WorldWideScience

Sample records for patient decision tools

  1. The development of a personalized patient education tool for decision making for postmenopausal women with osteoporosis

    NARCIS (Netherlands)

    Hiligsmann, M.; Ronda, G.; Weijden, T.T. van der; Boonen, A.

    2016-01-01

    A personalized patient education tool for decision making (PET) for postmenopausal women with osteoporosis was developed by means of a systematic development approach. A prototype was constructed and refined by involving various professionals and patients. Professionals and patients expressed a

  2. [Shared decision-making based on equal information. Patient guidelines as a tool for patient counseling].

    Science.gov (United States)

    Sänger, Sylvia; Kopp, Ina; Englert, Gerhard; Brunsmann, Frank; Quadder, Bernd; Ollenschläger, Günter

    2007-06-15

    In discussions on the quality of cross-sectorial health-care services high importance is attributed to patient education and patient counseling, with guideline-based patient information being considered a crucial tool. Guideline-based patient information is supposed to serve patients as a decision-making basis and, in addition, to also support the implementation of the guidelines themselves. The article highlights how patient guidelines for National Disease Management Guidelines in Germany--within the scope of patient education and patient counseling--may provide a uniform information platform for physicians and patients aiming to promote shared decision-making. The authors will also address the issue which contents should be included in patient guidelines in order to meet these requirements and which measures are required to review their quality. The present paper continues the series of articles on the Program for German National Disease Management Guidelines.

  3. A Decision Support Tool for Appropriate Glucose-Lowering Therapy in Patients with Type 2 Diabetes

    DEFF Research Database (Denmark)

    Ampudia-Blasco, F Javier; Benhamou, Pierre Yves; Charpentier, Guillaume

    2014-01-01

    Abstract Background: Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed...... a patient-specific decision support tool based on a systematic analysis of expert opinion. Materials and Methods: Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND....... The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Results: Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors...

  4. Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders

    DEFF Research Database (Denmark)

    Gross, Douglas P; Armijo-Olivo, Susan; Shaw, William S

    2016-01-01

    Purpose We aimed to identify and inventory clinical decision support (CDS) tools for helping front-line staff select interventions for patients with musculoskeletal (MSK) disorders. Methods We used Arksey and O'Malley's scoping review framework which progresses through five stages: (1) identifying...... the research question; (2) identifying relevant studies; (3) selecting studies for analysis; (4) charting the data; and (5) collating, summarizing and reporting results. We considered computer-based, and other available tools, such as algorithms, care pathways, rules and models. Since this research crosses...

  5. Assigning Treatment to HCC Patients for Transplantation: Utility of a New Decision-Making Tool.

    Science.gov (United States)

    Shah, Najmul Hassan; Dar, Faisal Saud; Bhatti, Abu Bakar Hafeez; Rana, Atif; Salih, Mohammad

    2016-10-28

    BACKGROUND The Barcelona clinic liver cancer (BCLC) staging system is considered the standard of care for hepatocellular carcinoma (HCC) management. It has various limitations, including lack of second-line treatment options and combination therapy. We prospectively collected data on our HCC patients based on a new decision-making tool (NDT). The objective of this study was to determine the applicability of this tool and compare it with BCLC for treatment allocation, in particular with respect to liver transplantation. MATERIAL AND METHODS We retrospectively reviewed HCC patients who were managed based on an NDT that was developed in 2012. All patients whose treatment decision was based on this tool between 2012 and 2015 were included. Comparison was made with BCLC. Survival was compared for patients who underwent liver transplantation. RESULTS Based on the NDT, 406 (40.6%) patients were eligible for curative treatment versus only 22 (2.2%) patients based on BCLC. A total of 58 (5.8%) patients underwent liver transplant based on the NDT, while only 2 (0.2%) were transplantable based on BCLC. Estimated 3-year survival for transplanted patients based on the NDT was 73%. There were 41 (4.1%) stage C and 15 (1.5%) stage D BCLC patients who received transplant based on the NDT. Estimated 3-year survival for stage A, C, and D BCLC patients who received transplantation was 100%,72%, and 67%, respectively (P=0.6). CONCLUSIONS The NDT correctly identified a group of HCC patients for liver transplantation who would otherwise have received palliative treatment based on the BCLC algorithm.

  6. A decision support tool for appropriate glucose-lowering therapy in patients with type 2 diabetes.

    Science.gov (United States)

    Ampudia-Blasco, F Javier; Benhamou, Pierre Yves; Charpentier, Guillaume; Consoli, Agostino; Diamant, Michaela; Gallwitz, Baptist; Khunti, Kamlesh; Mathieu, Chantal; Ridderstråle, Martin; Seufert, Jochen; Tack, Cees; Vilsbøll, Tina; Phan, Tra-Mi; Stoevelaar, Herman

    2015-03-01

    Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process

  7. External Validation of a Decision Tool To Guide Post-Operative Management of Patients with Secondary Peritonitis.

    Science.gov (United States)

    Atema, Jasper J; Ram, Kim; Schultz, Marcus J; Boermeester, Marja A

    Timely identification of patients in need of an intervention for abdominal sepsis after initial surgical management of secondary peritonitis is vital but complex. The aim of this study was to validate a decision tool for this purpose and to evaluate its potential to guide post-operative management. A prospective cohort study was conducted on consecutive adult patients undergoing surgery for secondary peritonitis in a single hospital. Assessments using the decision tool, based on one intra-operative and five post-operative variables, were performed on the second and third post-operative days and when the patients' clinical status deteriorated. Scores were compared with the clinical reference standard of persistent sepsis based on the clinical course or findings at imaging or surgery. Additionally, the potential of the decision tool to guide management in terms of diagnostic imaging in three previously defined score categories (low, intermediate, and high) was evaluated. A total of 161 assessments were performed in 69 patients. The majority of cases of secondary peritonitis (68%) were caused by perforation of the gastrointestinal tract. Post-operative persistent sepsis occurred in 28 patients. The discriminative capacity of the decision tool score was fair (area under the curve of the receiver operating characteristic = 0.79). The incidence rate differed significantly between the three score categories (p peritonitis, the decision tool score predicts with fair accuracy whether persistent sepsis is present.

  8. A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: lessons for tool developers.

    Science.gov (United States)

    Flynn, Darren; Ford, Gary A; Stobbart, Lynne; Rodgers, Helen; Murtagh, Madeleine J; Thomson, Richard G

    2013-06-18

    Tools to support clinical or patient decision-making in the treatment/management of a health condition are used in a range of clinical settings for numerous preference-sensitive healthcare decisions. Their impact in clinical practice is largely dependent on their quality across a range of domains. We critically analysed currently available tools to support decision making or patient understanding in the treatment of acute ischaemic stroke with intravenous thrombolysis, as an exemplar to provide clinicians/researchers with practical guidance on development, evaluation and implementation of such tools for other preference-sensitive treatment options/decisions in different clinical contexts. Tools were identified from bibliographic databases, Internet searches and a survey of UK and North American stroke networks. Two reviewers critically analysed tools to establish: information on benefits/risks of thrombolysis included in tools, and the methods used to convey probabilistic information (verbal descriptors, numerical and graphical); adherence to guidance on presenting outcome probabilities (IPDASi probabilities items) and information content (Picker Institute Checklist); readability (Fog Index); and the extent that tools had comprehensive development processes. Nine tools of 26 identified included information on a full range of benefits/risks of thrombolysis. Verbal descriptors, frequencies and percentages were used to convey probabilistic information in 20, 19 and 18 tools respectively, whilst nine used graphical methods. Shortcomings in presentation of outcome probabilities (e.g. omitting outcomes without treatment) were identified. Patient information tools had an aggregate median Fog index score of 10. None of the tools had comprehensive development processes. Tools to support decision making or patient understanding in the treatment of acute stroke with thrombolysis have been sub-optimally developed. Development of tools should utilise mixed methods and

  9. Development of a shared decision-making tool to assist patients and clinicians with decisions on oral anticoagulant treatment for atrial fibrillation.

