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PubMed1997

Exchanging clinical knowledge via Internet.

The need for effective and efficient exchange of clinical knowledge is increasing. Paper based methods for managing clinical knowledge are not meeting the demand for knowledge and this has undoubtedly contributed to the widely reported failures of clinical guidelines. Internet affords both opportunities and dangers for clinical knowledge. Systems such as Wax have demonstrated the importance of intuitive structure in the management of knowledge. We report on a new initiative for the global management of clinical knowledge.

Artificial Intelligence↗
PubMedDate not supplied

Knowledge and attitudes about acquired immunodeficiency syndrome in nursing and nonnursing groups.

A study was undertaken to determine the difference in knowledge and attitudes about acquired immunodeficiency syndrome (AIDS) in nursing and nonnursing groups, and to determine the effect that knowledge acquisition would have on attitudes about AIDS. The total study population consisted of 60 registered nurses, 50 baccalaureate nursing students, 42 liberal arts college students, and 30 nonnurse adults. An AIDS knowledge and attitude assess test was developed and used in the study. Univariate descriptive methodology, descriptive correlational analysis, and a pretest-posttest design were used. Phase I showed that professional nurses with graduate degrees have the highest knowledge base and the most positive attitudes about AIDS; and that nursing students' attitudes are more similar to the attitudes of nonnursing students than of professional nurses. Phase II showed that people's attitudes about AIDS could be changed by increasing their knowledge levels, and nursing students showed more increase in knowledge and more significant changes in attitudes following education than liberal arts college students.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Investigating the abstractness of children's early knowledge of argument structure.

In the current debate about the abstractness of children's early grammatical knowledge, Tomasello & Abbott-Smith (2002) have suggested that children might first develop 'weak' or 'partial' representations of abstract syntactic structures. This paper attempts to characterize these structures by comparing the development of constructions around verbs in Tomasello's (1992) case study of Travis, with those of 10 children (Stage I-II) in a year-length, longitudinal study. The results show some evidence that children's early knowledge of argument structure is verb-specific, but also some evidence that children can generalize knowledge about argument structure across verbs. One way to explain these findings is to argue that children are learning limited scope formulae around high frequency subjects and objects, which serve as building blocks for more abstract structures such as S+V and V+O. The implication is that children may have some verb-general knowledge of the transitive construction as early as Stage I, but that this knowledge is still far from being fully abstract knowledge.

Birth Order↗
PubMed2001

Emotion knowledge in economically disadvantaged children: self-regulatory antecedents and relations to social difficulties and withdrawal.

We examined the relations of verbal ability and self-regulation in preschool to emotion knowledge in first grade, and concurrent relations between emotion knowledge and indexes of social functioning in 143 children from low-income families. After controlling for children's verbal ability in preschool, teacher reports of attentional control and caregiver reports of behavioral control in preschool predicted children's emotion expression knowledge and emotion situation knowledge 2 years later. After controlling for verbal ability and attentional and behavioral control, children's emotion knowledge predicted concurrent teacher-reported social problems and social withdrawal. Results suggest that low levels of emotion knowledge co-occur with many important aspects of children's early social adaptation.

Adaptation, Psychological↗
PubMed1998

Patient Dependency Knowledge-Based Systems.

The ability of Patient Dependency Systems to provide information for staffing decisions and budgetary development has been demonstrated. In addition, they have become powerful tools in modern hospital management. This growing interest in Patient Dependency Systems has renewed calls for their automation. As advances in Information Technology and in particular Knowledge-Based Engineering reach new heights, hospitals can no longer afford to ignore the potential benefits obtainable from developing and implementing Patient Dependency Knowledge-Based Systems. Experience has shown that the vast majority of decisions and rules used in the Patient Dependency method are too complex to capture in the form of a traditional programming language. Furthermore, the conventional Patient Dependency Information System automates the simple and rigid bookkeeping functions. On the other hand Knowledge-Based Systems automate complex decision making and judgmental processes and therefore are the appropriate technology for automating the Patient Dependency method. In this paper a new technique to automate Patient Dependency Systems using knowledge processing is presented. In this approach all Patient Dependency factors have been translated into a set of Decision Rules suitable for use in a Knowledge-Based System. The system is capable of providing the decision-maker with a number of scenarios and their possible outcomes. This paper also presents the development of Patient Dependency Knowledge-Based Systems, which can be used in allocating and evaluating resources and nursing staff in hospitals on the basis of patients' needs.

Accounting↗
PubMed1999

Correlates of HIV/AIDS knowledge among U.S.-born and foreign-born Hispanics in the United States.

