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PubMed1998

Quality of diabetes care, diabetes knowledge and risk of severe hypoglycaemia one and four years after participation in a 5-day structured treatment and teaching programme for intensified insulin therapy.

Intensification of insulin therapy in the Diabetes Control and Complications Trial led to an improvement in the quality of diabetes care, which was accompanied, however, by a threefold increase in the risk of severe hypoglycaemia. The present trial, a long-term evaluation of a structured 5-day treatment and teaching programme (DTTP) for intensified insulin therapy, was performed to clarify factors determining HbA1c, the incidence of severe hypoglycaemia, diabetes knowledge and quality of life. Ninety-four Type 1 diabetic patients were examined at baseline and 4 years after participation in a DTTP. Comparison of baseline data with measurements at the 4-year follow-up examination showed that relative HbA1c (= HbA1c/mean normal) improved (1.9 +/- 0.51 vs 1.55 +/- 0.3*, p < 0.001, *excluding 4 patients with diabetes manifestation at baseline) and that frequencies of daily insulin injections (3.73 +/- 1.23 vs 4.9 +/- 0.69*, p < 0.001) and weekly blood glucose self-tests (6.6 +/- 10.1 vs 25.5 +/- 8.7*, p < 0.001) increased, whereas the incidence of severe hypoglycaemia (intravenous glucose, glucagon injection) remained stable (0.19 vs 0.24, p = 0.48). Patients with less diabetes knowledge had higher HbA1c levels and a higher incidence of severe hypoglycaemia. In the group of patients with severe hypoglycaemia, certain crucial gaps in diabetes knowledge were identified concerning the effects of physical activity, nutrition and long-term complications of diabetes. In multivariate analysis. The most important factor associated with HbA1c was diabetes knowledge which, however, was not influenced by educational level or other factors. Interventions, such as the identification of psychosocial factors which may interact with diabetes knowledge, quality of life and successful self-management of diabetes by patients, are needed to improve the efficacy of DTTPs and to prevent severe side effects such as hypoglycaemia.

Adult↗

PubMed1992

Sexual behaviour among youth clinic visitors in Sweden: knowledge and experiences in an HIV perspective.

OBJECTIVE: To study the knowledge and experience of sexuality, contraception and sexually transmitted diseases among sexually active adolescents in Sweden. SUBJECTS: Youth clinic visitors. SETTING: Seventy-four youth clinics from all over the country of Sweden. METHODS: A questionnaire with 17 multiple choice and nine open questions was distributed to all visitors at participating youth clinics during a 2-month period. RESULTS: A total of 9277 young persons answered the questionnaire. Their mean age was 17.5 years. Ninety-three percent were females. Knowledge on STD and STD protection was wide-spread and good. Chlamydia and HIV was recognised as STDs by 90% and 87% respectively. More than 99% knew of the condom method as a means for STD protection. Knowledge on contraceptive methods for pregnancy protection was also good. Ninety-three percent of the investigated adolescents had had coitus. Nine percent had experienced pregnancies and 17% STDs. The mean number of life-time sexual partners was 3.2. CONCLUSIONS: In spite of good knowledge on preventive measures among Swedish youth clinic visitors their sexual behaviour carriers risks for future health. Further interventions are needed to minimise these risks.

Adolescent↗

PubMed1992

An AIDS-related knowledge, attitudes, beliefs, and practices survey among schoolchildren in Barbados.

A knowledge, attitudes, beliefs, and practices (KABP) survey was performed among Barbadian secondary schoolchildren 11-16 years old in January 1990. The survey sought to assess the children's knowledge of AIDS and human immunodeficiency virus (HIV) transmission; their attitudes toward people with HIV/AIDS; their sexual practices; and changes needed in education programs seeking to reduce childhood HIV transmission. A pretested self-administered questionnaire was used. The survey sample was derived by selecting every eleventh student on the rosters of all the secondary schools in Barbados. All of the survey respondents completed the questionnaire on the same day, having been assembled examination-style for that purpose. The results showed high levels of correct knowledge about the principal routes of HIV transmission. However, a considerable proportion of the respondents harbored incorrect beliefs regarding mosquito transmission and dangers to blood donors, and many showed uncertainty or incorrect knowledge regarding possible HIV transmission by biting, spitting, or use of public toilets. About a third of the children (51.4% of the boys and 18.7% of the girls) said they had experienced sexual intercourse, though only 20% reported being sexually active in the year preceding the survey. Three-quarters of the sexually experienced group said they knew how to use condoms, but only a third said there was any time when they had used protection during sexual intercourse. Overall, the results indicate that education efforts prior to the survey had been effective, but that reinforcement of such efforts as well as their extension into the primary schools is warranted. Further research directed at helping these efforts to encourage more meaningful changes in sexual behavior is also needed.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Knowledge and attitude of general outpatient attendants in Nigeria to cervical cancer.

