Knowledge-based Health Research Articles

Identifying nursing sensitive indicators from electronic health records in acute cardiac care-Towards intelligent automated assessment of care quality.

The aim of this study is to explore the potential of using electronic health records for assessment of nursing care quality through nursing-sensitive indicators in acute cardiac care. Nursing care quality is a multifaceted phenomenon, making a holistic assessment of it difficult. Quality assessment systems in acute cardiac care units could benefit from big data-based solutions that automatically extract and help interpret data from electronic health records. This is a deductive descriptive study that followed the theory of value-added analysis. A random sample from electronic health records of 230 patients was analysed for selected indicators. The data included documentation in structured and free-text format. One thousand six hundred seventy-six expressions were extracted and divided into (1) established and (2) unestablished expressions, providing positive, neutral and negative descriptions related to care quality. Electronic health records provide a potential source of information for information systems to support assessment of care quality. More research is warranted to develop, test and evaluate the effectiveness of such tools in practice. Knowledge-based health care management would benefit from the development and implementation of advanced information systems, which use continuously generated already available real-time big data for improved data access and interpretation to better support nursing management in quality assessment.

Abstracts from The Cold Weather Operations Conference 2021

ABSTRACT A common effort for both military and civil healthcare is to achieve knowledge-based health care in cold weather injuries and fatal accidents in harsh arctic environment. The Cold Weather Operations Conference in November 2021, having more than 300 participants from 20 countries, was addressing the prevention and treatment of injuries and trauma care in cold weather conditions and the challenges for military prehospital casualty care. The intention of the programme was to stimulate further research and systematic knowledge-based clinical work. The abstracts from the conference present cold weather research and clinical experience relevant for readers of the International Journal of Circumpolar Health.

Climate, knowledge, comfort related to LGBTQ+ health and healthcare

AimConduct a college level assessment of the perspective of staff, faculty and students on the climate, educational adequacy, and understanding on LGBTQ+ health and healthcare. BackgroundLGBTQ+ individuals face health disparities and discrimination. Inadequate educational preparation allows students to enter their professions with inadequate knowledge and biases. DesignCross-sectional study of faculty, staff, students (N = 343) in a college of health and human services college in the Midwest. MethodsData were gathered via anonymous internet surveys focused on LGBTQ+ climate, knowledge, and comfort. Descriptive statistics and chi square were used for analysis. ResultsWitnessing or experiencing LGBTQ+ harassment was more common in the community (33%, n = 115) than the university campus (5.6%), classrooms (2.9%, n = 10), clinical areas (0.3%, n = 1). While the majority (81.4-100%) correctly answered knowledge-based health questions regarding the LGBTQ+ population, 21% noted that they experienced more discomfort discussing sexual health with LGBTQ+ patients compared to non-LGBTQ+ patients.

Understanding the Transformation to a Knowledge-Based Health Bioeconomy: Exploring Dynamics Linked to Preventive Medicine in Kenya

The bioeconomy transition is seen as a means to achieving industrial competitiveness. Targeted actions on leverage points can have specific effects on transitional changes in system dynamics; these actions have yet to be identified in the context of the knowledge-based health bioeconomy in Kenya. This paper employs system dynamics and grounded theory to identify causations linked to the feedback mechanisms in a complex adaptive system specific to preventive medicine in Kenya. The causal relations identified will allow for extended empirical interrogations. We conducted sixteen semi-structured interviews with key informants using purposive and theoretical sampling. Through these interviews, we obtained detailed information on trends for leverage points for a transition to a bioeconomy in Kenya. We developed three qualitative themes along the structure of information flows, rules, and goals of the system. In addition, we determined the overall perception of the health bioeconomy and elaborated stakeholder-specific applications. We identified a dissociation as a general perception that knowledge generation is the preservation of the public sector. Government effectiveness was found to affect public-service turnaround time, transparency, and regulatory interventions. Finally, we identified weak network failures as the key system failures whose functional deficiencies can be exploited for future policy legitimation.

Enhancing Research and Development in the Health Sciences as a Strategy to Establish a Knowledge-Based Economy in the State of Kuwait: A Call for Action.

