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PubMed2006

Knowing 7 x 8, but not the meaning of 'elephant': evidence for the dissociation between numerical and non-numerical semantic knowledge.

Patients affected by semantic dementia (SD) and other severe cognitive deficits may show preserved numerical skills, including the retrieval of multiplication facts from long-term memory. No studies so far specifically investigated the network of arithmetic facts in semantic dementia. Thus, it is unknown whether preserved multiplication in SD truly reflects intact semantic knowledge or preserved retrieval of verbal sequences (just as the recitation of rhymes or poems). In the present study a patient (SG) with SD underwent an extensive assessment of number processing and calculation abilities. In particular, multiplication knowledge was investigated through a series of computerised tasks (production task, multiple-choice task, number bisection task with multiplicative triplets, number-matching task). SG demonstrated excellent performance in all number processing and calculation tasks. In computerised tasks tapping multiplication fact knowledge, SG was as accurate and fast as healthy controls. Analyses on individual regression slopes indicated that SG's reaction time effects (problem-size effect, problem-difficulty effect, interference effects, and facilitation effect) were comparable to those found in controls in each task. These results add new evidence to the independence of numerical knowledge from other semantic information and provide further insight into the organisation of stored arithmetic knowledge.

Dementia↗
PubMed2005

Severe acute respiratory syndrome (SARS): knowledge, attitudes, practices and sources of information among physicians answering a SARS fever hotline service.

In June 2003, Taiwan introduced a severe acute respiratory syndrome (SARS) telephone hotline service to provide concerned callers with rapid access to information, advice and appropriate referral where necessary. This paper reports an evaluation of the knowledge, attitude, practices and sources of information relating to SARS among physicians who staffed the SARS fever hotline service. A retrospective survey was conducted using a self-administered postal questionnaire. Participants were physicians who staffed a SARS hotline during the SARS epidemic in Taipei, Taiwan from June 1 to 10, 2003. A response rate of 83% was obtained. All respondents knew the causative agent of SARS, and knowledge regarding SARS features and preventive practices was good. However, only 54% of respondents knew the incubation period of SARS. Hospital guidelines and news media were the major information sources. In responding to two case scenarios most physicians were likely to triage callers at high risk of SARS appropriately, but not callers at low risk. Less than half of all respondents answered both scenarios correctly. The results obtained suggest that knowledge of SARS was generally good although obtained from both medical and non-medical sources. Specific knowledge was however lacking in certain areas and this affected the ability to appropriately triage callers. Standardized education and assessment of prior knowledge of SARS could improve the ability of physicians to triage callers in future outbreaks.

Clinical Competence↗
PubMed2004

Impact of attending a 1-day multi-professional course (ALERT) on the knowledge of acute care in trainee doctors.

We have described previously deficiencies in the knowledge in trainee doctors of aspects of acute illness, its recognition and management. This led to the development of a 1-day multi-professional course in acute care for newly qualified doctors and nurses, ALERT. Using a questionnaire, we assessed the knowledge of basic aspects of acute care amongst 118 senior house officers, 36 of whom had previously attended an ALERT course. The average (+/-S.D.) knowledge score was higher for those who had completed an ALERT course (9.44 +/- 1.63 points versus 7.45 +/- 2.32 points; P < 0.05). In addition, those in the post-ALERT group also showed significantly better knowledge of the signs of complete airway obstruction, normal capillary refill time, percentage survival after in-hospital cardiac arrest, consent arrangements for operation in unconscious patients, minimum hourly urine output, the need to inflate the reservoir bag on a high concentration oxygen mask and the role of the reservoir. Similar differences existed between trainees who had completed an ALERT course and a group of SHOs assessed in 1991, who had not done so. We believe that we have demonstrated evidence that doctors' knowledge of acute care can be improved by attending courses such as ALERT.

Adult↗
PubMed2005

Governance in operating room nursing: nurses' knowledge of individual surgeons.