    Science.gov (United States)

    Kaiser, Karen; Cheng, Wendy Y; Jensen, Sally; Clayman, Marla L; Thappa, Andrew; Schwiep, Frances; Chawla, Anita; Goldberger, Jeffrey J; Col, Nananda; Schein, Jeff

    2015-12-01

    Decision aids (DAs) are increasingly used to operationalize shared decision-making (SDM) but their development is not often described. Decisions about oral anticoagulants (OACs) for atrial fibrillation (AF) involve a trade-off between lowering stroke risk and increasing OAC-associated bleeding risk, and consideration of how treatment affects lifestyle. The benefits and risks of OACs hinge upon a patient's risk factors for stroke and bleeding and how they value these outcomes. We present the development of a DA about AF that estimates patients' risks for stroke and bleeding and assesses their preferences for outcomes. Based on a literature review and expert discussions, we identified stroke and major bleeding risk prediction models and embedded them into risk assessment modules. We identified the most important factors in choosing OAC treatment (warfarin used as the default reference OAC) through focus group discussions with AF patients who had used warfarin and clinician interviews. We then designed preference assessment and introductory modules accordingly. We integrated these modules into a prototype AF SDM tool and evaluated its usability through interviews. Our tool included four modules: (1) introduction to AF and OAC treatment risks and benefits; (2) stroke risk assessment; (3) bleeding risk assessment; and (4) preference assessment. Interactive risk calculators estimated patient-specific stroke and bleeding risks; graphics were developed to communicate these risks. After cognitive interviews, the content was improved. The final AF tool calculates patient-specific risks and benefits of OAC treatment and couples these estimates with patient preferences to improve clinical decision-making. The AF SDM tool may help patients choose whether OAC treatment is best for them and represents a patient-centered, integrative approach to educate patients on the benefits and risks of OAC treatment. Future research is needed to evaluate this tool in a real-world setting. The

  10. A decision-making tool to prescribe knee orthoses in daily practice for patients with osteoarthritis.

    Science.gov (United States)

    Coudeyre, Emmanuel; Nguyen, Christelle; Chabaud, Aurore; Pereira, Bruno; Beaudreuil, Johann; Coudreuse, Jean-Marie; Deat, Philippe; Sailhan, Frédéric; Lorenzo, Alain; Rannou, François

    2018-03-01

    To develop a decision-making tool (DMT) to facilitate the prescription of knee orthoses for patients with osteoarthritis (OA) in daily practice. A steering committee gathered a multidisciplinary task force experienced in OA management/clinical research. Two members performed a literature review with qualitative analysis of the highest-quality randomized controlled trials and practice guidelines to confirm evidence concerning knee orthosis for OA. A first DMT draft was presented to the task force in a 1-day meeting in January 2016. The first version of the DMT was criticized and discussed regarding everyday practice issues. Every step was discussed and amended until consensus agreement was achieved within the task force. Then 4 successive consultation rounds occurred by electronic communication, first with primary- and secondary-care physicians, then with international experts. All corrections and suggestions by each member were shared with the rest of the task force and included to reach final consensus. The final version was validated by the steering committee. The definition and indication of several types of knee orthoses (sleeve, patello-femoral, hinged or unicompartmental offloading braces) were detailed. Orthoses may be proposed in addition to first-line non-pharmacological treatment if patient acceptance is considered good. At every step, a specific clinical assessment is needed. Based on the latest high-level evidence, practice guidelines, and an expert panel, a DMT to facilitate daily practice prescription of knee orthoses for OA patients was designed. An evaluation of DMT implementation in a wide range of health professionals is still needed. Copyright © 2018 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.

  11. [Improving shared decision-making for hospital patients: Description and evaluation of a treatment intensity assessment tool].

    Science.gov (United States)

    Amblàs-Novellas, Jordi; Casas, Sílvia; Catalán, Rosa María; Oriol-Ruscalleda, Margarita; Lucchetti, Gianni Enrico; Quer-Vall, Francesc Xavier

    2016-01-01

    Shared decision-making between patients and healthcare professionals is crucial to guarantee adequate coherence between patient values and preferences, caring aims and treatment intensity, which is key for the provision of patient-centred healthcare. The assessment of such interventions are essential for caring continuity purposes. To do this, reliable and easy-to-use assessment systems are required. This study describes the results of the implementation of a hospital treatment intensity assessment tool. The pre-implementation and post-implementation results were compared between two cohorts of patients assessed for one month. Some record of care was registered in 6.1% of patients in the pre-implementation group (n=673) compared to 31.6% of patients in the post-implementation group (n=832) (P<.01), with differences between services. Hospital mortality in both cohorts is 1.9%; in the pre-implementation group, 93.75% of deceased patients had treatment intensity assessment. In hospital settings, the availability of a specific tool seems to encourage very significantly shared decision-making processes between patients and healthcare professionals -multiplying by more than 5 times the treatment intensity assessment. Moreover, such tools help in the caring continuity processes between different teams and the personalisation of caring interventions to be monitored. More research is needed to continue improving shared decision-making for hospital patients. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

  12. Implementation of a Clinical Decision Support Tool for Stool Cultures and Parasitological Studies in Hospitalized Patients.

    Science.gov (United States)

    Nikolic, D; Richter, S S; Asamoto, K; Wyllie, R; Tuttle, R; Procop, G W

    2017-12-01

    There is substantial evidence that stool culture and parasitological examinations are of minimal to no value after 3 days of hospitalization. We implemented and studied the impact of a clinical decision support tool (CDST) to decrease the number of unnecessary stool cultures (STCUL), ova/parasite (O&P) examinations, and Giardia / Cryptosporidium enzyme immunoassay screens (GC-EIA) performed for patients hospitalized >3 days. We studied the frequency of stool studies ordered before or on day 3 and after day 3 of hospitalization (i.e., categorical orders/total number of orders) before and after this intervention and denoted the numbers and types of microorganisms detected within those time frames. This intervention, which corresponded to a custom-programmed hard-stop alert tool in the Epic hospital information system, allowed providers to override the intervention by calling the laboratory, if testing was deemed medically necessary. Comparative statistics were employed to determine significance, and cost savings were estimated based on our internal costs. Before the intervention, 129/670 (19.25%) O&P examinations, 47/204 (23.04%) GC-EIA, and 249/1,229 (20.26%) STCUL were ordered after 3 days of hospitalization. After the intervention, 46/521 (8.83%) O&P examinations, 27/157 (17.20%) GC-EIA, and 106/1,028 (10.31%) STCUL were ordered after 3 days of hospitalization. The proportions of reductions in the number of tests performed after 3 days and the associated P values were 54.1% for O&P examinations ( P < 0.0001), 22.58% for GC-EIA ( P = 0.2807), and 49.1% for STCUL ( P < 0.0001). This was estimated to have resulted in $8,108.84 of cost savings. The electronic CDST resulted in a substantial reduction in the number of evaluations of stool cultures and the number of parasitological examinations for patients hospitalized for more than 3 days and in a cost savings while retaining the ability of the clinician to obtain these tests if clinically indicated. Copyright © 2017

  13. Decision support tool for early differential diagnosis of acute lung injury and cardiogenic pulmonary edema in medical critically ill patients.

