of sources of information, duration of taking medication, use of inhaled steroids, female sex and better education were all positively related with a higher knowledge score in this group. CONCLUSION: Adult asthmatics did not have sufficient knowledge about their medication. Improving such knowledge should therefore be an important element in the development of a self-management programme.

Adult↗
PubMed1997

[Food and nutrition knowledge of school-age children's mothers from elementary and high school from different socioeconomic levels].

The objective of this study was to determine the degree of knowledge on food and nutrition of school-age children's mothers from Chile's Metropolitan Region and to measure the impact of socioeconomic, sociocultural and demographic variables on knowledge. A representative and proportional sample of 4,509 school-age children was chosen from Chile's Metropolitan Region and the degree of knowledge on food and nutrition on mothers of 1,985 of them was determined. The sample was stratified according to grade (I, II, IV, VI, VIII elementary school grades and I and IV high school grades), sex, type of school and geographic area. Socioeconomic status (SES) was determined through Graffar's modified method. The degree of knowledge on food and nutrition was assessed by a test based on the specific objectives pursued by the elementary school curriculum programs of the Ministry of Education and submitted to adequate statistical proofs for its content validity and reliability. Mother's schooling level mean was 9.7 +/- 4.0 y. The field study was carried out on 1986-1987. Statistical procedures included analysis of variance, Student "t" test for comparison of the means, correlation and regression. Results revealed that mothers did not know food and nutrition matters in fundamental aspects related to the observance of a healthy lifestyle, both, for themselves and their family. The degree of knowledge of food and nutrition significantly and positively correlated with SES, mother's schooling and occupation level, housing conditions (quality and sanitation) and age, and significantly and inversely correlated with the number of sons and crowding, besides of being significantly higher in urban than rural mothers. Mother's schooling level and geographic area were the independent variables with the greatest explanatory power in the food and nutrition knowledge variance (r2 = 0.1723), but mother's schooling level explains 93.2% of the explained variance. Results suggest the need to introduce, during school age, nutrition education programs focused on mother and children to improve the population life quality.

Adult↗
PubMed1998

Cancer pain management. Improving knowledge and patient care.

OBJECTIVE: A pain management project was designed to assess the effectiveness of a multifaceted intervention for improving GPs' knowledge of cancer pain management. Two hypotheses were tested: that the intervention would influence GPs' knowledge in the area of cancer pain management; that information would be gathered to assist in the production of educational material. METHOD: The project involved assessment of GP knowledge, feedback and discussion at project officer visits, mailings and participation in developing guidelines. RESULTS: All participants who completed the second round of visits were glad they had participated in the program. A discussion of the information topics covered is included. CONCLUSION: Increasing GPs' knowledge of the management of symptoms is only one of many factors that influence their prescribing patterns. In cancer pain management lack of knowledge is a significant contributor to unnecessary patient suffering. We have been able to demonstrate the success of a multifaceted intervention in improving the knowledge of cancer pain management by GPs. Although not measured directly, it is hoped that this will lead to improved quality of life for patients cared for by these practitioners.

Australia↗
PubMed1998

An assessment of two training interventions designed to increase the knowledge of obstetrical nurses and nurse-midwives about the maternal serum triple screen.

The purpose of this study was to assess the effects of two brief training interventions designed to improve nurses' and nurse-midwives' knowledge about the maternal serum triple screen. The low intervention consisted of written information on the triple screen; the high intervention consisted of written information plus a one hour oral presentation. Knowledge was assessed at baseline, immediately following the oral presentation (high intervention only), and one month following the interventions. Forty-seven nurses, nurse-midwives and nursing assistants participated. Sixteen respondents (34 per cent) who routinely talk to patients about the triple screen obtained a score of less than 70 per cent on the knowledge questionnaire at baseline assessment. Respondents' knowledge about the maternal serum triple screen included areas that needed to be improved in order for them to be able to provide patients with accurate and complete information. Both interventions assessed in this study resulted in an increase in participants' knowledge about the maternal serum triple screen, however the high intervention was more effective. This study presents evidence that improvements in health care professionals' knowledge can be made with brief educational interventions.

Down Syndrome↗
PubMed1998

Patient education in psoriatic arthritis: a cross sectional study on knowledge by a validated self-administered questionnaire.