Kuwait Vision 2035 is an initiative that was launched in 2017 by His Highness the Emir of the State of Kuwait Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabah. This initiative includes the implementation of a detailed development plan aimed at transforming the state of Kuwait into a regional leader in science, technology, and innovation. Health research will arguably prove to be one of the most impactful research arenas when it comes to accomplishing the goals set forth by the Kuwait Vision 2035 Development Plan. The high impact of health research is derived from its capacity to aid in the establishment of a knowledge-based health industry. The state of Kuwait lacks a system for promoting and managing national R&D efforts. At present, the research and development (R&D) expenditure in the state of Kuwait is far below the international standards that have been shown to lead to innovation and the subsequent development of a knowledge-based economy. Improvement of the weak and unstructured existing R&D apparatus in the State of Kuwait is among the most urgent challenges facing the nation as it strives toward innovation and development of a knowledge-based economy. Developing health research capacities in the State of Kuwait can significantly contribute toward improving public health, health promotion, disease prevention and treatment, and overall human welfare. Importantly, the positive impacts of such extensive benefits will not be restricted to the state of Kuwait and its citizens, but may in fact reap benefits for the global society as a whole. This article first analyzes the current status of healthcare services and health science research in the State of Kuwait, and then summarizes some essential R&D design principles that Kuwait needs to implement in order to achieve the milestones set forth in the Kuwait Vision 2035 Development Plan.

Lifestyle Modification Practices and Drug Prescription Use in Elderly Americans with Metabolic Syndrome: A Nationwide Population-Based Study

AimTo determine differences in lifestyle modification practices and use of prescription drugs in a representative sample of Mexican American (MA), non-Hispanic White (NHW), and non-Hispanic Black (NHB) elderly Americans with metabolic syndrome (MetS). MethodsData from the United States National Health and Nutritional Examination Surveys were used in this study. Lifestyle modification practices include ongoing physical activity, weight control, and ongoing diet modifications. Prescription drugs include anti-diabetic, anti-obesity, lipid-lowering, insulin sensitizers, renin-angiotensin system (RAS) blockers, fibrates, and cilostazol. Race/ethnic-specific prevalence odds ratios from the multivariate logistic regression analyses were used to determine associations between selected independent variables and MetS control (defined as the use of lifestyle modification practices or prescription drugs), adjusting for covariates. ResultsThe rates of ongoing weight control (73.4% versus 68.1% in MA and 66.3% in NHW) and diet modification practices (78.1% versus 77.4% in MA and 66.7% in NHW) were higher among NHB, and rate of ongoing physical activity (61.8% versus 52.8% in NHW and 56.4% in NHB) was higher among MA participants compared to their other racial/ethnic elderly counterparts (P < 0.001). Lipid-lowering and insulin-sensitizing drugs were the most commonly used prescription drugs in the last 30 days. The prevalence of nonuse of lifestyle modification practices or prescription drugs for MetS management was 15.1%, 21.3%, and 12.7% in MA, NHW, and NHB participants, respectively. MA, NHB race/ethnicity, a higher level of education, and increased BMI were significantly associated with increased odds of MetS control. Lack of drug prescription insurance and increased age were associated with decreased odds of MetS control. ConclusionsGiven the clinical importance of MetS, improving knowledge-based health decisions relative to lifestyle modification practices is very important. Moreover, sources of low-cost medications that links elderly patients with drug prescription coverage programs may help to improve the management of MetS.

Using Natural Language Processing Techniques to Provide Personalized Educational Materials for Chronic Disease Patients in China: Development and Assessment of a Knowledge-Based Health Recommender System.