OBJECTIVES: This study sets out to determine: a. How much women in low socio-economic settings know about cancer and cervical cancer. b. Their source of information. c. Their general attitude to cervical cancer. DESIGN: A cross sectional study. SETTING: General outpatient (GOP) department of a tertiary hospital in Ibadan, Nigeria. SUBJECTS: 254 randomly selected women aged 20 to 65 years attending or visiting the GOP department in a University Teaching Hospital were studied. MAIN OUTCOME MEASURES: Knowledge about cancer and cervical cancer as well as source of information. RESULTS: The response rate was 100%. Of the respondents, 90% had heard of cancer at one time or the other while only 15% had heard of cervical cancer. The media (38%) and peers (36%) were the major sources of information on cancer. Fifty five percent, 53% and 61% had no knowledge while 40% and 23% had poor to moderate overall knowledge of cervical cancer. CONCLUSION: Knowledge about cervical cancer is poor in these women, unlike findings in developed countries. There is need to educate our women on the early warning signs of cervical cancer as failure to recognise the early symptoms and signs contribute to the late presentation common in Nigeria.

Adult↗

PubMed2005

Taking well-child care into the 21st century: a novel, effective method for improving parent knowledge using computerized tutorials.

BACKGROUND: Despite expert panel recommendations, few pediatric providers administer sufficient anticipatory guidance and educational counseling during well-child visits, largely owing to lack of time. OBJECTIVES: To design a waiting room educational kiosk that uses interactive, self-guided, computerized tutorials to give anticipatory guidance to parents at the 6-week and 4-month well-child visits, and assess impact on parent knowledge. The intervention required no additional provider time, and automatically printed a summary for the medical record. SETTING: A government-funded hospital serving Navajo patients in New Mexico. METHODS: After a well-child visit, knowledge regarding issues such as fever management, dental care, sleep position, nutrition, and car seat use was tested in a group of parents receiving standard care (control), and a group using the computerized tutorials in addition to standard care (intervention). RESULTS: Fifty-two parents in the control group and 49 parents in the intervention group completed the knowledge assessment. Ninety-five percent of intervention subjects completed the computerized tutorial without clinic staff involvement. Compared with the control group, the intervention group had superior knowledge in all tested areas. The percentage of correct responses to all questions was higher for the intervention group in the following categories: car seat use (49% vs 31%, P<.01), dental care (80% vs 27%, P<.001), and nutrition (43% vs 21%, P<.001). Among parents of 6-week-old infants, a greater number of parents in the intervention group identified fever as 100.4 degrees F or higher (86% vs 50%, P<.001), and fewer replied that they would give antipyretics to a febrile child younger than 3 months old without consulting a provider (52% vs 100%, P<.001). The percentage of parents with a perfect score or only one question wrong on the 21-item test was 17-fold higher in the intervention group (P<.001). CONCLUSION: Computerized anticipatory guidance at well-child visits increases knowledge over printed materials alone and is usable by the majority of parents.

Adult↗

PubMed1996

Effects of structured encounter forms on pediatric house staff knowledge, parent satisfaction, and quality of care. A randomized, controlled trial.

OBJECTIVE: To evaluate the effects of health supervision structured encounter forms on pediatric house staff knowledge, parent satisfaction, and quality of care. DESIGN: Randomized, controlled trial. SETTING: Pediatric house staff continuity clinic in a university-based children's hospital. PARTICIPANTS: 53 pediatric house officers and 153 parents. INTERVENTIONS: House staff were randomized to use structured encounter forms focused on developmental milestones (group 1) or anticipatory guidance/preventive care (group 2) during health supervision visits. OUTCOME MEASURES: Changes in house staff knowledge were assessed with pretests and posttests. Parent satisfaction was assessed with surveys. Quality of care, defined as compliance with recommended guidelines for age-specific health supervision, was assessed by audiotaping visits. RESULTS: Group 1 demonstrated greater but not significantly different improvement in knowledge of developmental milestones than group 2, while group 2 improved more than group 1 in knowledge of anticipatory guidance/ preventive care. Parent satisfaction with developmental screening was significantly greater for group 1 visits than for group 2 visits (P < .001). Group 1 demonstrated significantly greater compliance than group 2 with recommended standards of developmental screening (P = .001). CONCLUSIONS: The use of structured encounter forms for health supervision in pediatric house staff continuity clinics may increase house staff knowledge of developmental milestones and anticipatory guidance/preventive care, increases parent satisfaction with developmental assessment during health supervision, and improves compliance with recommended guidelines for developmental assessment.