OBJECTIVE: To assess the level of knowledge in a group of patients with psoriatic arthritis (PsA) following one reading of an information leaflet [UK Arthritis Rheumatism Council (ARC) booklet] using a validated self-administered questionnaire. Comparisons with subsets of the disease and level of general education were also made. METHODS: A multiple choice self-administered questionnaire was carried out in a group of 59 patients (32 male, 27 female, mean age 47.53 +/- 12.71 yrs) with established disease (mean duration 9.6 +/- 8.5 yrs). The questionnaire covered 4 broad areas of the disease (general knowledge of skin and joint disease, etiology, symptoms, blood test; general management and drug therapy; physiotherapy treatments; joint protection and priorities) and it was written collecting the majority of the information from an ARC booklet on PsA and from advice from the rheumatology team. Detailed statistical analysis was performed to validate the questionnaire and to measure any associations with demographic data. RESULTS: The questionnaire was consistent, reliable, and easy to read. Patients showed a lack of knowledge with some erroneous beliefs about their disease (i.e., causes, blood tests, longterm drugs). No statistical associations were found between the level of knowledge achieved and demographic data and patterns of disease. A significant association was found between the median score and level of general education (Kruskal-Wallis analysis of variance 7.97, p = 0.02). CONCLUSION: The questionnaire is a good instrument to assess knowledge in PsA. The ARC booklet alone seems inadequate to provide sufficient knowledge of disease. Patients' erroneous beliefs were highlighted and these should be addressed.

Analysis of Variance↗
PubMed1998

[Level of knowledge about nourishment/nutrition among school adolescents in Cadiz].

OBJECTIVE: To determine the level of knowledge about nourishment/nutrition and how this knowledge is distributed among school adolescent population in the town of Cádiz. DESIGN: Descriptive and transversal study. SETTING: Schools. PARTICIPANTS: Sample of 630 subjects from the school adolescent population in the town of Cádiz. MEASUREMENTS AND MAIN RESULTS: The average level of knowledge about nourishment/nutrition is 6.63 (in a 0-13 scale). No significant differences were found according to the perception of proportion or disproportion in height and weight, level of concern about body fats and getting fat, diets, avoiding some food or taking some medication, dietary fibers and infusions or any other weight-reducing products and physical exercise and fitting. The relationship between the level of knowledge and the BMI is very close to statistical significance. CONCLUSIONS: We found a middle level of knowledge about nourishment/nutrition. We think this level of knowledge should be raised and other factors determining healthy habits should be considered. It is necessary to go on with research and contextualize nourishment habits.

Adolescent↗
PubMedDate not supplied

The effects of peer education on STD and AIDS knowledge among prisoners in Mozambique.

The study was designed to evaluate the impact of education on AIDS knowledge among prison inmates in Maputo, Mozambique. A 6-month follow-up study was carried out in 1993 among 300 prisoners. A knowledge, attitudes, and practices questionnaire regarding AIDS and STD was administered to each subject as part of the intake medical examination and after an educational intervention provided by 30 prisoner 'activists'. A large proportion of prisoners had high risk behaviours (65% had 2 or more sexual partners per month and 39% had a history of STD) and low AIDS knowledge at incarceration. Statistically significant increases in knowledge occurred after the intervention. Prisoners with less formal education had a poorer performance on the initial questionnaire (43% vs 69% P < 0.00001) and had a greater improvement after the intervention (41% vs 24%, P < 0.00001). The results demonstrate that educational interventions involving peer health educators contribute positively to the acquisition of knowledge among prisoners.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Sources of information and their relationship to the degree of knowledge about AIDS in Mexican adolescents].