BackgroundHealth education emerged as an important intervention for improving the awareness and self-management abilities of chronic disease patients. The development of information technologies has changed the form of patient educational materials from traditional paper materials to electronic materials. To date, the amount of patient educational materials on the internet is tremendous, with variable quality, which makes it hard to identify the most valuable materials by individuals lacking medical backgrounds.ObjectiveThe aim of this study was to develop a health recommender system to provide appropriate educational materials for chronic disease patients in China and evaluate the effect of this system.MethodsA knowledge-based recommender system was implemented using ontology and several natural language processing (NLP) techniques. The development process was divided into 3 stages. In stage 1, an ontology was constructed to describe patient characteristics contained in the data. In stage 2, an algorithm was designed and implemented to generate recommendations based on the ontology. Patient data and educational materials were mapped to the ontology and converted into vectors of the same length, and then recommendations were generated according to similarity between these vectors. In stage 3, the ontology and algorithm were incorporated into an mHealth system for practical use. Keyword extraction algorithms and pretrained word embeddings were used to preprocess educational materials. Three strategies were proposed to improve the performance of keyword extraction. System evaluation was based on a manually assembled test collection for 50 patients and 100 educational documents. Recommendation performance was assessed using the macro precision of top-ranked documents and the overall mean average precision (MAP).ResultsThe constructed ontology contained 40 classes, 31 object properties, 67 data properties, and 32 individuals. A total of 80 SWRL rules were defined to implement the semantic logic of mapping patient original data to the ontology vector space. The recommender system was implemented as a separate Web service connected with patients' smartphones. According to the evaluation results, our system can achieve a macro precision up to 0.970 for the top 1 recommendation and an overall MAP score up to 0.628.ConclusionsThis study demonstrated that a knowledge-based health recommender system has the potential to accurately recommend educational materials to chronic disease patients. Traditional NLP techniques combined with improvement strategies for specific language and domain proved to be effective for improving system performance. One direction for future work is to explore the effect of such systems from the perspective of patients in a practical setting.

Assessing Knowledge-Based and Perceived Health Literacy Among Japanese Adolescents: A Cross-Sectional Study.

Health literacy assessment is a major aspect of planning health education for adolescents. We evaluated the health literacy of Japanese adolescents using both perceived and knowledge-based health literacy scales. Study questionnaires were administered to 773 junior and senior high school students aged 12 to 18 years. We tested a model describing the hierarchical relations between functional, communicative, critical, and knowledge-based health literacy using path analysis. Critical health literacy was found to be influenced by functional, communicative, and knowledge-based health literacy, while functional and knowledge-based health literacy were correlated. The model, with slight modification, was supported. The result indicates that perceived functional health literacy scores did not directly correlate with higher perceived critical health literacy; rather, they only informed critical health literacy when participants had high knowledge-based health literacy.

Knowledge-based block chain networks for health log data management mobile service

There is a rapidly growing interest in health care due to the recent development of IT convergence technologies according to the 4th industrial revolution. More services for personal health management of users are available and studies on the establishment of knowledge base for an efficient health log data management in the health care field are being carried out with the emergence of block chain technology which is the next generation information security technology. In this paper, a knowledge-based block chain network for health log data management mobile service is suggested. The user’s log data and context information are applied to block chain technology that is difficult to forge and falsify in the knowledge-based health platform, enabling a large amount of users’ log data and context information accumulated continuously to be stored in a block in the knowledge base using the side chain structure that stores information through the configuration of knowledge-based data transaction. This enables high expandability and security to be secured in mobile environment as well. The result of comparative evaluation with the existing ontology knowledge model for verifying the validity shows that the suggested method presented approximately 16.5% higher performance in accuracy and reproducibility.

Health perception and adherence with blood pressure control among rural Chinese adults with hypertension.

The aim of this study was to examine associations among blood pressure, personal and illness characteristics, illness perception and medication and self-management adherence among adults with hypertension in rural mainland China. Despite the high prevalence of hypertension in China, the control rate is only 20%. Identifying factors associated with blood pressure control is critical. Cross-sectional survey. Data were collected from 163 hypertensive adults in two rural villages in mainland China. Measures included a demographic questionnaire, the Chinese Illness-Perception Questionnaire-Revised, Medication Adherence Inventory and the Inventory of Adherence to Self-management. Height, weight, and blood pressure were also measured using standard approaches. Hierarchical linear regression was used to assess the association between blood pressure and significant variables identified in bivariate analysis. The mean systolic pressure observed in this sample was 147mmHg and the diastolic mean was 81mmHg. None of the variables analysed were associated with systolic blood pressure. Gender, age, and household annual income were associated with diastolic blood pressure, explaining 23% of the variance in the regression model. Illness coherence contributed an additional 2%. These findings suggest: (a) healthcare providers should focus on educating rural hypertensive adults about healthful diets and behaviours to manage hypertension, especially for those with high household income; (b) knowledge-based health education alone is not adequate; (c) illness perception may not be directly associated with blood pressure; and (d) the Chinese Illness-Perception Questionnaire-Revised and the Inventory of Adherence to Self-management require validation and potential revision for use with rural Chinese populations.