No national study of Hispanics has examined variation in HIV/AIDS-related knowledge by ethnicity, place of birth, and duration in the United States (for the foreign born) at least in part because of data constraints. Data from the 1991 and 1992 National Health Interview AIDS Supplements were used to examine the influence of these factors, and other sociodemographic and HIV/AIDS-related variables, on a 25-item HIV/AIDS knowledge scale. Descriptive and multivariate analyses indicate that foreign-born Hispanics with shorter durations in the United States have significantly lower levels of HIV/AIDS knowledge, as do those of Mexican and Cuban ethnicity. Numerous other factors, most of which are known to be associated with HIV/AIDS knowledge in the general population, were found to be significantly associated with HIV/AIDS knowledge among Hispanics in multivariate analyses; these include age, education, gender, rural residence, residence in the West, knowing a person with HIV/AIDS, personal risk for HIV/AIDS, and having been tested for HIV outside of the blood donation system. Results suggest that HIV/AIDS information campaigns targeted to Hispanics may not be equally effective in reaching foreign-born and U.S.-born subgroups or persons of differing ethnicities. Future studies should examine sources of HIV/AIDS information and the mechanisms of knowledge acquisition and transmission within specific subgroups of the Hispanic population.

Journal Article↗
PubMed2004

Making explicit the implicit knowledge assets in healthcare: the case of multidisciplinary teams in care and cure environments.

Research in Australia and the United States offers evidence of sophisticated, implicit, knowledge assets in two diverse healthcare environments, care and cure. Two case studies representing these two distinct archetypal environments are presented (a palliative care organization in Australia and a spinal care unit in the United States); both are based around multidisciplinary service delivery and demonstrate the existence of implicit knowledge assets. Yet the full potential of these knowledge assets is not being realized. A Knowledge Management Infrastructure model is proffered as a way of making explicit the elements of these knowledge assets in both case studies. In addition, this model provides a systematic and robust approach to structuring the conceptualization of knowledge assets across a range of healthcare environments.

Australia↗
PubMed2000

The value of a questionnaire in assessing the acquisition and retention of basic science knowledge by dental students.

This cross-sectional study aimed to assess and compare, by performances in a questionnaire, the level of knowledge of basic medical sciences in 6th-form school pupils studying science subjects as entrance requirements to University and in 2nd, 3rd and 4th-year undergraduate dental students. A 40-part multiple response, true/false questionnaire, testing recall of factual knowledge in anatomy, biochemistry, physiology and oral biology, was used as the method of assessment. The results suggested that this simple format was an acceptable and useful method of assessment of the knowledge level of the study groups. The difference in scores of knowledge, expected to be higher in 2nd-year students compared to 6th form groups, was greatest in anatomy and oral biology, less in biochemistry and, unexpectedly, was not apparent in physiology. A difference in performance on the knowledge questionnaire was observed between 4th and 2nd year dental students, attributable primarily to decreased scores for 4th year dental students in biochemistry and, to a lesser extent, anatomy. The results obtained with this standardised test of factual knowledge recall may be of value to teachers compiling medical sciences courses for dental undergraduates and to those planning and evaluating new curricula with a less didactic approach.

Cross-Sectional Studies↗
PubMed2003

Patterns of knowledge in children's addition.

Patterns of conceptual and procedural knowledge of addition were examined in 5- to 8-year-olds (N = 80). Conceptual knowledge was measured by assessing children's responses to problems in which addends were reordered or decomposed and recombined. Problems were presented using abstract symbols, numbers, and physical objects. Children were more successful in noticing that addends had been reordered rather than decomposed and in noticing the decomposition of addends presented with objects rather than with symbols. Distinct profiles of procedural competence were derived from an analysis of children's problem-solving accuracy and strategies. Profiles were associated with patterns of conceptual knowledge and with age, although age and conceptual knowledge were not related. Findings highlight the usefulness of identifying profiles of procedural and conceptual knowledge for understanding the development of children's knowledge of addition.

Aptitude↗
PubMed2004

Modeling the effects of prior knowledge on learning incongruent features of category members.

The authors conducted 3 experiments addressing the issue of how observations and multiple sources of prior knowledge are put together in category learning. In Experiments 1 and 2, learning was faster for critical features, which were predictable on the basis of prior knowledge, than for filler features, and this advantage increased as more observations were made. In addition, learning was fastest for incongruent features that could only be predicted using knowledge from other domains. In Experiment 3, presenting contradictory features that violated prior knowledge led to rote learning rather than use of prior knowledge. The results were simulated with the Baywatch model, which addresses how observations of category members lead to recruitment and selection of sources of prior knowledge.