    Science.gov (United States)

    Schmickl, Christopher N; Shahjehan, Khurram; Li, Guangxi; Dhokarh, Rajanigandha; Kashyap, Rahul; Janish, Christopher; Alsara, Anas; Jaffe, Allan S; Hubmayr, Rolf D; Gajic, Ognjen

    2012-01-01

    At the onset of acute hypoxic respiratory failure, critically ill patients with acute lung injury (ALI) may be difficult to distinguish from those with cardiogenic pulmonary edema (CPE). No single clinical parameter provides satisfying prediction. We hypothesized that a combination of those will facilitate early differential diagnosis. In a population-based retrospective development cohort, validated electronic surveillance identified critically ill adult patients with acute pulmonary edema. Recursive partitioning and logistic regression were used to develop a decision support tool based on routine clinical information to differentiate ALI from CPE. Performance of the score was validated in an independent cohort of referral patients. Blinded post hoc expert review served as gold standard. Of 332 patients in a development cohort, expert reviewers (κ, 0.86) classified 156 as having ALI and 176 as having CPE. The validation cohort had 161 patients (ALI = 113, CPE = 48). The score was based on risk factors for ALI and CPE, age, alcohol abuse, chemotherapy, and peripheral oxygen saturation/Fio(2) ratio. It demonstrated good discrimination (area under curve [AUC] = 0.81; 95% CI, 0.77-0.86) and calibration (Hosmer-Lemeshow [HL] P = .16). Similar performance was obtained in the validation cohort (AUC = 0.80; 95% CI, 0.72-0.88; HL P = .13). A simple decision support tool accurately classifies acute pulmonary edema, reserving advanced testing for a subset of patients in whom satisfying prediction cannot be made. This novel tool may facilitate early inclusion of patients with ALI and CPE into research studies as well as improve and rationalize clinical management and resource use.

  14. Decision-making and referral processes for patients with motor neurone disease: a qualitative study of GP experiences and evaluation of a new decision-support tool.

    Science.gov (United States)

    Baxter, Susan; McDermott, Christopher J

    2017-05-08

    The diagnosis of motor neurone disease (MND) is known to be challenging and there may be delay in patients receiving a correct diagnosis. This study investigated the referral process for patients who had been diagnosed with MND, and whether a newly-developed tool (The Red Flags checklist) might help General Practitioners (GPs) in making referral decisions. We carried out interviews with GPs who had recently referred a patient diagnosed with MND, and interviews/surveys with GPs who had not recently referred a patient with suspected MND. We collected data before the Red Flags checklist was introduced; and again one year later. We analysed the data to identify key recurring themes. Forty two GPs took part in the study. The presence of fasciculation was the clinical feature that most commonly led to consideration of a potential MND diagnosis. GPs perceived that their role was to make onward referrals rather than attempting to make a diagnosis, and delays in correct diagnosis tended to occur at the specialist level. A quarter of participants had some awareness of the newly-developed tool; most considered it useful, if incorporated into existing systems. While fasciculation is the most common symptom associated with MND, other bulbar, limb or respiratory features, together with progression should be considered. There is a need for further research into how decision-support tools should be designed and provided, in order to best assist GPs with referral decisions. There is also a need for further work at the level of secondary care, in order that referrals made are re-directed appropriately.

  15. A web-based neurological pain classifier tool utilizing Bayesian decision theory for pain classification in spinal cord injury patients

    Science.gov (United States)

    Verma, Sneha K.; Chun, Sophia; Liu, Brent J.

    2014-03-01

    Pain is a common complication after spinal cord injury with prevalence estimates ranging 77% to 81%, which highly affects a patient's lifestyle and well-being. In the current clinical setting paper-based forms are used to classify pain correctly, however, the accuracy of diagnoses and optimal management of pain largely depend on the expert reviewer, which in many cases is not possible because of very few experts in this field. The need for a clinical decision support system that can be used by expert and non-expert clinicians has been cited in literature, but such a system has not been developed. We have designed and developed a stand-alone tool for correctly classifying pain type in spinal cord injury (SCI) patients, using Bayesian decision theory. Various machine learning simulation methods are used to verify the algorithm using a pilot study data set, which consists of 48 patients data set. The data set consists of the paper-based forms, collected at Long Beach VA clinic with pain classification done by expert in the field. Using the WEKA as the machine learning tool we have tested on the 48 patient dataset that the hypothesis that attributes collected on the forms and the pain location marked by patients have very significant impact on the pain type classification. This tool will be integrated with an imaging informatics system to support a clinical study that will test the effectiveness of using Proton Beam radiotherapy for treating spinal cord injury (SCI) related neuropathic pain as an alternative to invasive surgical lesioning.

  16. A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design.

    Science.gov (United States)

    Zheng, Hua; Rosal, Milagros C; Li, Wenjun; Borg, Amy; Yang, Wenyun; Ayers, David C; Franklin, Patricia D

    2018-04-30

    Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery. The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants' responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods. Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra "next page" click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status. We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients' use. ©Hua Zheng, Milagros C Rosal, Wenjun Li, Amy Borg, Wenyun Yang, David C Ayers, Patricia D Franklin. Originally published in JMIR Human

  17. A web-based clinical decision tool to support treatment decision-making in psychiatry: a pilot focus group study with clinicians, patients and carers.

    Science.gov (United States)

    Henshall, Catherine; Marzano, Lisa; Smith, Katharine; Attenburrow, Mary-Jane; Puntis, Stephen; Zlodre, Jakov; Kelly, Kathleen; Broome, Matthew R; Shaw, Susan; Barrera, Alvaro; Molodynski, Andrew; Reid, Alastair; Geddes, John R; Cipriani, Andrea

    2017-07-21

    Treatment decision tools have been developed in many fields of medicine, including psychiatry, however benefits for patients have not been sustained once the support is withdrawn. We have developed a web-based computerised clinical decision support tool (CDST), which can provide patients and clinicians with continuous, up-to-date, personalised information about the efficacy and tolerability of competing interventions. To test the feasibility and acceptability of the CDST we conducted a focus group study, aimed to explore the views of clinicians, patients and carers. The CDST was developed in Oxford. To tailor treatments at an individual level, the CDST combines the best available evidence from the scientific literature with patient preferences and values, and with patient medical profile to generate personalised clinical recommendations. We conducted three focus groups comprising of three different participant types: consultant psychiatrists, participants with a mental health diagnosis and/or experience of caring for someone with a mental health diagnosis, and primary care practitioners and nurses. Each 1-h focus group started with a short visual demonstration of the CDST. To standardise the discussion during the focus groups, we used the same topic guide that covered themes relating to the acceptability and usability of the CDST. Focus groups were recorded and any identifying participant details were anonymised. Data were analysed thematically and managed using the Framework method and the constant comparative method. The focus groups took place in Oxford between October 2016 and January 2017. Overall 31 participants attended (12 consultants, 11 primary care practitioners and 8 patients or carers). The main themes that emerged related to CDST applications in clinical practice, communication, conflicting priorities, record keeping and data management. CDST was considered a useful clinical decision support, with recognised value in promoting clinician-patient

  18. A decision support tool for appropriate glucose-lowering therapy in patients with type 2 diabetes

    NARCIS (Netherlands)

    Ampudia-Blasco, F.J.; Benhamou, P.Y.; Charpentier, G.; Consoli, A.; Diamant, M.; Gallwitz, B.; Khunti, K.; Mathieu, C.; Ridderstrale, M.; Seufert, J.; Tack, C.J.; Vilsboll, T.; Phan, T.; Stoevelaar, H.