Knowledge-based health service considering user convenience using hybrid Wi-Fi P2P

Recently, with changing paradigms in health, the focus of healthcare is shifting from treatment after contracting disease to prevention and early diagnosis of disease. Accordingly, the healthcare paradigm is changing from diagnosis and treatment to preventive management, emphasizing prevention of chronic diseases, such as obesity. In particular, obesity in children and adolescents has become a global issue. Lifestyle and health management using BT---IT convergence is needed to improve and manage the health of children and adolescents, and convenience and accessibility must be improved. For that, use of a machine-to-machine (M2M) u-health cluster that allows wireless network connection is increasing, along with wireless networks for measuring biometrics. Expanded to communications between people and objects as well as between objects, M2M refers to the next-generation convergence infra-architecture that offers intelligent services through various media. Because various wireless devices form a cluster when building a service platform using M2M, when the number of users with various M2M devices increases, data traffic increases and causes network overload, deteriorating system performance. To solve this problem, services are increasingly being built by combining a conventional network and Wi-Fi technology. However, in an M2M network, there is a limitation due to low transfer speed, because the network processes biometrics and data through different sensor nodes, and wireless communications based on the system is composed of different wireless sensor nodes. Thus, in this paper, we proposed a knowledge-based health service considering user convenience using a hybrid wireless fidelity (Wi-Fi) peer-to-peer (P2P) architecture. For knowledge-based health services in conventional M2M-based smart health services, hybrid Wi-Fi P2P and wireless devices must be linked. Because there are different ways to link hybrid Wi-Fi P2P devices, depending on the network environment, in this study, a dynamic configuration mechanism is applied to Wi-Fi P2P linkage of wireless devices in an M2M environment. The proposed service provides a high-quality health service (whenever patients use the knowledge-based health service) by building a network using a dispersed cross-layer optimization algorithm that optimizes variables of the transmission control protocol/internet protocol stack in order to improve the energy efficiency of the u-health sensor network and system reliability.

How to promote health competence at work

Health competence is a key concept in occupational health and safety and workplace health promotion for maintaining and enhancing health resources. The effects of governmental or occupational measures to protect or improve health fall short of what is required with regard to the challenges of a changing workplace, e.g., due to the delimitation of work. To secure employability it is becoming more and more important to encourage the personal responsibility of employees. To offer new conclusions on how employers and employees can promote health competence, a survey is required of the research within the fields of health competence and competence development, and of the status quo in enterprises. In this context, a Delphi Study provides an important contribution, with a focus on small and medium-sized enterprises. The development of an extensive understanding of health competence is essential in a work-related context. Beyond knowledge-based health literacy, an action-oriented concept of competence implies the ability and willingness to act in a reasonable and creative manner in complex situations. The development of health competence requires learning embedded in working processes, which challenges competent behaviour. Enabling informal learning is a promising innovative approach and therefore coordinated operational activities are necessary. Ultimately, this is a matter of suitable organisational measures being implemented to meet the health competence needs of an enterprise. Even though the each individual employee bears his or her own health competence, the development potential lies largely within the prevailing working conditions.