Cognition↗
PubMed2001

Knowledge of diabetes among personnel in home-based care: how does it relate to medical mishaps?

OBJECTIVE: To assess the influence of knowledge about diabetes on the performance of diabetes care for the elderly involving insulin treatment, with special attention to aspects of patient safety in home care. DESIGN: A questionnaire was administered to nurse's aides and assistant nurses (n = 3144). Answers to questions about knowledge of diabetes were related to "relevant" or "risky measures" as judged from a hypothetical diabetes case. A 94% response rate was obtained. The study took place in January 1997 in 15 of Sweden's 289 municipalities. RESULTS: Insufficient theoretical knowledge about how the blood sugar is related to an insulin reaction led to an almost threefold increased risk of taking a "risky measure". Insufficient knowledge about reasons for an insulin reaction also resulted in a higher risk, as was the case for personnel working in home based care in contrast to those working solely in Institutional care. In addition, the risk that a nurse's aide would take a "risky measure" was higher than that for an assistant nurse. This may indicate that the basic theoretical knowledge of nurse's aides is inadequate. CONCLUSION: Deficiencies in basic knowledge of diabetes among nurse's aides and assistant nurses constitute a major cause of potentially serious mishaps in home care of elderly diabetic patients treated with insulin.

Clinical Competence↗
PubMed2001

Do short cases elicit different thinking processes than factual knowledge questions do?

PURPOSE: To assess whether case-based questions elicit different thinking processes from factual knowledge-based questions. METHOD: 20 general practitioners (GPs) and 20 students solved case-based questions and matched factual knowledge-based questions while thinking aloud. Verbatim protocols were analysed. Five indicators were defined: extent of protocols; immediate responses; re-reading of information given in the stem or case after the question had been read; order of re-reading information, and type of consideration, i.e. 'true-false' type or 'vector', that is, a deliberation which has a magnitude and a direction. RESULTS: Cases elicited longer protocols than factual knowledge questions. Students re-read more given information than GPs. GPs gave an immediate response on twice as many occasions as students. GPs re-ordered the case information, whereas students re-read the information in the order it was presented. This ordering difference was not found in the factual knowledge questions. Factual knowledge questions mainly led to 'true-false' considerations, whereas cases elicited mainly 'vector' considerations. CONCLUSION: Short case-based questions lead to thinking processes which represent problem-solving ability better than those elicited by factual knowledge questions.

Education, Medical↗
PubMed2001

Nurses' knowledge and attitudes about antibiotic therapy in critical care.

PURPOSE: To assess critical care nurses' knowledge about antibiotic use in critical care settings, and attitudes concerning the role of the nurse in monitoring response to and appropriate use of antibiotic therapy. METHOD: 90 critical care nurses from 6 adult critical care units at a 780-bed academic, health sciences centre, completed an investigator-developed survey about their knowledge of antibiotic use and their attitudes concerning the role of the nurse. RESULTS: The majority of respondents worked full time (83%) and were BSN (Bachelor of Science in Nursing) prepared (62%), with an average of 9 years' nursing experience and 7 years' experience in intensive care. Using a 100-mm visual analog scale, mean scores on knowledge and comfort with: (1) interpreting culture and sensitivity; (2) white blood cell (WBC) data; and (3) discussing results and therapy with physicians were all less than 50 mm. However, the mean score for nurses' belief of responsibility related to this collaborative role was 76. A knowledge quiz of lab interpretation and antibiotic therapy revealed a mean score of 53.8%. Beliefs about roles were correlated with comfort in discussing therapies with physicians rather than with knowledge. Although nurses value the collaborative surveillance role, they may lack the knowledge and confidence to enact it.

Adult↗
PubMed2002

[Knowledge management in rehabilitation--proposal for a systematic development of clinical practice guidelines].