    2015-01-01

    BACKGROUND: Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a

  19. Shared decision making in type 2 diabetes with a support decision tool that takes into account clinical factors, the intensity of treatment and patient preferences : Design of a cluster randomised (OPTIMAL) trial

    NARCIS (Netherlands)

    Den Ouden, Henk; Vos, Rimke C.; Reidsma, Carla; Rutten, Guy Ehm

    2015-01-01

    Background: No more than 10-15% of type 2 diabetes mellitus (T2DM) patients achieve all treatment goals regarding glycaemic control, lipids and blood pressure. Shared decision making (SDM) should increase that percentage; however, not all support decision tools are appropriate. Because the

  20. Barriers and Facilitators to Patient-Provider Communication When Discussing Breast Cancer Risk to Aid in the Development of Decision Support Tools.

    Science.gov (United States)

    Yi, Haeseung; Xiao, Tong; Thomas, Parijatham S; Aguirre, Alejandra N; Smalletz, Cindy; Dimond, Jill; Finkelstein, Joseph; Infante, Katherine; Trivedi, Meghna; David, Raven; Vargas, Jennifer; Crew, Katherine D; Kukafka, Rita

    2015-01-01

    The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%-94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention.

  1. Integrating a Decision Management Tool with UML Modeling Tools

    DEFF Research Database (Denmark)

    Könemann, Patrick

    by proposing potential subsequent design issues. In model-based software development, many decisions directly affect the structural and behavioral models used to describe and develop a software system and its architecture. However, these decisions are typically not connected to the models created during...... integration of formerly disconnected tools improves tool usability as well as decision maker productivity....

  2. Development and Validation of a Decision Tool for Early Identification of Adult Patients with Severe and Complex Eating Disorder Psychopathology in Need of Highly Specialized Care.

    Science.gov (United States)

    Dingemans, Alexandra E; Goorden, Maartje; Lötters, Freek J B; Bouwmans, Clazien; Danner, Unna N; van Elburg, Annemarie A; van Furth, Eric F; Hakkaart-van Roijen, Leona

    2017-09-01

    Patients with complex and severe eating disorders often receive a number of ineffective or/and insufficient treatments. Direct referral of these patients to highly specialized tertiary treatment facilities in an earlier stage of the disorder is likely to be more (cost)-effective. The aim of the study was to develop a decision tool that aids clinicians in early identification of these patients. After identification of criteria that were indicative of severity and complexity of eating disorder psychopathology by means of a systematic review of literature and consultation of a focus group, a Delphi method was applied to obtain consensus from experts on the list of relevant criteria. Finally, the decision tool was validated in clinical practice, and cut-off criteria were established. The tool demonstrated good feasibility and validity to identify patients for highly specialized tertiary care. The final decision tool consisted of five criteria that can easily be implemented in clinical practice. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

  3. Application of the PredictAD Decision Support Tool to a Danish Cohort of Patients with Alzheimer's Disease and Other Dementias

    DEFF Research Database (Denmark)

    Simonsen, A H; Mattila, J; Hejl, A M

    2013-01-01

    Background: The diagnosis of Alzheimer's disease (AD) is based on an ever-increasing body of data and knowledge making it a complex task. The PredictAD tool integrates heterogeneous patient data using an interactive user interface to provide decision support. The aim of this project was to invest......Background: The diagnosis of Alzheimer's disease (AD) is based on an ever-increasing body of data and knowledge making it a complex task. The PredictAD tool integrates heterogeneous patient data using an interactive user interface to provide decision support. The aim of this project...... forest. Results: The DSI performed best for this realistic dataset with an accuracy of 76.6% compared to the accuracies for the naïve Bayesian classifier and random forest of 67.4 and 66.7%, respectively. Furthermore, the DSI differentiated between the four diagnostic groups with a p value of ....0001. Conclusion: In this dataset, the DSI method used by the PredictAD tool showed a superior performance for the differentiation between patients with AD and those with other dementias. However, the methods need to be refined further in order to optimize the differential diagnosis between AD, FTD, VaD and DLB....

  4. Tools for collaborative decision-making

    CERN Document Server

    Zaraté, Pascale

    2013-01-01

    Decision-making has evolved recently thanks to the introduction of information and communication technologies in many organizations, which has led to new kinds of decision-making processes, called "collaborative decision-making", at the organizational and cognitive levels. This book looks at the development of the decision-making process in organizations. Decision-aiding and its paradigm of problem solving are defined, showing how decision-makers now need to work in a cooperative way. Definitions of cooperation and associated concepts such as collaboration and coordination are given and a framework of cooperative decision support systems is presented, including intelligent DSS, cooperative knowledge-based systems, workflow, group support systems, collaborative engineering, integrating with a collaborative decision-making model in part or being part of global projects. Several models and experimental studies are also included showing that these new processes have to be supported by new types of tools, several ...

  5. MARKET EVALUATION MODEL: TOOL FORBUSINESS DECISIONS

    OpenAIRE

    Porlles Loarte, José; Yenque Dedios, Julio; Lavado Soto, Aurelio

    2014-01-01

    In the present work the concepts of potential market and global market are analyzed as the basis for strategic decisions of market with long term perspectives, when the implantation of a business in certain geographic area is evaluated. On this conceptual frame, the methodological tool is proposed to evaluate a commercial decision, for which it is taken as reference the case from the brewing industry in Peru, considering that this industry faces in the region entrepreneurial reorderings withi...

  6. Decision support frameworks and tools for conservation

    Science.gov (United States)

    Schwartz, Mark W.; Cook, Carly N.; Pressey, Robert L.; Pullin, Andrew S.; Runge, Michael C.; Salafsky, Nick; Sutherland, William J.; Williamson, Matthew A.

    2018-01-01

    The practice of conservation occurs within complex socioecological systems fraught with challenges that require transparent, defensible, and often socially engaged project planning and management. Planning and decision support frameworks are designed to help conservation practitioners increase planning rigor, project accountability, stakeholder participation, transparency in decisions, and learning. We describe and contrast five common frameworks within the context of six fundamental questions (why, who, what, where, when, how) at each of three planning stages of adaptive management (project scoping, operational planning, learning). We demonstrate that decision support frameworks provide varied and extensive tools for conservation planning and management. However, using any framework in isolation risks diminishing potential benefits since no one framework covers the full spectrum of potential conservation planning and decision challenges. We describe two case studies that have effectively deployed tools from across conservation frameworks to improve conservation actions and outcomes. Attention to the critical questions for conservation project planning should allow practitioners to operate within any framework and adapt tools to suit their specific management context. We call on conservation researchers and practitioners to regularly use decision support tools as standard practice for framing both practice and research.

  7. Decision Analysis Tools for Volcano Observatories

    Science.gov (United States)

    Hincks, T. H.; Aspinall, W.; Woo, G.

    2005-12-01

    Staff at volcano observatories are predominantly engaged in scientific activities related to volcano monitoring and instrumentation, data acquisition and analysis. Accordingly, the academic education and professional training of observatory staff tend to focus on these scientific functions. From time to time, however, staff may be called upon to provide decision support to government officials responsible for civil protection. Recognizing that Earth scientists may have limited technical familiarity with formal decision analysis methods, specialist software tools that assist decision support in a crisis should be welcome. A review is given of two software tools that have been under development recently. The first is for probabilistic risk assessment of human and economic loss from volcanic eruptions, and is of practical use in short and medium-term risk-informed planning of exclusion zones, post-disaster response, etc. A multiple branch event-tree architecture for the software, together with a formalism for ascribing probabilities to branches, have been developed within the context of the European Community EXPLORIS project. The second software tool utilizes the principles of the Bayesian Belief Network (BBN) for evidence-based assessment of volcanic state and probabilistic threat evaluation. This is of practical application in short-term volcano hazard forecasting and real-time crisis management, including the difficult challenge of deciding when an eruption is over. An open-source BBN library is the software foundation for this tool, which is capable of combining synoptically different strands of observational data from diverse monitoring sources. A conceptual vision is presented of the practical deployment of these decision analysis tools in a future volcano observatory environment. Summary retrospective analyses are given of previous volcanic crises to illustrate the hazard and risk insights gained from use of these tools.