Lifestyle as a choice of necessity: Young women, health and obesity

Sociologists of health have regularly called into question strictly knowledge-based health promotion approaches that focus on individual lifestyle change, claiming preference for collective actions on social determinants of health. These critiques have more recently been directed towards the issue of obesity. Although there is a growing body of work that shows the connection between poverty, obesity and ill health, few studies have focused on the concerns for health and lifestyle of vulnerable populations. In this qualitative study, 15 in-depth interviews were conducted with young underprivileged women in order to capture their dispositions towards health practices by outlining sociocultural factors that do (or do not) incline them to pursue a health regimen and weight control strategies. By drawing on Pierre Bourdieu’s concepts of habitus, practical sense and ‘choice of the necessary’, the results suggest that inclinations to follow normative health guidelines are strongly influenced by family and financial responsibilities and by pressing health concerns rather than a calculation of how the prescribed risk avoidance behaviours will improve personal health and/or prevent illness for one’s own sake. In conclusion, this study highlights the limits of prescribed ‘solutions’ to health improvement that have little to no consideration of embodied social knowledge and lived experiences.

Identifying the medical practice after total hip arthroplasty using an integrated hybrid approach

A critical option of total hip arthroplasty (THA) is considered only when tried more conservative treatments but continued to have pain, stiffness, or problems with the function of ones hip. THA plays one of major concerns under the waves of the rapid growth of aging populations and the constrained health care resources in Taiwan. Moreover, prior studies indicated that imbalanced class distribution problems do exist in the constructed classification model and cause seriously negative effects on model performances in the health care industry. Therefore, this study proposes an integrated hybrid approach to provide an alternate method for classifying the quality (e.g., the staying length in hospital) of medical practice with an imbalanced class problem after performing a THA procedure for hip replacement patients and their doctors in the health care industry. The proposed approach is constituted by seven components: expert knowledge, global discretization, imbalanced bootstrap technique, reduct and core methods, rough sets, rule induction, and rule filter. The proposed approach is illustrated in practice by examining an experimental dataset from the National Health Insurance Research Database (NHIRD) in Taiwan. The experimental results reveal that the proposed approach has better performance than the listed methods under evaluation criteria. The output created by the rough set LEM2 algorithm is a comprehensible decision rule set that can be applied in knowledge-based health care services as desired. The analytical results provide useful THA information for both academics and practitioners and these results could be applicable to other diseases or to other countries with similar social and cultural practices.

L5.3 Building an Information Platform for New Drug Discovery

Acceleration in the continuum of discovery, translation and delivery of personalized cancer care requires an integrated network information system to utilize the overwhelming amount of information being generated in basic, translational and clinical research. The stakeholders themselves: researchers, clinicians, administrators and patients must be part of developing and delivering a rapid learning, knowledge-based health system that creates value for the stakeholder, and provides evidence-based alternatives. For example, by having access to a large prospective database of patients, clinicians would be able to find patients most suitable for clinical trials based on their clinical and molecular characteristics which would result in shortening the time to reach adequate patient accrual, and patients would be most suitably matched to the “right” trial. In 2003, the Moffitt Cancer Center in Tampa, Florida launched an initiative in personalized cancer care that has now expanded to 18 health institutions in 10 states, called Total Cancer CareTM (TCC). Critical to the pursuit of personalized medicine is the development of a large regional cancer biorepository in parallel with the development of a relational data warehouse and an information system containing patient's clinical and molecular data. The Total Cancer CareTM Protocol, now with >89K consented patients, >32K tumors and >16K genetic profiles, provides the mechanism to accomplish these goals. A Health and Research Informatics platform facilitates the rapid identification of patient subjects eligible for specific trials. Several pre-clinical projects to define biomarker prevalence, concordance between gene expression and protein expression, and to validate biomarkers, are underway using the TCC database. Specific cohorts of subjects with various cancers identified at Moffitt and within the TCC consortium have been found to be clinically and molecularly eligible for trials involving a variety of biomarkers and targeted agents. Enrollment on these early phase studies that use CLIA defined biomarkers is well underway. This approach has the potential to dramatically decrease trial accrual times, require fewer subjects per trial, and result in increased response rates by specifically targeting molecular alterations in patient tumors.