Adolescent↗

PubMed2000

Patients' knowledge of options at the end of life: ignorance in the face of death.

CONTEXT: Effectiveness of legislation promoting advance directives and legalizing physician-assisted suicide depends on patients' understanding their legal options about end-of-life care. However, outpatients' understanding of their legal options at the end of life has not been studied. OBJECTIVES: To estimate the percentage of outpatients who are informed about 4 areas relevant to end-of-life care: refusal and withdrawal of lifesaving treatments, physician-assisted suicide, active euthanasia, and double effect; and to determine whether authoring advance directives, experiencing illness, acting as a proxy for health care decisions, and caring for an ill loved one are associated with better knowledge in end-of-life care. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: One thousand consecutive English-speaking, adult patients attending 1 university-based internal medicine clinic and 3 community-based, university-affiliated, mixed internal medicine and family practice clinics in Oregon during May and June 1999. MAIN OUTCOME MEASURES: Percentage of correct responses in the 4 topic areas and total knowledge score, adjusted for demographic (eg, age, race, educational level, income level, marital status) and experiential (eg, health, proxy decision making, advance directives, and death of a loved one) factors. RESULTS: Of the 1000 patients invited to participate, 728 (73%) consented and completed the questionnaire and were included in the analysis. A total of 69% of respondents answered correctly regarding refusal of treatment, 46% for withdrawal of treatment, 23% for assisted suicide, 32% for active euthanasia, and 41% for double effect. Sixty-two percent of respondents did not distinguish between assisted suicide and euthanasia. After adjustment for other covariates, better knowledge was significantly associated with white race (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.3-4.2), having at least a college degree (OR, 3.0; 95% CI, 1.4-6.7), and having been a proxy for health care decisions (OR, 1.8; 95% CI, 1.2-2.6). Personal experience with illness (OR, 1.0; 95% CI, 0.6-1.5), death or illness of a loved one (OR, 1.6; 95% CI, 1.0-2.7), and authoring an advance directive (OR,1.3; 95% CI, 0.9-2.0) were not associated with better knowledge. CONCLUSIONS: A significant proportion of outpatients at university-affiliated clinics in Oregon appear to misunderstand options in end-of-life care. Our results suggest that greater public knowledge about end-of-life care is needed, and advance care planning must be preceded by education about options in end-of-life care. JAMA. 2000;284:2483-2488.

Adult↗

PubMed1987

Knowledge-based indexing of the medical literature: the Indexing Aid Project.

This article describes the Indexing Aid Project for conducting research in the areas of knowledge representation and indexing for information retrieval in order to develop interactive knowledge-based systems for computer-assisted indexing of the periodical medical literature. The system uses an experimental frame-based knowledge representation language, FrameKit, implemented in Franz Lisp. The initial prototype is designed to interact with trained MEDLINE indexers who will be prompted to enter subject terms as slot values in filling in document-specific frame data structures that are derived from the knowledge-base frames. In addition, the automatic application of rules associated with the knowledge-base frames produces a set of Medical Subject Heading (MeSH) keyword indices to the document. Important features of the system are representation of explicit relationships through slots which express the relations; slot values, restrictions, and rules made available by inheritance through "is-a" hierarchies; slot values denoted by functions that retrieve values from other slots; and restrictions on slot values displayable during data entry.

Abstracting and Indexing↗

PubMed2004

Technology-enabled knowledge translation: frameworks to promote research and practice.

Knowledge translation articulates how new scientific insights can be implemented efficiently into clinical practice to reap maximal health benefits. Modern information and communication technologies can be effective tools to help in the collection, processing, and targeted distribution of information from which clinicians, researchers, administrators, policy makers in health, and the public can benefit. Effective implementation of knowledge translation through the use of information and communication technologies, or technology-enabled knowledge translation (TEKT), would benefit both the individual health professional and the health system. Successful TEKT in health requires cultivation and acceptance in the following key domains: Perceiving types of knowledge and ways in which clinicians acquire and apply knowledge in practice. Understanding the conceptual and contextual frameworks of information and communication technologies applied to health systems, particularly the push, pull, and exchange communication models. Comprehending essential issues in implementation of information and communication technologies and strategies to take advantage of emerging opportunities and overcome existing barriers. Establishing a common and widely acceptable evaluation framework in order that researchers can compare various methodologies in their rightful contexts in TEKT research and adoption. Achieving harmony and common understanding in these areas will go a long way in fostering a fertile and innovative environment to encourage research and advance understanding in this exciting domain of TEKT.