  8. Promoting Shared Decision Making in Disorders of Sex Development (DSD): Decision Aids and Support Tools.

    Science.gov (United States)

    Siminoff, L A; Sandberg, D E

    2015-05-01

    Specific complaints and grievances from adult patients with disorders of sex development (DSD), and their advocates center around the lack of information or misinformation they were given about their condition and feeling stigmatized and shamed by the secrecy surrounding their condition and its management. Many also attribute poor sexual function to damaging genital surgery and/or repeated, insensitive genital examinations. These reports suggest the need to reconsider the decision-making process for the treatment of children born with DSD. This paper proposes that shared decision making, an important concept in adult health care, be operationalized for the major decisions commonly encountered in DSD care and facilitated through the utilization of decision aids and support tools. This approach may help patients and their families make informed decisions that are better aligned with their personal values and goals. It may also lead to greater confidence in decision making with greater satisfaction and less regret. A brief review of the past and current approach to DSD decision making is provided, along with a review of shared decision making and decision aids and support tools. A case study explores the need and potential utility of this suggested new approach. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Evaluating online diagnostic decision support tools for the clinical setting.

    Science.gov (United States)

    Pryor, Marie; White, David; Potter, Bronwyn; Traill, Roger

    2012-01-01

    Clinical decision support tools available at the point of care are an effective adjunct to support clinicians to make clinical decisions and improve patient outcomes. We developed a methodology and applied it to evaluate commercially available online clinical diagnostic decision support (DDS) tools for use at the point of care. We identified 11 commercially available DDS tools and assessed these against an evaluation instrument that included 6 categories; general information, content, quality control, search, clinical results and other features. We developed diagnostically challenging clinical case scenarios based on real patient experience that were commonly missed by junior medical staff. The evaluation was divided into 2 phases; an initial evaluation of all identified and accessible DDS tools conducted by the Clinical Information Access Portal (CIAP) team and a second phase that further assessed the top 3 tools identified in the initial evaluation phase. An evaluation panel consisting of senior and junior medical clinicians from NSW Health conducted the second phase. Of the eleven tools that were assessed against the evaluation instrument only 4 tools completely met the DDS definition that was adopted for this evaluation and were able to produce a differential diagnosis. From the initial phase of the evaluation 4 DDS tools scored 70% or more (maximum score 96%) for the content category, 8 tools scored 65% or more (maximum 100%) for the quality control category, 5 tools scored 65% or more (maximum 94%) for the search category, and 4 tools score 70% or more (maximum 81%) for the clinical results category. The second phase of the evaluation was focused on assessing diagnostic accuracy for the top 3 tools identified in the initial phase. Best Practice ranked highest overall against the 6 clinical case scenarios used. Overall the differentiating factor between the top 3 DDS tools was determined by diagnostic accuracy ranking, ease of use and the confidence and

  10. Integrating decision management with UML modeling concepts and tools

    DEFF Research Database (Denmark)

    Könemann, Patrick

    2009-01-01

    , but also for guiding the user by proposing subsequent decisions. In model-based software development, many decisions directly affect the structural and behavioral models used to describe and develop a software system and its architecture. However, the decisions are typically not connected to these models...... of formerly disconnected tools could improve tool usability as well as decision maker productivity....

  11. Shaping an Effective Health Information Website on Rare Diseases Using a Group Decision-Making Tool: Inclusion of the Perspectives of Patients, Their Family Members, and Physicians

    Science.gov (United States)

    Litzkendorf, Svenja; Schmidt, Katharina; Pauer, Frédéric; Damm, Kathrin; Frank, Martin; Graf von der Schulenburg, Johann-Matthias

    2017-01-01

    Background Despite diverging definitions on rare conditions, people suffering from rare diseases share similar difficulties. A lack of experience by health professionals, a long wait from first symptoms to diagnosis, scarce medical and scientific knowledge, and unsatisfactory treatment options all trigger the search for health information by patients, family members, and physicians. Examining and systematically integrating stakeholder needs can help design information platforms that effectively support this search. Objective The aim of this study was to innovate on the group decision-making process involving patients, family members, and physicians for the establishment of a national rare disease Internet platform. We determined differences in the relevance of health information—especially examining quantifiable preference weights—between these subgroups and elucidated the structure and distribution of these differences in people suffering from rare diseases, their family members, and physicians, thus providing information crucial to their collaboration. Methods The included items were identified using a systematic Internet research and verified through a qualitative interview study. The identified major information needs included medical issues, research, social help offers, and current events. These categories further comprised sublevels of diagnosis, therapy, general disease pattern, current studies, study results, registers, psychosocial counseling, self-help, and sociolegal advice. The analytic hierarchy process was selected as the group decision-making tool. A sensitivity analysis was used to determine the stability and distribution of results. t tests were utilized to examine the results’ significance. Results A total of 176 questionnaires were collected; we excluded some questionnaires in line with our chosen consistency level of 0.2. Ultimately, 120 patients, 24 family members, and 32 physicians participated in the study (48 men and 128 women, mean

  12. Shaping an Effective Health Information Website on Rare Diseases Using a Group Decision-Making Tool: Inclusion of the Perspectives of Patients, Their Family Members, and Physicians.

    Science.gov (United States)

    Babac, Ana; Litzkendorf, Svenja; Schmidt, Katharina; Pauer, Frédéric; Damm, Kathrin; Frank, Martin; Graf von der Schulenburg, Johann-Matthias

    2017-11-20

    Despite diverging definitions on rare conditions, people suffering from rare diseases share similar difficulties. A lack of experience by health professionals, a long wait from first symptoms to diagnosis, scarce medical and scientific knowledge, and unsatisfactory treatment options all trigger the search for health information by patients, family members, and physicians. Examining and systematically integrating stakeholder needs can help design information platforms that effectively support this search. The aim of this study was to innovate on the group decision-making process involving patients, family members, and physicians for the establishment of a national rare disease Internet platform. We determined differences in the relevance of health information-especially examining quantifiable preference weights-between these subgroups and elucidated the structure and distribution of these differences in people suffering from rare diseases, their family members, and physicians, thus providing information crucial to their collaboration. The included items were identified using a systematic Internet research and verified through a qualitative interview study. The identified major information needs included medical issues, research, social help offers, and current events. These categories further comprised sublevels of diagnosis, therapy, general disease pattern, current studies, study results, registers, psychosocial counseling, self-help, and sociolegal advice. The analytic hierarchy process was selected as the group decision-making tool. A sensitivity analysis was used to determine the stability and distribution of results. t tests were utilized to examine the results' significance. A total of 176 questionnaires were collected; we excluded some questionnaires in line with our chosen consistency level of 0.2. Ultimately, 120 patients, 24 family members, and 32 physicians participated in the study (48 men and 128 women, mean age=48 years, age range=17-87 years

  13. Clinical impact of pharmacogenetic profiling with a clinical decision support tool in polypharmacy home health patients: A prospective pilot randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Lindsay S Elliott