Mapping of health system functions to strengthen priority programs. The case of maternal health in Mexico

BackgroundHealth system strengthening is critical to ensure the integration and scaling-up of priority health promotion, disease prevention and control programs. Normative guidelines are available to address health system function imbalances while strategic and analytical frameworks address critical functions in complex systems. Tacit knowledge-based health system constructs can help identify actors' perspectives, contributing to improve strengthening strategies. Using maternal health as an example, this paper maps and analyses the health system functions that critical actors charged with formulating and delivering priority health programs consider important for their success.MethodsUsing concept mapping qualitative and statistical methods, health system functions were mapped for different categories of actors in high maternal mortality states of Mexico and at the federal level. Functions within and across maps were analyzed for degree of classification, importance, feasibility and coding.ResultsHospital infrastructure and human resource training are the most prominent functions in the maternal health system, associated to federal efforts to support emergency obstetric care. Health policy is a highly diffuse function while program development, intercultural and community participation and social networks are clearly stated although less focused and with lower perceived importance. The importance of functions is less correlated between federal and state decision makers, between federal decision makers and reproductive health/local health area program officers and between state decision makers and system-wide support officers. Two sets of oppositions can be observed in coding across functions: health sector vs. social context; and given structures vs. manageable processes.ConclusionsConcept mapping enabled the identification of critical functions constituting adaptive maternal health systems, including aspects of actor perspectives that are seldom included in normative and analytical frameworks. Important areas of divergence across actors' perceptions were identified to target capacity strengthening efforts towards better integrated, performing health systems.

Exploring the link between populomics and knowledge management: Patient-oriented case exemplars

The challenge of population-level health problems, such as healthcare disparities, encompasses socio-behavioural, community and biologic factors and advances in information and communication technologies (ICTs). These elements are reflected in the key ethos of contemporary knowledge management (KM), as knowledge emerges from the confluence of people, process and technology. This paper illustrates how knowledge-based health case studies can be used as effective exemplars to illuminate understanding and explore possible connections between populomics and KM.

Transforming Ottawa Charter health promotion concepts into Swedish public health policy

Swedish public health policy clearly illustrates how the concept of the Ottawa Charter for health promotion can be utilized at a national level. The impact has been more implicit than explicit. Public health has a long history in Sweden and much of the present and future is, and will be, linked to traditional values and structures. International input, however, has been essential to prompt new approaches and change. Health inequalities remain the major shortcoming. The Swedish system offers universal access to healthcare in a decentralized system. Still, primary healthcare, and the health services as a whole have not yet sufficiently embraced the idea of health promotion. Political attention to modern public health at the Prime Minister level was established in late 1980s. Since, continuous initiatives in terms of organization, infrastructure and funding have taken place. With regard to funding, a vast majority of the resources allocated to health promotion will be found outside the health sector. An interesting observation is that the Swedish public health policy with its 11 objective domains remains the same, also after a change of government. Future challenges include maintaining and developing an intersectoral mechanism for implementation, allocating more resources for intervention research to strengthen knowledge-based health promotion, and developing tools for coping better with the challenges of globalisation identified in the Bangkok Charter.

The role of service user research in generating knowledge-based health and social care: from conflict to contribution

The role of service user research in generating knowledge-based health and social care: from conflict to contribution

Can we achieve health information for all by 2015?

Universal access to information for health professionals is a prerequisite for meeting the Millennium Development Goals and achieving Health for All. However, despite the promises of the information revolution, and some successful initiatives, there is little if any evidence that the majority of health professionals in the developing world are any better informed than they were 10 years ago. Lack of access to information remains a major barrier to knowledge-based health care in developing countries. The development of reliable, relevant, usable information can be represented as a system that requires cooperation among a wide range of professionals including health-care providers, policy makers, researchers, publishers, information professionals, indexers, and systematic reviewers. The system is not working because it is poorly understood, unmanaged, and under-resourced. This Public Health article proposes that WHO takes the lead in championing the goal of "Universal access to essential health-care information by 2015" or "Health Information for All". Strategies for achieving universal access include funding for research into barriers to use of information, evaluation and replication of successful initiatives, support for interdisciplinary networks, information cycles, and communities of practice, and the formation of national policies on health information.