Representing Nursing KnowledgeRepresenting Nursing Knowledge

Applications for Database DesignApplications for Database Design

Josette Jones, RNc

Patricia Brennan, RN, PhD

University of Wisconsin–Eau Claire

Presentation OverviewPresentation Overview

Introduction Background and Significance Role of Knowledge Representation Systems Indexing WebPages Using MESH Information Retrieval Evaluation

University of Wisconsin–Eau Claire

IntroductionIntroduction

Effective Use of Information in HealthCare– Accessible context– Matching to individual needs

Indexing and Organizing On-line Resources– Content– Anticipated Usage

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Background and SignificanceBackground and Significance

Changes in healthcare impact discharge teaching

Patient-specific health information is available on the WWW

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Role of Role of Knowledge Representations Knowledge Representations

Systems in IndexingSystems in Indexing

Indexing techniques

Description attributes

Keyword attributes

• Knowledge Representation Systems (KRS)

University of Wisconsin–Eau Claire

Knowledge Representation Knowledge Representation SystemsSystems

A Knowledge Representation System has: – An underlying knowledge representation

language (meta-language) with its vocabulary and explicit structure

– A semantic (meaning of the expressions of the language)

– A restricted syntax (set of reasoning rules) Examples of Health Care / Nursing Knowledge

Representation Systems

University of Wisconsin–Eau Claire

Indexing WebPages Using a Indexing WebPages Using a Medical ThesaurusMedical Thesaurus

University of Wisconsin–Eau Claire

The HeartCare ProjectThe HeartCare Project

Providing health information – Graduated to patient’s stage of recovery – Tailored to his/her medical profile and individual needs

Filtered set of cardiac recovery resources available on the web stored in an Access© database

– Self constructed web pages – Web pages are described with index terms– Index terms describe the medical profile

Matching algorithm web page – patient

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Indexing Web Pages Indexing Web Pages in HeartCarein HeartCare

Nurse-clinicians tagged web documents with:

Selected concepts from Medical Language Subject Heading (MeSH)

Supplemented with terms reflecting local clinical practice

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Example of IndexingExample of Indexing

http://www.women.americanheart.org/physicians/sub_content/ten.htmltagged with the terms “diet” and “weight” is pulled 4 different times for the menu heading “Ten questions a woman should ask her healthcare provider”

http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/calccb.html tagged with terms “Beta Blockers/Calcium Channel Blockers”and “Medications” are pulled for all conditions that have the subject heading assigned, even when not applicable

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Implications for RetrievalImplications for Retrieval

Too many pages pulled per patient

Too many duplicate pages

Some pages were pulled that did not exactly match the patient profile

Examples of Total Web Pages in Examples of Total Web Pages in Combination with Menu TitleCombination with Menu Title

Retrieved for PatientsRetrieved for Patients

PatientCombinations Retrieved

Unique Combinations

Patient 1 266 138

Patient 2 891 647

Patient 3 324 281

Patient 4 584 203

Menu Title Condition

Taking charge of your health - Week 3-6 Diabetes

Taking charge of your health - Week 3-6 Hypertension

Taking charge of your health - Week 3-6 Smoking

Beginning lifestyle changes - Week 7-12 Hypertension

Beginning lifestyle changes - Week 7-12 Smoking

Beginning lifestyle changes - Week 7-12 Diabetes

Changing your lifestyle - Week 13-26 Diabetes

Changing your lifestyle - Week 13-26 Hypertension

Changing your lifestyle - Week 13-26 Smoking

http://rex.nci.nih.gov/NCI_Pub_Interface/Clearing_the_Air/clearing.html

Example of Duplicate Page Retrieval Example of Duplicate Page Retrieval Using Keywords Using Keywords

“smoking and behavior changes”“smoking and behavior changes”

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Pages Retrieved that Does not Pages Retrieved that Does not Match the Patient’s ProfileMatch the Patient’s Profile

Sample Male Patient with Risk Factors Hypertension and Stress

# of Web pages Non-matching topic

11 Risk of smoking and smoking cessation

8 Risk factors for women

5 Being overweight and weight loss

2 Diabetes management

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EvaluationEvaluation

Flawed indexing system

Lacking structure of index terms

Conceptualization problem

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DiscussionDiscussion

Keywords must be part of semantic representation understood by users and indexers

Relation content and usage must be explicated

Keywords must converge

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This study is supported by NLM/NINR Grant LM06249, Principal Investigator Dr. P.F. Brennan

The authors want to thank the members from the HeartCare team for their advice and support.

Patricia F. Brennanpbrennan@ie.engr.wisc.edu

University of Wisconsin Madison

Josette Joneswouterjf@uwec.edu

University of Wisconsin Eau Claire