    Full Text Available In polypharmacy patients under home health management, pharmacogenetic testing coupled with guidance from a clinical decision support tool (CDST on reducing drug, gene, and cumulative interaction risk may provide valuable insights in prescription drug treatment, reducing re-hospitalization and emergency department (ED visits. We assessed the clinical impact of pharmacogenetic profiling integrating binary and cumulative drug and gene interaction warnings on home health polypharmacy patients.This prospective, open-label, randomized controlled trial was conducted at one hospital-based home health agency between February 2015 and February 2016. Recruitment came from patient referrals to home health at hospital discharge. Eligible patients were aged 50 years and older and taking or initiating treatment with medications with potential or significant drug-gene-based interactions. Subjects (n = 110 were randomized to pharmacogenetic profiling (n = 57. The study pharmacist reviewed drug-drug, drug-gene, and cumulative drug and/or gene interactions using the YouScript® CDST to provide drug therapy recommendations to clinicians. The control group (n = 53 received treatment as usual including pharmacist guided medication management using a standard drug information resource. The primary outcome measure was the number of re-hospitalizations and ED visits at 30 and 60 days after discharge from the hospital. The mean number of re-hospitalizations per patient in the tested vs. untested group was 0.25 vs. 0.38 at 30 days (relative risk (RR, 0.65; 95% confidence interval (CI, 0.32-1.28; P = 0.21 and 0.33 vs. 0.70 at 60 days following enrollment (RR, 0.48; 95% CI, 0.27-0.82; P = 0.007. The mean number of ED visits per patient in the tested vs. untested group was 0.25 vs. 0.40 at 30 days (RR, 0.62; 95% CI, 0.31-1.21; P = 0.16 and 0.39 vs. 0.66 at 60 days (RR, 0.58; 95% CI, 0.34-0.99; P = 0.045. Differences in composite outcomes at 60 days (exploratory endpoints

  14. Strategic Risk Assessment: A Decision Tool for Complex Decisions

    Energy Technology Data Exchange (ETDEWEB)

    Pollard, Simon; Duarte-Davidson, Raquel; Yearsley, Roger [Environment Agency, London (United Kingdom). National Centre for Risk Analysis and Options Appraisal; Kemp, Ray; Crawford, Mark [Galson Sciences Limited, Oakham (United Kingdom)

    2001-07-01

    Reporting on the state of the environment often requires policy makers and regulators to prioritise a range of diverse environmental issues for the purpose of directing future action on environmental protection and improvement. Information on environmental issues to inform this type of analysis can be disparate, it may be too voluminous or even absent. Data on a range of issues are rarely presented in a common format that allows easy comparison. Nevertheless, strategic judgements are required on the significance of impacts from various environmental pressures and on the inherent uncertainties. Prioritising issues forces a discussion among stakeholders of the relative significance of 'environmental harm' from pressures acting on various receptors in the environment. Discussions of this sort rapidly evolve into a discourse on risks and values. In an attempt to help systematise these discussions and provide practical tools for the analysis of environmental risks at a strategic level, the Environment Agency of England and Wales has initiated developmental research on strategic risk assessment. The tools developed under this research use the concept of 'environmental harm' as a common currency, viewed from technical, social and economic perspectives, to analyse impacts from a range of environmental pressures. Critical to an informed debate is an understanding and analysis both of the various characteristics of harm (spatial and temporal extent, reversibility, latency, etc.) and of the social response to the actual or potential environmental harm. Recent developments in this approach allow a presentation of the analysis in a structured fashion so as to better inform risk management decisions. Here, we present recent developments in the strategic risk assessment research tool, as tested by case studies from state of the environment reporting and the analysis of a regional environmental plan. We discuss its relative advantages and limitations and its

  15. Strategic Risk Assessment: A Decision Tool for Complex Decisions

    International Nuclear Information System (INIS)

    Pollard, Simon; Duarte-Davidson, Raquel; Yearsley, Roger

    2001-01-01

    Reporting on the state of the environment often requires policy makers and regulators to prioritise a range of diverse environmental issues for the purpose of directing future action on environmental protection and improvement. Information on environmental issues to inform this type of analysis can be disparate, it may be too voluminous or even absent. Data on a range of issues are rarely presented in a common format that allows easy comparison. Nevertheless, strategic judgements are required on the significance of impacts from various environmental pressures and on the inherent uncertainties. Prioritising issues forces a discussion among stakeholders of the relative significance of 'environmental harm' from pressures acting on various receptors in the environment. Discussions of this sort rapidly evolve into a discourse on risks and values. In an attempt to help systematise these discussions and provide practical tools for the analysis of environmental risks at a strategic level, the Environment Agency of England and Wales has initiated developmental research on strategic risk assessment. The tools developed under this research use the concept of 'environmental harm' as a common currency, viewed from technical, social and economic perspectives, to analyse impacts from a range of environmental pressures. Critical to an informed debate is an understanding and analysis both of the various characteristics of harm (spatial and temporal extent, reversibility, latency, etc.) and of the social response to the actual or potential environmental harm. Recent developments in this approach allow a presentation of the analysis in a structured fashion so as to better inform risk management decisions. Here, we present recent developments in the strategic risk assessment research tool, as tested by case studies from state of the environment reporting and the analysis of a regional environmental plan. We discuss its relative advantages and limitations and its wider potential role

  16. Risk analysis as a decision tool

    International Nuclear Information System (INIS)

    Yadigaroglu, G.; Chakraborty, S.

    1985-01-01

    From 1983 - 1985 a lecture series entitled ''Risk-benefit analysis'' was held at the Swiss Federal Institute of Technology (ETH), Zurich, in cooperation with the Central Department for the Safety of Nuclear Installations of the Swiss Federal Agency of Energy Economy. In that setting the value of risk-oriented evaluation models as a decision tool in safety questions was discussed on a broad basis. Experts of international reputation from the Federal Republic of Germany, France, Canada, the United States and Switzerland have contributed to report in this joint volume on the uses of such models. Following an introductory synopsis on risk analysis and risk assessment the book deals with practical examples in the fields of medicine, nuclear power, chemistry, transport and civil engineering. Particular attention is paid to the dialogue between analysts and decision makers taking into account the economic-technical aspects and social values. The recent chemical disaster in the Indian city of Bhopal again signals the necessity of such analyses. All the lectures were recorded individually. (orig./HP) [de

  17. An Introduction to Solar Decision-Making Tools

    Energy Technology Data Exchange (ETDEWEB)

    Mow, Benjamin [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-12

    The National Renewable Energy Laboratory (NREL) offers a variety of models and analysis tools to help decision makers evaluate and make informed decisions about solar projects, policies, and programs. This fact sheet aims to help decision makers determine which NREL tool to use for a given solar project or policy question, depending on its scope.

  18. Markov decision processes: a tool for sequential decision making under uncertainty.

    Science.gov (United States)

    Alagoz, Oguzhan; Hsu, Heather; Schaefer, Andrew J; Roberts, Mark S

    2010-01-01

    We provide a tutorial on the construction and evaluation of Markov decision processes (MDPs), which are powerful analytical tools used for sequential decision making under uncertainty that have been widely used in many industrial and manufacturing applications but are underutilized in medical decision making (MDM). We demonstrate the use of an MDP to solve a sequential clinical treatment problem under uncertainty. Markov decision processes generalize standard Markov models in that a decision process is embedded in the model and multiple decisions are made over time. Furthermore, they have significant advantages over standard decision analysis. We compare MDPs to standard Markov-based simulation models by solving the problem of the optimal timing of living-donor liver transplantation using both methods. Both models result in the same optimal transplantation policy and the same total life expectancies for the same patient and living donor. The computation time for solving the MDP model is significantly smaller than that for solving the Markov model. We briefly describe the growing literature of MDPs applied to medical decisions.

  19. A tool for study of optimal decision trees

    KAUST Repository

    Alkhalid, Abdulaziz; Chikalov, Igor; Moshkov, Mikhail

    2010-01-01

    The paper describes a tool which allows us for relatively small decision tables to make consecutive optimization of decision trees relative to various complexity measures such as number of nodes, average depth, and depth, and to find parameters

  20. Clinical Decision Support Tools: The Evolution of a Revolution

    NARCIS (Netherlands)

    Mould, D. R.; D'Haens, G.; Upton, R. N.