This paper explores governance and control in operating room nurses' clinical practice. Traditionally, operating room nurses have been portrayed as "handmaidens" to the surgeons, a position which implies that nurses' bodies and the knowledge they use in practice are sites of discursive control by others. This paper unsettles this understanding by showing how operating room nurses studied ethnographically in an Australian setting are both disciplined by and actively shape practice through knowing surgeons' technical requirements for surgery, through inscribing them in discourses of time, and through having deep knowledge of the surgeons' "soul". We argue that as a form of governance, nurses' knowledge of surgeons is a subjugated form of knowledge, located low down on a hierarchy of knowledges. Furthermore, as a form of governance that has previously been unarticulated in the literature, it transcends the traditional lines of authority and control in the nurse-doctor relationship. The data in this paper are drawn from an ethnographic study that explored a range of nurse-nurse and nurse-doctor communication practices in operating room nursing.

Anthropology, Cultural↗
PubMed2003

Prior knowledge and subtyping effects in children's category learning.

Two experiments examined how 5- and 10-year-old children revise their category representations when exposed to exemplars that are congruent or incongruent with existing knowledge. During training children were presented with exemplars containing features that were congruent or incongruent with children's social stereotypes together with a stereotype-neutral feature. In the knowledge-subtyping condition this neutral feature predicted the stereotype-congruence of the other features. In the knowledge-standard condition the neutral feature was uncorrelated with stereotype-congruence. At test children made judgements about feature co-occurrence within the learned category. In each experiment these judgements were influenced by both stereotypical beliefs and exemplar observation. Stereotypical beliefs, however, had a greater influence on co-occurrence judgements in the knowledge-subtyping than in the standard conditions. In Experiment 2 these effects were shown to generalize to judgements about features that were not presented during training. These results challenge current models of knowledge-based categorization by showing that exemplar structure determines whether novel exemplar features are incorporated into category representations.

Child↗
PubMed1997

Cerebral pathways for calculation: double dissociation between rote verbal and quantitative knowledge of arithmetic.

We describe two acalculic patients, one with a left subcortical lesion and the other with a right inferior parietal lesion and Gerstmann's syndrome. Both suffered from "pure anarithmetia": they could read arabic numerals and write them to dictation, but experienced a pronounced calculation deficit. On closer analysis, however, distinct deficits were found. The subcortical case suffered from a selective deficit of rote verbal knowledge, including but not limited to arithmetic tables, while her semantic knowledge of numerical quantities was intact. Conversely the inferior parietal case suffered from a category-specific impairment of quantitative numerical knowledge, particularly salient in subtraction and number bissection tasks, with preserved knowledge of rote arithmetic facts. This double dissociation suggests that numerical knowledge is processed in different formats within distinct cerebral pathways. We suggest that a left subcortical network contributes to the storage and retrieval of rote verbal arithmetic facts, while a bilateral inferior parietal network is dedicated to the mental manipulation of numerical quantities.

Aged↗
PubMed2002

The educational preparation of undergraduate nursing students in pharmacology: clinical nurses' perceptions and experiences of graduate nurses' medication knowledge.

This paper explores clinical nurses' perceptions and experiences of graduate nurses' pharmacology knowledge. Six focus group interviews were conducted with clinical nurses of various appointment levels at two metropolitan public and two regional public hospitals in Victoria, Australia. Four major themes emerged from the study. First, participants indicated that graduate nurses had an overall lack of depth of pharmacology knowledge. While clinical nurses indicated that graduate nurses had enormous deficits in their pharmacology education, these deficits were not confined to graduate nurses--all nurses experienced difficulties in understanding and demonstrating pharmacological concepts in the clinical practice setting. Second, there was an unstructured approach to addressing the continuing education needs of graduate nurses. Third, theoretical and clinical principles of pharmacology knowledge were perceived to be important for practice. Fourth, improvements for nursing education involved the need for undergraduate students to take greater responsibility in monitoring and administering medications and the need for more structured learning experiences. The ultimate goal of consolidating pharmacology knowledge for graduate nurses is to optimise medication use, thereby improving the health outcomes of patients. Current teaching and learning opportunities appear to be inadequate in their efforts to enhance and improve graduate nurses' pharmacology knowledge. These inadequacies need to be addressed if the ultimate goal is to become a reality.

Adult↗
PubMed2002

Knowledge is not everything: analysis of children's performance on a haptic comparison task.