INTRODUCTION: In Mexico 2.1% of the cases of AIDS are in adolescents. The cases of AIDS in the age group of 20 to 29 account for 30.5% of all the cases and an important proportion could have been infected with HIV in their adolescence, in view of the length of the incubation period from the infection with HIV to the manifestation of the syndrome. The adolescent's knowledge of HIV/AIDS varies. In some urban contexts the adolescents have lay concepts and myths that could guide them into misting practices that could lead to contamination by HIV. The mass media, especially television, and interpersonal sources such as teachers, parents and peers are important sources of information about HIV/AIDS and have a central role in the social construction and public perception of the problem in adolescents. The objective of the study is to relate the degree of knowledge of HIV/AIDS to the exposure to information sources among adolescents in Guadalajara city, in Mexico. MATERIAL AND METHOD: Survey sample with autoapplied questionnaire. Sample of 1,410 adolescents, male and female, of 15 to 19 years of age, in the four socioeconomic strata. The Chi-square and BTukey tests, 95% confidence interval for proportions and means, and simple ANOVA factor were applied. RESULTS: A considerate degree of knowledge (mean of 13.94 correct answer out of 24, standard deviation = 4.09, 95% CI = 13.69-14.11) was found significant mean differences in favor of the high (15.70) and medium (14.26) strata as opposed to the low (13.51) and marginalized (12.85) (F = 19.39, p < .0001, BTukey level .050). The information published by the newspapers (F = 11.1; p < .001) and the teachers (F = 3.72; p < .05) had a direct relationship to the degree of knowledge imported by the daily exposure to the television and other social demographic variables. CONCLUSIONS: The results describe the presence of inequalities by socioeconomic strata in the list of sources in information and the levels of knowledge about HIV/AIDS. It is necessary to strengthen and develop educational action and the publication of messages through the media, institutions and interpersonal networks, with emphasis on interpersonal and media sources available to the low and marginalized strata, and at the same time, to strengthen the action of sources of information available to the other socioeconomic strata.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Physician knowledge, financial incentives and treatment decisions for depression.

BACKGROUND: Two important policy levers to affect health care delivery are financing and informational interventions. Unfortunately, these two approaches have not been considered simultaneously and little is known about how their effects compare. AIMS OF THE STUDY: This paper estimates the relative role of financial incentives (prepaid versus fee for service) and provider information (perceived knowledge of antidepressant medications and skill in counseling for depression) on quality of care for less and more severely depressed patients and their health and cost outcomes. METHODS: We develop a theoretical model of provider behavior and estimate a reduced form using a multinomial probit model with heteroskedastic covariances. The likely effects of changing provider knowledge about depression treatment in primary care are then simulated and contrasted with the effects of a shift toward prepaid managed care as opposed to fee-for-service care. The empirical model is estimated using data from the Medical Outcomes Study. RESULTS: We conclude that financing and information have different effects and that their combination can achieve the conflicting goals of improved health outcomes and reduced direct treatment goals. Moreover, including family income as one important dimension of social cost suggests that the combination of informational interventions and a shift to prepaid care may dominate either one intervention in isolation from a social cost perspective. Specifically regarding information, we found that increasing provider knowledge could have the highly desirable effect of greater targeting of treatments to sicker patients while not raising overall treatment rates much - a treatment pattern that many hoped managed care could achieve, but for which there has been little evidence. CONCLUSIONS: Our analysis illustrates the value of considering these widely different policy goals simultaneously. We learned that variation in physician knowledge generally had stronger associations with clinically relevant practice patterns for depression than did a complete change in financing strategy. The moderate change in perceived knowledge we simulated (not near the extremes of observed values of perceived knowledge) was associated with enough improvement in appropriateness of care to more than offset the reduction in appropriateness with a complete shift from fee-for-service to prepaid managed care. IMPLICATIONS FOR HEALTH POLICY: The paper demonstrates the importance of considering different interventions simultaneously. Combining informational and financial interventions simultaneously can achieve better quality of care and reduce health care costs, something neither intervention can in isolation.

Journal Article↗
PubMed1995

The legitimacy of clinical knowledge: towards a medical epistemology embracing the art of medicine.

The traditional medical epistemology, resting on a biomedical paradigmatic monopoly, fails to display an adequate representation of medical knowledge. Clinical knowledge, including the complexities of human interaction, is not available for inquiry by means of biomedical approaches, and consequently is denied legitimacy within a scientific context. A gap results between medical research and clinical practice. Theories of knowledge, especially the concept of tacit knowing, seem suitable for description and discussion of clinical knowledge, commonly denoted "the art of medicine." A metaposition allows for inquiry of clinical knowledge, inviting an expansion of the traditional medical epistemology, provided that relevant criteria for scientific knowledge within this field are developed and applied. The consequences of such approaches are discussed.