    2016-01-01

    Dashboard systems for clinical decision support integrate data from multiple sources. These systems, the newest in a long line of dose calculators and other decision support tools, utilize Bayesian approaches to fully individualize dosing using information gathered through therapeutic drug

  1. Visual Decision Support Tool for Supporting Asset ...

    Science.gov (United States)

    Abstract:Managing urban water infrastructures faces the challenge of jointly dealing with assets of diverse types, useful life, cost, ages and condition. Service quality and sustainability require sound long-term planning, well aligned with tactical and operational planning and management. In summary, the objective of an integrated approach to infrastructure asset management is to assist utilities answer the following questions:•Who are we at present?•What service do we deliver?•What do we own?•Where do we want to be in the long-term?•How do we get there?The AWARE-P approach (www.aware-p.org) offers a coherent methodological framework and a valuable portfolio of software tools. It is designed to assist water supply and wastewater utility decision-makers in their analyses and planning processes. It is based on a Plan-Do-Check-Act process and is in accordance with the key principles of the International Standards Organization (ISO) 55000 standards on asset management. It is compatible with, and complementary to WERF’s SIMPLE framework. The software assists in strategic, tactical, and operational planning, through a non-intrusive, web-based, collaborative environment where objectives and metrics drive IAM planning. It is aimed at industry professionals and managers, as well as at the consultants and technical experts that support them. It is easy to use and maximizes the value of information from multiple existing data sources, both in da

  2. Development and field testing of a decision support tool to facilitate shared decision making in contraceptive counseling.

    Science.gov (United States)

    Dehlendorf, Christine; Fitzpatrick, Judith; Steinauer, Jody; Swiader, Lawrence; Grumbach, Kevin; Hall, Cara; Kuppermann, Miriam

    2017-07-01

    We developed and formatively evaluated a tablet-based decision support tool for use by women prior to a contraceptive counseling visit to help them engage in shared decision making regarding method selection. Drawing upon formative work around women's preferences for contraceptive counseling and conceptual understanding of health care decision making, we iteratively developed a storyboard and then digital prototypes, based on best practices for decision support tool development. Pilot testing using both quantitative and qualitative data and cognitive testing was conducted. We obtained feedback from patient and provider advisory groups throughout the development process. Ninety-six percent of women who used the tool in pilot testing reported that it helped them choose a method, and qualitative interviews indicated acceptability of the tool's content and presentation. Compared to the control group, women who used the tool demonstrated trends toward increased likelihood of complete satisfaction with their method. Participant responses to cognitive testing were used in tool refinement. Our decision support tool appears acceptable to women in the family planning setting. Formative evaluation of the tool supports its utility among patients making contraceptive decisions, which can be further evaluated in a randomized controlled trial. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. The role of depression pharmacogenetic decision support tools in shared decision making.

    Science.gov (United States)

    Arandjelovic, Katarina; Eyre, Harris A; Lenze, Eric; Singh, Ajeet B; Berk, Michael; Bousman, Chad

    2017-10-29

    Patients discontinue antidepressant medications due to lack of knowledge, unrealistic expectations, and/or unacceptable side effects. Shared decision making (SDM) invites patients to play an active role in their treatment and may indirectly improve outcomes through enhanced engagement in care, adherence to treatment, and positive expectancy of medication outcomes. We believe decisional aids, such as pharmacogenetic decision support tools (PDSTs), facilitate SDM in the clinical setting. PDSTs may likewise predict drug tolerance and efficacy, and therefore adherence and effectiveness on an individual-patient level. There are several important ethical considerations to be navigated when integrating PDSTs into clinical practice. The field requires greater empirical research to demonstrate clinical utility, and the mechanisms thereof, as well as exploration of the ethical use of these technologies.

  4. Accelerated bridge construction (ABC) decision making and economic modeling tool.

    Science.gov (United States)

    2011-12-01

    In this FHWA-sponsored pool funded study, a set of decision making tools, based on the Analytic Hierarchy Process (AHP) was developed. This tool set is prepared for transportation specialists and decision-makers to determine if ABC is more effective ...

  5. Virtual Beach: Decision Support Tools for Beach Pathogen Prediction

    Science.gov (United States)

    The Virtual Beach Managers Tool (VB) is decision-making software developed to help local beach managers make decisions as to when beaches should be closed due to predicted high levels of water borne pathogens. The tool is being developed under the umbrella of EPA's Advanced Monit...

  6. A tool for study of optimal decision trees

    KAUST Repository

    Alkhalid, Abdulaziz

    2010-01-01

    The paper describes a tool which allows us for relatively small decision tables to make consecutive optimization of decision trees relative to various complexity measures such as number of nodes, average depth, and depth, and to find parameters and the number of optimal decision trees. © 2010 Springer-Verlag Berlin Heidelberg.

  7. SMARTool: A tool for clinical decision support for the management of patients with coronary artery disease based on modeling of atherosclerotic plaque process.

    Science.gov (United States)

    Sakellarios, Antonis I; Rigas, George; Kigka, Vassiliki; Siogkas, Panagiotis; Tsompou, Panagiota; Karanasiou, Georgia; Exarchos, Themis; Andrikos, Ioannis; Tachos, Nikolaos; Pelosi, Gualtriero; Parodi, Oberdan; Fotiaids, Dimitrios I

    2017-07-01

    SMARTool aims to the development of a clinical decision support system (CDSS) for the management and stratification of patients with coronary artery disease (CAD). This will be achieved by performing computational modeling of the main processes of atherosclerotic plaque growth. More specifically, computed tomography coronary angiography (CTCA) is acquired and 3-dimensional (3D) reconstruction is performed for the arterial trees. Then, blood flow and plaque growth modeling is employed simulating the major processes of atherosclerosis, such as the estimation of endothelial shear stress (ESS), the lipids transportation, low density lipoprotein (LDL) oxidation, macrophages migration and plaque development. The plaque growth model integrates information from genetic and biological data of the patients. The SMARTool system enables also the calculation of the virtual functional assessment index (vFAI), an index equivalent to the invasively measured fractional flow reserve (FFR), to provide decision support for patients with stenosed arteries. Finally, it integrates modeling of stent deployment. In this work preliminary results are presented. More specifically, the reconstruction methodology has mean value of Dice Coefficient and Hausdorff Distance is 0.749 and 1.746, respectively, while low ESS and high LDL concentration can predict plaque progression.

  8. Duplicate laboratory test reduction using a clinical decision support tool.

    Science.gov (United States)

    Procop, Gary W; Yerian, Lisa M; Wyllie, Robert; Harrison, A Marc; Kottke-Marchant, Kandice

    2014-05-01

    Duplicate laboratory tests that are unwarranted increase unnecessary phlebotomy, which contributes to iatrogenic anemia, decreased patient satisfaction, and increased health care costs. We employed a clinical decision support tool (CDST) to block unnecessary duplicate test orders during the computerized physician order entry (CPOE) process. We assessed laboratory cost savings after 2 years and searched for untoward patient events associated with this intervention. This CDST blocked 11,790 unnecessary duplicate test orders in these 2 years, which resulted in a cost savings of $183,586. There were no untoward effects reported associated with this intervention. The movement to CPOE affords real-time interaction between the laboratory and the physician through CDSTs that signal duplicate orders. These interactions save health care dollars and should also increase patient satisfaction and well-being.