The relative effects of developmental level and domain-specific knowledge on children's ability to identify and make similarity decisions about object concepts based only on haptic (touch) information were investigated. Children aged 4-9 years with varying levels of dinosaur knowledge completed a cross-comparison task in which they haptically explored pairs of familiar (dinosaur) and unfamiliar (sea creature) models that varied in terms of their degree of differentiability. Older children explored models more exhaustively, found more differentiating features and consequently made fewer errors than younger children did. High knowledge enabled children to identify models correctly, but was also associated with the use of a hypothesis testing strategy, which led children to make greater numbers of "miss" errors on the cross-comparison task. Performance in the control domain illustrated that the hypothesis testing strategy was specific to the high knowledge domain. Potential explanations for the role of knowledge and development in haptic exploration are considered.

Child↗
PubMed2003

A knowledge-based approach to the deflocculation problem: integrating on-line, off-line, and heuristic information.

A knowledge-based approach for the supervision of the deflocculation problem in activated sludge processes was considered and successfully applied to a full-scale plant. To do that, a methodology that integrates on-line, off-line and heuristic information has been proposed. This methodology consists of three steps: (i). development of a decision tree (which involves knowledge acquisition and representation); (ii). implementation into a rule-based system; and (iii). validation. The set of symptoms most useful in diagnosing the deflocculation problem has been identified, the different branches to diagnose pin-point floc and dispersed growth have been built (using generic and specific knowledge), and all this knowledge has been codified into an object-oriented shell. The results obtained in the application of this knowledge-based approach to the Granollers WWTP (which treats about 130000 inhabitants-equivalents) showed that the system was able to identify correctly the problem with reasonable accuracy. Our positive experience building this system suggests that this approach is a practical and valuable element to include in an intelligent supervisory system combining numerical and reasoning techniques.

Artificial Intelligence↗
PubMed1999

Adding medications in the emergency department: effect on knowledge of medications in older adults.

INTRODUCTION: Older adults constitute 20% of the ED population. Of older patients discharged from the emergency department, 40% receive at least one new medication to add to their already complex medication regimen. The purpose of this study was to determine the effect of increasing medication complexity on knowledge of newly prescribed medications for older adults discharged from the emergency department. METHODS: The complexity of self-administered medications after ED treatment was measured with the Medication Complexity Index to determine its potential influence on the patient's knowledge of medication. The Knowledge of Medication Subtest, a measure of the effectiveness of medication teaching, was administered by telephone interview 48 to 72 hours after ED discharge. RESULTS: Sixty rural ED patients ranging in age from 60 to 98 years completed the study. Higher medication complexity after the addition of medications in the emergency department was associated with less knowledge of their medications (r = 0.37, P =. 004). DISCUSSION: The increase in medication complexity that results from ED therapeutic intervention may decrease knowledge of medications. A heightened emphasis should be placed on effective medication teaching, counseling, and follow-up for older adult ED patients.

Age Factors↗
PubMed2003

Factors associated with patients' knowledge of and attitudes towards treatment with lithium.

BACKGROUND: Treatment with lithium is often compromised by poor adherence, by side-effects and by patients' having serum levels outside the therapeutic range. These factors may be affected by patients' knowledge and attitudes towards lithium, and we set out to establish factors associated with knowledge about and attitudes towards lithium among a large representative sample of patients. METHOD: Patients known to be taking lithium in Grampian during 1995 were surveyed postally during 1998 with the Lithium Knowledge Test (LKT) and the Lithium Attitudes Questionnaire (LAQ). Scores on these measures were analysed against patients' sociodemographic and clinical characteristics by stepwise multiple regression. RESULTS: Of 742 patients, 411 (55%) completed an LKT and 362 (49%) completed an LAQ. Stepwise multiple regression established that positive attitudes towards lithium on the LAQ were associated with higher serum lithium levels (P=0.005) and with continuing to take lithium (P<0.001). Higher knowledge on the LKT was associated with positive attitudes on the LAQ (P=0.002), with younger age (P<0.001), and with shorter duration of treatment (P=0.01) LIMITATIONS: The study was retrospective and the response rate was relatively low. CONCLUSIONS: Education about lithium is likely to be of particular importance in the elderly and 'refresher courses' are advisable for those who have been on lithium for lengthy periods. Interventions which modify attitudes, rather than enhancing knowledge, are likely to be helpful in promoting adherence.

Adult↗
PubMed1986

Retention of knowledge and self-care skills after an intensive in-patient diabetes education program.