Decision Making↗
PubMed1989

Knowledge base design for decision support in respirator therapy.

A knowledge base is built for decision support applied to respirator therapy (the KUSIVAR project). The knowledge representation is object-oriented using frames to store multiple forms of knowledge: variable descriptions, transformation tables, rules and mathematical models. The system is data-driven, generating and displaying advice automatically triggered by changes in data from the respirator and the patient. The inferenceing mechanism is forward-chaining i.e. a rule is evaluated as soon as it's condition is satisfied. Temporal aspects of the reasoning are represented by a number of mechanisms, among others limited validity times for data, trend analysis and mathematical models. The knowledge base is organized according to disease groups and decision situation which simplifies knowledge acquisition and improves response times since it enables the system to focus on a limited set of rules in each situation. To test the feasibility of the system design a prototype has been built using Knowledge Engineering Environment (KEE) from Intellicorp on an Explorer workstation from Unisys. The production system, which is interfaced to a Siemens Elema Servo Ventilator 900C, is currently being implemented under the Microsoft Windows multitasking environment on a microcomputer based on an Intel 80386 processor.

Decision Support Techniques↗
PubMed1991

Medical logic module (MLM) representation of knowledge in a ventilator treatment advisory system.

In any medical expert system it is the inherent knowledge that is the power of the system and not the particulars of its implementation. Therefore it would be valuable to use a representation that would allow: knowledge transfer between different systems, users, experts and 'importers' to be able to evaluate the logic, experts to easily input their knowledge and be guided how to use the syntax. Adren Syntax of Medical Logic Module is a proposed knowledge representation, fulfilling these criteria. The Arden Syntax has been used to represent rules and logic in a decision support system for ventilator therapy in patients with acute respiratory failure (ARF) that is under development. The medical experts involved in the project have used the Arden Syntax as a convenient way for transfer and storage of medical knowledge. The syntax is easy to learn and may be used with a minimum of training. In the present system, Medical Logical Modules have been used to represent knowledge pertinent to the initiation and maintenance phases of ventilator therapy.

Acute Disease↗
PubMed2004

Numeric and symbolic knowledge representation of cerebral cortex anatomy: methods and preliminary results.

The human cerebral cortex anatomy describes the brain organization at the scale of gyri and sulci. It is used as landmarks for neurosurgery as well as localization support for functional data analysis or inter-subject data comparison. Existing models of the cortex anatomy either rely on image labeling but fail to represent variability and structural properties or rely on a conceptual model but miss the inner 3D nature and relations of anatomical structures. This study was therefore conducted to propose a model of sulco-gyral anatomy for the healthy human brain. We hypothesized that both numeric knowledge (i.e., image-based) and symbolic knowledge (i.e., concept-based) have to be represented and coordinated. In addition, the representation of this knowledge should be application-independent in order to be usable in various contexts. Therefore, we devised a symbolic model describing specialization, composition and spatial organization of cortical anatomical structures. We also collected numeric knowledge such as 3D models of shape and shape variation about cortical anatomical structures. For each numeric piece of knowledge, a companion file describes the concept it refers to and the nature of the relationship. Demonstration software performs a mapping between the numeric and the symbolic aspects for browsing the knowledge base.

Cerebral Cortex↗
PubMed2007

The role of biomedical knowledge in diagnosis of difficult clinical cases.

Although biomedical knowledge is believed to be of little value in diagnosis of routine clinical cases, studies of clinical reasoning have found that physicians revert to use of basic biomedical knowledge when faced with challenging clinical problems. The current paper presents two experiments that empirically examine the role of biomedical knowledge in diagnosis of difficult cases by novice diagnosticians. Novices are taught to diagnose a series of artificial diseases using either knowledge of causal mechanisms or a list of clinical features. In Experiment 1, participants are then tested on two types of clinical challenges: (1) case summaries with irrelevant findings; (2) cases using unfamiliar terminology. Participants with an understanding of underlying mechanisms out performed their counterparts on both types of cases. In Experiment 2, participants are tested 1 week after initial training. Participants with knowledge of causal mechanisms were found to do better on cases with unfamiliar terminology. The results of the two studies provide additional support for the critical role of biomedical knowledge in diagnosis of difficult clinical cases.