Artificial Intelligence↗

PubMed2007

Knowledge of dementia among South Asian (Indian) older people in Manchester, UK.

OBJECTIVES: The aim of this study was to examine knowledge of dementia in South Asian older people, as compared with Caucasian older people. METHODS: Attendees, not known to suffer from dementia, of one South Asian and two predominantly Caucasian day centres for older people in Manchester (UK) were asked to complete the Dementia Knowledge Questionnaire (DKQ). The DKQ was translated into Gujarathi and Urdu by the professional translators. RESULTS: One hundred and ninety-one DKQs from Indian and 55 DKQs from Caucasian (white UK/Irish/European) older people were included in the analyses. Knowledge of dementia was poor in both Indian and Caucasian older people, especially so in the former. The median (25th-75th percentile) total DKQ scores were 3 (2-5) in Indians and 6 (3.5-9) in Caucasians (p < 0.001). Indian older people showed significantly less knowledge about basic aspects (p < 0.001) and epidemiology (p < 0.001) of dementia when compared to Caucasian older people. Both groups faired equally badly on questions about aetiology (p = 0.91) and symptomatology (p = 0.66). Indian older people were less aware of personality, reasoning, and speech being the affected in dementia (p < 0.001, p < 0.001 and p = 0.04, respectively). CONCLUSION: Indian older people in Manchester (UK) do not seem to have sufficient knowledge about dementia, which may be one of the reasons for their relative absence in the local dementia treatment clinics.

Aged↗

PubMed2006

What effect does an educational intervention have on interns' confidence and knowledge regarding acute dyspnea management? A randomized controlled trial.

BACKGROUND: Though acute dyspnea is commonly encountered in hospitalized patients, interns often receive only informal instruction in managing such patients. We hypothesized that formal instruction would improve interns' knowledge and confidence in managing patients with acute dyspnea. METHODS: Twenty-six internal medicine interns were randomized to receive either standard education or standard education plus the educational intervention. The educational intervention included two small-group, case-based discussions on acute dyspnea management. All participants completed pre- and post-intervention surveys over four months that assessed their knowledge and confidence in managing patients with acute dyspnea. RESULTS: Of the 16 interns in the intervention group, 14 attended one of the two small-group sessions while seven attended both sessions. Mean confidence increased by 21.2% in the intervention group and 14.4% in the control group. The trend over time for both groups was significant (P < .001); the effect of the intervention was not (P = .19). Mean knowledge scores increased 7.6% in the intervention group and 5.5% in the control group. Again, the trend over time for both groups was significant (P < .01), but the effect of the intervention was not (P = .65). A per-protocol analysis revealed a trend toward significance with mean scores increasing 15.6% (P = .067). CONCLUSIONS: Our trial found that intern confidence and knowledge about acute dyspnea management increased significantly over time; however, no significant differences between the intervention and control groups were seen. The complete intervention was not administered to the majority of the intervention group, thereby skewing results to the null. The per-protocol analysis suggests attendance at educational sessions may improve knowledge. Future interventions should use a more sensitive testing instrument, a larger sample, and a more powerful intervention.

Clinical Competence↗

PubMed1992

Determination of concentrations by time domain fitting of proton NMR echo signals using prior knowledge.

A fast and flexible time domain iterative fitting procedure that can be used to fit free induction decays as well as echo-like signals is described. Damping constants of the first and second part of the echo do not have to be identical. Prior knowledge can be used to diminish the number of parameters to be fitted, which results in an improved accuracy. It is shown how prior knowledge is mathematically incorporated in the Gauss-Newton method. From proton NMR measurements of model solutions actual prior knowledge is extracted. With this knowledge relative concentrations are determined from a mixture of metabolites. The fitted results agree with the true values within the margins of the noise. After some minor changes the same prior knowledge was successfully used to analyze a series of in vivo rat brain measurements.

Magnetic Resonance Spectroscopy↗

PubMed1998

Knowledge inhibition and N400: a study with words that look like common words.