Diabetes knowledge and self-care skills were studied in 35 adults with IDDM and NIDDM before and after an intensive in-patient education program and 6-12 months after discharge. Knowledge and skills were compared to fasting serum glucose levels and percent ideal body weight (%IBW). Although knowledge improved during hospitalization and knowledge and skills were maintained at follow-up, there was not a significant relationship between fasting serum glucose levels and knowledge or self-care skills or %IBW.

Adult↗
PubMed2003

Does reading about stroke increase stroke knowledge? The impact of different print materials.

The purpose of this study was to determine whether print materials on stroke resulted in increased knowledge in a sample of lay people. One hundred and seventy-seven participants received (at random) one of five versions of a stroke information packet, or a control packet on colorectal cancer. Participants rated the materials on readability, understandability and usefulness immediately after reading. After a delay of 18 days on average, participants answered questions assessing stroke knowledge. Ratings of all packets were generally positive; however, stroke knowledge scores were significantly higher for the stroke information groups compared to the control group only for knowledge of causal mechanisms (stroke pathophysiology). While there was some indication that the fictionalized material on stroke was more effective than the expository materials, overall the impact of print materials on stroke knowledge, measured after a delay of at least 1 week, was minimal at best. Further research is needed to determine whether fictional contexts make some information more memorable.

Adult↗
PubMed2000

Towards dynamic cardiac scenes interpretation based on spatial-temporal knowledge.

Cardiac motion analysis enables to identify pathologies related to myocardial anomalies or coronary arteries circulation deficiencies. Conventionally, bi-dimensional (2D) left ventricle contour images have been extensively used, to perform quantitative measurements and qualitative evaluations of the cardiac function. Nevertheless, there are other cardiac anatomical structures, the coronary arteries, imaged on routine procedures, upon which complementary motion interpretation can be conducted. This paper presents an experimental methodology to perform dynamic cardiac scenes interpretation, studying three-dimensional (3D) coronary arteries spatial-temporal behavior. Being an alternative way to approach computer assisted cardiac motion interpretation, it reveals a wide range of rarely explored spatial-temporal situations and proposes how to address them. Considering the challenges to achieve dynamic scene interpretation, it is explained how spatial and temporal knowledge, are connected to specialist knowledge and measured parameters, to obtain a dynamic scene interpretation. Global and local motion features are modeled according to cardiac motion and geometrical knowledge, before its transformation into symbols. Anatomical knowledge and spatial-temporal knowledge are applied, along with spatial-temporal reasoning schemes, to access symbols meaning. Experimental results obtained using real data are presented. Complexity of interpretation envisioning is discussed, taking the given results as an example.

Artificial Intelligence↗
PubMed1994

The basic knowledge assessment tool: is it useful?

Registered Nurses (RN's) caring for the critically ill, require a wide range of specialised skills and knowledge. Assessing knowledge of RN's within Intensive Care Units (ICU's) is imperative if we are to ensure that patients are afforded quality care. The aim of this study was to evaluate existing knowledge of the RN's working in the ICU of a major teaching hospital using the Basic Knowledge Assessment Tool (BKAT). Overall mean test scores of 78% were encouraging. Knowledge gaps were evident in gastrointestinal and endocrine disorders. Significantly higher scores were obtained by RN's trained in the hospital based system (p = 0.02) and those possessing ICU qualifications (p = 0.01). There were no differences in scores according to age and length of ICU experience. Registered nurses scored badly in a number of questions, which highlighted some problems in the terminology used in the BKAT.

Adult↗
PubMed1994

Continuous quality improvement and knowledge for improvement applied to asthma care.

BACKGROUND: Two key ideas in the practice of continuous quality improvement (CQI) in health care are knowledge for improvement as distinguished from professional knowledge in improving the end results of patient care and the failure of the bad apple theory to explain variation in outcomes. METHODS: As part of their eight-week primary care clerkship, medical students at Case Western Reserve University (Cleveland, Ohio) are assigned to more than 20 sites in the greater Cleveland area where they observe and report on the cost and outcome of care for a patient with asthma. (An earlier article presented run charts and fishbone diagrams based on these reports.) In continuing this project, as described in this article, students report on the frequency of causes of variation in costs and outcomes of care. RESULTS: Students are asked to cite the one factor they believe had the most important effect on the cost and clinical outcome of the asthma patient they studied. For cost variation ranked by frequency, disease severity and site of care are reported most frequently, each accounting for 18% of responses. The most frequently reported cause of outcome variation was disease severity. No correlation was found between cost and outcome; higher costs do not produce healthier patients nor are they associated with greater outcome severity. For the nine most frequently used sites of care, the one-way analysis of means for costs shows that average costs for eight of nine sites are well within the expected range. Only one site (G) falls outside the upper boundary. Bringing this one "bad apple" site into conformity would have very little effect on overall costs. The one-way analysis of standard deviations shows that there may be only one case in the site that explains the bad apple outlier. CONCLUSION: Although more than one half of the causes of asthma variation reported in this study fall outside traditional professional knowledge, most of the content of health professions education still falls within the professional realm. Real improvement will require combining traditional professional knowledge with knowledge for improvement.