In the past ten years, the German pension scheme has launched several initiatives that can be regarded as milestones on the way to a scientifically founded rehabilitation system. These initiatives were: the Rehab Commission (1989 - 1991), the Quality Assurance Programme (since 1994), and the German Research Funding Programme "Rehabilitation Sciences" (in cooperation with the Federal Ministry for Education and Research, since 1996). As a next step on this way, we propose an initiative aiming at a systematic development and implementation of clinical practice guidelines for the main diagnostic groups in rehabilitation. Guidelines for diagnostic and therapeutic decisions are an instrument to sift through the abundance of fast changing knowledge in medicine, to assess the existing knowledge according to its scientific evidence, and to transform it into recommendations for clinical practice. In rehabilitation, guidelines seem to be particularly needed because specialized knowledge is mostly disseminated through an informal "training on the job". Our proposal intends to establish a reference centre for each of the main indications (cardiology, musculoskeletal diseases, etc.). These centres should cooperate with experts from clinical practice and research, as well as with representatives of the cost-carrying agencies and patient organisations, and should systematically analyse the processes of rehabilitation in the most important diagnostic groups. Guided by a "process matrix of rehabilitation", these analyses should identify the points at which far-reaching decisions are called for during the processes of rehabilitation. At these points, the knowledge base available for rational decisions should be examined. When there is no sufficient scientific knowledge, consensus conferences should be organized in order to collect and assess the available expertise of practitioners and to establish guidelines for clinical practice. Since compliance with such guidelines could be easily checked in the routine quality assurance programme, this proposal seems to be a promising way of improving the knowledge base in rehabilitation in a rather short time.

Diagnosis-Related Groups↗
PubMed2003

Differential impairment of person-specific knowledge in a patient with semantic dementia.

We report the case of ST, a 61-year-old gentleman of superior intelligence, who presented with a five-year history of slowly progressive word finding difficulty for proper names. MRI (magnetic resonance imaging) showed marked atrophy in the left anterior temporal lobe and SPECT (single photon emission computed tomography) demonstrated hypoperfusion in the left anterior and inferior temporal region. A detailed behavioral analysis of the integrity of his semantic system revealed naming deficits for both proper and common names. ST also showed severe impairments in person-specific semantic knowledge, but preservation of knowledge for famous places and common objects. ST's semantic knowledge deficit for people emerged whether he was tested with the faces or the names of famous individuals. Variables that affect name retrieval, such as familiarity, age of acquisition, and frequency of concept encounter, do not account for the selective impairment of person-specific knowledge evidenced by ST. Qualitative differences between the nature of knowledge representations for people and for common objects may underlie this effect. Disruptions in left temporal regions associated with semantic processing may be sufficient to produce a selective deficit in person-specific knowledge.

Attention↗
PubMed2001

The nature of declarative and nondeclarative knowledge for implicit and explicit learning.

Using traditional implicit and explicit artificial-grammar learning tasks, the author investigated the similarities and differences between the acquisition of declarative knowledge under implicit and explicit learning conditions and the functions of the declarative knowledge during testing. Results suggested that declarative knowledge was not predictive of or required for implicit learning but was related to consistency in implicit learning performance. In contrast, declarative knowledge was predictive of and required for explicit learning and was related to consistency in performance. For explicit learning, the declarative knowledge functioned as a guide for other behavior. In contrast, for implicit learning, the declarative knowledge did not serve as a guide for behavior but was instead a post hoc description of the most commonly seen stimuli.

Adult↗
PubMed2005

Antecedents of emotion knowledge: Predictors of individual differences in young children.

Individual differences in emotion knowledge were examined among 188 4-year-old, predominantly African American children. Cognitive ability and negative emotionality, maternal characteristics (parenting, verbal intelligence, and depressive symptoms), environmental risk, and child sex were examined as predictors of emotion knowledge. Regression analyses indicated that cognitively skilled children who resided in relatively low risk environments with verbally intelligent mothers possessed greater emotion knowledge. Proximal (4-year) child cognitive ability was a stronger predictor than distal (2-year) cognitive ability. Positive parenting at 4 years was correlated with child emotion knowledge, but this relation disappeared when parenting was examined in the context of other predictors. These findings highlight the potential role of child cognitive ability, along with environmental risk and maternal verbal intelligence, in children's emotion knowledge and demonstrate the importance of examining a variety of predictors for their unique contribution to emotion knowledge.

Journal Article↗
PubMed1991

Description of knowledge structures within a concept-based curriculum framework.

The development of declarative knowledge was examined within the parameters of movement-based curricula. Declarative knowledge represents factual or foundational knowledge frequently articulated as curriculum content. A semantic ordered tree technique was used to investigate the knowledge structures of three groups of teacher preparation subjects (novice, coursework, student teacher) and one group of elementary physical education teachers (experts). Structures were examined based on frequency and coherence criteria. ANOVA was used to examine differences between groups. Results suggested that declarative knowledge appeared to develop in complexity from novice to expert within the parameters of concept-based movement curricula. The Active Structural Networks Theory was used to interpret structural development through the accretion, tuning, and restructuring phases. Knowledge structures of the novice and coursework groups seemed to represent accretion, whereas those of student teachers and experts represented tuning and restructuring.

Analysis of Variance↗