Analysis of Variance↗
PubMed2005

The effect of experiential knowledge on construction of risk perception in hereditary breast/ovarian cancer.

The purpose of this study was to explore the connection between experiential knowledge of hereditary breast/ovarian cancer and understandings of personal cancer risk. Using a qualitative research design, the investigator conducted in-depth interviews with 53 individuals (45 female, 8 male) from families at high-risk for hereditary breast/ovarian cancer. Study results showed that two forms of experiential knowledge, empathetic and embodied knowledge, were integral to participants' constructions of their cancer risk. They also illustrated that knowledge derived from experience often took precedence over objective clinical estimates of risk. The paper discusses the clinical implications of these findings and suggests that counseling strategies, which expand upon patient's lived experience and knowledge of the disease, may enhance communication of genetic risk. Assessment of experiential knowledge promises to suggest new ways to frame genetic information that will enable people to better understand their objective risk or to modify exaggerated and/or inaccurate risk perceptions.

Adult↗
PubMed2002

Knowledge and attitudes of primary care physicians toward sleep and sleep disorders.

PURPOSE: To assess primary care physician (PCP) sleep knowledge and attitudes. METHOD: A sample of 580 PCPs practicing adult medicine in Northeast Ohio was selected, using a systematic random method (every 10th name on the American Medical Association mailing list). A three-part structured survey consisted of 30 attitude items and 33 multiple-choice test questions assessing knowledge, with some demographic questions. Repeat mailings were sent to nonrespondents 4 to 6 weeks apart from October 1999 through April 2000. RESULTS: 46 surveys were undeliverable and 105 (20%) useable questionnaires were returned. Of respondents, 94% were board certified with 76% certified in more than one area. When asked to rate their knowledge of sleep disorders, none rated themselves as excellent, 10% rated themselves as good, 60% as fair, and 30% as poor. The factors rated highest in influencing current practices regarding sleep and sleep disorders were articles in journals, continuing medical education courses, and discussions with specialists. Knowledge average was 34% (3 to 94%). Though virtually all agreed that prevention counseling should be a part of patient care, fewer agreed that they spend more time counseling patients on the benefits of sleep than of diet or exercise. CONCLUSIONS: The majority of PCPs rated their own knowledge of sleep disorders as fair or poor. Knowledge testing and attitude assessment lend credence to these perceptions.

Attitude↗
PubMed1989

Knowledge management as a decision support method: a diagnostic workup strategy application.

We have explored the potential of a computer-based approach called "knowledge management" to aid in clinical problem solving and education. The major features of the approach are its ability to support flexible and immediate access by a user to relevant knowledge and annotation and organization of the knowledge for personal use and subsequent retrieval. We illustrate this approach with its application to diagnostic workup strategy problems. In this application, knowledge may be in the form of static narrative text, diagrams, pictures, graphs, tables, flow charts, or bibliographic citations. Other more dynamic forms of knowledge may be the result of simulations, "what if" analyses or modeling, quantitative mathematical or statistical calculation, or heuristic inference. User assessment has demonstrated the system's ease of use and user perception of its desirability, but underscores the need for a "critical mass" of knowledge before such an approach will be widely utilized.

Decision Support Techniques↗
PubMed1983

Relationship between demographic variables, nonformal education, and the infection control practitioner's knowledge of surveillance.

Since methods used for surveillance have not been standardized, infection control practitioners choose a method based on peer-teaching, on-the-job training, or nonformal education programs. However, results of a previous study showed that 63% of ICPs were unsatisfied with their method of surveillance but did not know how to proceed with an alternative method. The purpose of this descriptive developmental study was to investigate the relationship between surveillance knowledge and the demographic profiles of ICPs and evaluate how this knowledge was affected by a nonformal education process (seminar). Results showed that the surveillance knowledge of ICPs was significantly (p less than 0.05) related to the hospital type and size in which they worked, their educational preparation, the years spent in infection control, the CDC course they took, and the development of an infection control program. The nonformal education process showed a significant (p less than 0.05) increase in surveillance knowledge. In summary, five demographic variables were found to be related to the surveillance knowledge of ICPs, and this knowledge was significantly increased by a nonformal educational process.

Analysis of Variance↗