In addition to their own representations, low frequency words, such as BRIBE, can covertly activate the representations of higher frequency words they look like (e.g., BRIDE). Hence, look-alike words can activate knowledge that is incompatible with the knowledge corresponding to accurate representations. Comparatively, eccentric words, that is, low frequency words that do not look as much like higher frequency words, are less likely to activate incompatible knowledge. This study focuses on the hypothesis that the N400 component of the event-related potential reflects the inhibition of incompatible knowledge. This hypothesis predicts that look-alike words elicit N400s of greater amplitudes than eccentric words in conditions where incompatible knowledge is inhibited. Results from a single item lexical decision experiment are reported which support the inhibition hypothesis.

Adult↗

PubMed1993

Automated integration of external databases: a knowledge-based approach to enhancing rule-based expert systems.

Expert system applications in the biomedical domain have long been hampered by the difficulty inherent in maintaining and extending large knowledge bases. We have developed a knowledge-based method for automatically augmenting such knowledge bases. The method consists of automatically integrating data contained in commercially available, external, online databases with data contained in an expert system's knowledge base. We have built a prototype system, named DBX, using this technique to augment an expert system's knowledge base as a decision support aid and as a bibliographic retrieval tool. In this paper, we describe this prototype system in detail, illustrate its use, and discuss the lessons we have learned in its implementation.

Artificial Intelligence↗

PubMed1997

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

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

Age Factors↗

PubMed1998

Facilitating Knowledge-Based Inferences in Less-Skilled Readers

The present study replicated Long, Oppy, and Seely's (1994) finding that skilled readers make knowledge-based inferences spontaneously during reading whereas less-skilled readers do not. However, the study also showed that less-skilled readers can make knowledge-based inferences with appropriate textual support. Evidence for knowledge-based inferences was obtained by examining whether readers were faster to make lexical decision responses to theme-appropriate targets (e.g., burglar) than to theme-inappropriate targets (e.g., blueprint), when reading short passages (e.g., The old woman awoke to a sound from downstairs. She reached into her purse and found only a file.). Whereas skilled readers generated knowledge-based inferences under all text conditions, less-skilled readers only showed evidence of having generated knowledge-based inferences when the text incorporated a question inviting the inference (e.g., The old woman awoke and said, 'Why is there a sound downstairs?' She reached into her purse and found only a file.) and text-presentation speed was slower. Copyright 1998 Academic Press.

Journal Article↗

PubMed2001

Symbolic representation of anatomical knowledge: concept classification and development strategies.

In this paper a novel approach to anatomy knowledge representation is described. The focus of the present research has been on the development of a representational framework where the conceptual level has been implemented by using hierarchical and nonhierarchical conceptual networks. This has allowed handling the demand for multiple views of anatomy (systemic and topographical views). The terminological level of the knowledge representation has been implemented by using a compositional strategy which has avoided the explicit storage of the terms used to express composite concepts. Hierarchical relations and composite concept representations have required supervision of both the inheritance and concept reconstruction. For this purpose heuristic knowledge has been stored in terms of consistency rules in the knowledge base. As proof of the capability of this system, we show how the knowledge base has been used to provide symbolic access to spatial information consisting of a reduced set of images from the Visible Human Dataset.

Anatomy, Cross-Sectional↗

PubMedDate not supplied

Americans' knowledge of cancer risk and survival.

BACKGROUND: There are more than 500,000 deaths from cancer each year in the United States. This study examines Americans' knowledge of risk factors for breast, cervical, colon, and prostate cancers, which account for over 130,000 of these deaths, and their knowledge of the prospects of surviving these cancers following early detection. METHODS: Data were obtained from 12,035 subjects who completed the 1992 National Health Interview Survey Cancer Control Supplement which includes questions about cancer risk factors and survival. RESULTS: The majority of respondents were unable to identify major cancer risk factors when prompted with a list. Approximately two-thirds did not recognize that age increased the risk for breast and colon cancer, that diet increased the risk for colon cancer, or that multiple sex partners increased the risk for cervical cancer. Knowledge about survival was also poor. Only about half thought they had a good chance of survival following early detection of colon and cervical cancers, for which 5-year relative survival exceeds 90%. CONCLUSIONS: Americans lack knowledge about major risk factors for common cancers and about the prospects of survival following early detection. Knowledge about risk factors and about survival from cervical and colon cancers was poor at all ages, among all races, at all income levels, and at all educational levels. It was poorest among blacks and Hispanics and among those with the lowest income and least education. Americans need education about cancer risk factors and survival.

Adult↗