Asthma↗
PubMed2003

Knowledge and expectations of patients receiving aeroallergen immunotherapy.

BACKGROUND: Patients receiving aeroallergen immunotherapy frequently have poor knowledge and unfounded expectations of various important aspects of their treatment. OBJECTIVE: To evaluate patients' knowledge about the content, benefit, and risk related to the aeroallergen immunotherapy that they were receiving. METHODS: A self-administered questionnaire was distributed to all patients older than 16 years who had undergone aeroallergen immunotherapy for allergic rhinitis at 3 university-affiliated allergy clinics. RESULTS: A total of 132 patients (77 males and 57 females; mean +/- SD age, 30 +/- 13 years) participated in the study. The mean +/- SD duration of treatment was 30 +/- 60 months. Complete recovery of their allergies was expected by 39% of the patients. One fifth of the study group did not know when improvement should be expected, and 18% anticipated improvement to occur within days or weeks from the initiation of treatment. Only 32% were aware that immunotherapy might have some potential risk or adverse effects, and 24.2% failed to identify at least one of the allergens they were receiving. Patients who were interviewed during their first 6 months of aeroallergen immunotherapy had more knowledge about it than those who had been undergoing long-term treatment. CONCLUSIONS: There is a grave lack of knowledge and numerous misconceptions among substantial numbers of patients receiving aeroallergen immunotherapy. More educational effort is needed to increase patients' knowledge about immunotherapy before and during aeroallergen immunotherapy to improve their compliance and the success and safety of this therapeutic modality.

Adolescent↗
PubMed2000

Barriers to adolescent adherence to contraception. Knowledge Of depo provera timing

Background: Depo Provera is a long-acting progestin contraceptive method that is both highly effective and safe. However, continuation rates at one-year range from 30-42%. It has been suggested that one common reason for discontinuation is poor adherence with appointments. Poor adherence could be related to lack of knowledge regarding the timing of the next injection. Therefore, the purpose of the current investigation was to examine whether adolescent girls were knowledgeable about when their next injection was due.Methods: Adolescent girls were recruited from an urban-based adolescent clinic to participate in a longitudinal study of psychosexual development. The girls were seen every 6 months over three years. At the last three visits, those adolescents on Depo Provera were asked when their next injection was due. Responses were coded as accurate if the date given was within 10-14 weeks of the last injection. Results: There were 45 girls who were using Depo Provera and seen for at least one study visit. The girls ranged in age from 15-19 years, and 87% were African-American; the remainder were Caucasian. 22 girls were seen/and on Depo Provera for 1 visit, 12 for 2 visits, and 11 for 3 visits. Collapsing their answers across visits, 27 of girls were always correct, 11 were sometimes correct, and 7 were never correct. Race and age were not related to whether they were always correct, sometimes correct, or never correct. At the last visit, we examined whether or not length of time on Depo Provera was related to correctness. The relationship appeared to be curvilinear. That is, those girls who had been on Depo Provera the longest time (>/= 18 months) and the least (< 6 months) time were most likely to be correct.Conclusions: This study demonstrates that many (40%) adolescents do not know when their injection is due, and in fact, the correctness of adolescents' knowledge is not consistent over time. Age and race were not significantly related to knowledge of timing. Therefore, ALL adolescents should be provided with reminders about the timing of their next injection. Finally, the curvilinear relationship needs to be examined further. This finding that adolescents on Depo Provera for 6-12 months were the least knowledgeable is consistent with research on oral contraceptive adherence indicating this is a vulnerable time period for contraceptive discontinuation.

Journal Article↗