  9. Stereotactic Radiosurgery in the Management of Patients With Brain Metastases of Non-Small Cell Lung Cancer: Indications, Decision Tools and Future Directions

    Directory of Open Access Journals (Sweden)

    Dianne Hartgerink

    2018-05-01

    Full Text Available Brain metastases (BM frequently occur in non-small cell lung cancer (NSCLC patients. Most patients with BM have a limited life expectancy, measured in months. Selected patients may experience a very long progression-free survival, for example, patients with a targetable driver mutation. Traditionally, whole-brain radiotherapy (WBRT has been the cornerstone of the treatment, but its indication is a matter of debate. A randomized trial has shown that for patients with a poor prognosis, WBRT does not add quality of life (QoL nor survival over the best supportive care. In recent decades, stereotactic radiosurgery (SRS has become an attractive non-invasive treatment for patients with BM. Only the BM is irradiated to an ablative dose, sparing healthy brain tissue. Intracranial recurrence rates decrease when WBRT is administered following SRS or resection but does not improve overall survival and comes at the expense of neurocognitive function and QoL. The downside of SRS compared with WBRT is a risk of radionecrosis (RN and a higher risk of developing new BM during follow-up. Currently, SRS is an established treatment for patients with a maximum of four BM. Several promising strategies are currently being investigated to further improve the indication and outcome of SRS for patients with BM: the effectivity and safety of SRS in patients with more than four BM, combining SRS with systemic therapy such as targeted agents or immunotherapy, shared decision-making with SRS as a treatment option, and individualized isotoxic dose prescription to mitigate the risk of RN and further enhance local control probability of SRS. This review discusses the current indications of SRS and future directions of treatment for patients with BM of NSCLC with focus on the value of SRS.

  10. Developing a Support Tool for Global Product Development Decisions

    DEFF Research Database (Denmark)

    Søndergaard, Erik Stefan; Ahmed-Kristensen, Saeema

    2016-01-01

    This paper investigates how global product development decisions are made through a multiple-case study in three Danish engineering. The paper identifies which information and methods are applied for making decisions and how decision-making can be supported based on previous experience. The paper...... presents results from 51 decisions made in the three companies, and based on the results of the studies a framework for a decision-support tool is outlined and discussed. The paper rounds off with an identification of future research opportunities in the area of global product development and decision-making....

  11. Decision-support tools for climate change mitigation planning

    DEFF Research Database (Denmark)

    Puig, Daniel; Aparcana Robles, Sandra Roxana

    . For example, in the case of life-cycle analysis, the evaluation criterion entails that the impacts of interest are examined across the entire life-cycle of the product under study, from extraction of raw materials, to product disposal. Effectively, then, the choice of decision-support tool directs......This document describes three decision-support tools that can aid the process of planning climate change mitigation actions. The phrase ‘decision-support tools’ refers to science-based analytical procedures that facilitate the evaluation of planning options (individually or compared to alternative...... options) against a particular evaluation criterion or set of criteria. Most often decision-support tools are applied with the help of purpose-designed software packages and drawing on specialised databases.The evaluation criteria alluded to above define and characterise each decision-support tool...

  12. [Patients' decision for aesthetic surgery].

    Science.gov (United States)

    Fansa, H; Haller, S

    2011-12-01

    Aesthetic surgery is a service which entails a high degree of trust. Service evaluation prior to provision is difficult for the patient. This leads to the question of how to manage the service successfully while still focusing on the medical needs. The decision to undergo an operation is not influenced by the operation itself, but by preoperative events which induce the patient to have the operation done. According to "buying decisions" for products or in service management, the decision for an aesthetic operation is extensive; the patient is highly involved and actively searching for information using different directed sources of information. The real "buying decision" consists of 5 phases: problem recognition, gathering of information, alternative education, purchase decision, and post purchase behaviour. A retrospective survey of 40 female patients who have already undergone an aesthetic operation assessed for problem recognition, which types of information were collected prior to the appointment with the surgeon, and why the patients have had the operation at our hospital. They were also asked how many alternative surgeons they had been seen before. Most of the patients had been thinking about undergoing an operation for several years. They mainly used the web for their research and were informed by other (non-aesthetic) physicians/general practitioners. Requested information was about the aesthetic results and possible problems and complications. Patients came based on web information and because of recommendations from other physicians. 60% of all interviewees did not see another surgeon and decided to have the operation because of positive patient-doctor communication and the surgeon's good reputation. Competence was considered to be the most important quality of the surgeon. However, the attribute was judged on subjective parameters. Environment, office rooms and staff were assessed as important but not very important. Costs of surgery were ranked second

  13. Medical decision making tools: Bayesian analysis and ROC analysis

    International Nuclear Information System (INIS)

    Lee, Byung Do

    2006-01-01

    During the diagnostic process of the various oral and maxillofacial lesions, we should consider the following: 'When should we order diagnostic tests? What tests should be ordered? How should we interpret the results clinically? And how should we use this frequently imperfect information to make optimal medical decision?' For the clinicians to make proper judgement, several decision making tools are suggested. This article discusses the concept of the diagnostic accuracy (sensitivity and specificity values) with several decision making tools such as decision matrix, ROC analysis and Bayesian analysis. The article also explain the introductory concept of ORAD program

  14. PSA as a tool for decision making

    International Nuclear Information System (INIS)

    Niehaus, F.; Lederman, L.

    1986-01-01

    The question on ''How safe is safe enough'' is being responded presently by deterministic criteria. Probabilistic criteria in support to more rational and less emotional decisions in regulatory and licensing issues, rationalization of resource allocation and research prioritization, among others, have a potential which is only marginally being explored. This paper discussed PSA limitations and proposes three areas for the use of PSA in decision making, namely: preventing accidents, mitigating accidents, and defining regulatory requirements. Current activities of the International Atomic Energy Agency in these areas are mentioned. PSA studies depict clearly the uncertainties and this is viewed as a positive aspect, which is unique to the use of probabilistic methods. (orig.)

  15. PSA as a tool for decision making

    Energy Technology Data Exchange (ETDEWEB)

    Niehaus, F; Lederman, L

    1986-05-01

    The question on ''How safe is safe enough'' is being responded presently by deterministic criteria. Probabilistic criteria in support to more rational and less emotional decisions in regulatory and licensing issues, rationalization of resource allocation and research prioritization, among others, have a potential which is only marginally being explored. This paper discussed PSA limitations and proposes three areas for the use of PSA in decision making, namely: preventing accidents, mitigating accidents, and defining regulatory requirements. Current activities of the International Atomic Energy Agency in these areas are mentioned. PSA studies depict clearly the uncertainties and this is viewed as a positive aspect, which is unique to the use of probabilistic methods.

  16. A Decision-Making Tools Workshop

    Science.gov (United States)

    1999-08-01

    alchemy for the decision support systems that you are creating. Dimensions will expand to unfathomable proportions. Measurements will span from the...into consideration information such as a company’s finances , forecasts of sales, earnings, expansion plans etc. The Technical Analysis agent uses

  17. Decision support tools for policy and planning

    International Nuclear Information System (INIS)

    Jacyk, P.; Schultz, D.; Spangenberg, L.

    1995-01-01

    A decision support system (DSS) is being developed at the Radioactive Liquid Waste Treatment Facility, Los Alamos National Laboratory (LANL). The DSS will be used to evaluate alternatives for improving LANL's existing central radioactive waste water treatment plant and to evaluate new site-wide liquid waste treatment schemes that are required in order to handle the diverse waste streams produced at LANL. The decision support system consists of interacting modules that perform the following tasks: rigorous process simulation, configuration management, performance analysis, cost analysis, risk analysis, environmental impact assessment, transportation modeling, and local, state, and federal regulation compliance checking. Uncertainty handling techniques are used with these modules and also with a decision synthesis module which combines results from the modules listed above. We believe the DSS being developed can be applied to almost any other industrial water treatment facility with little modification because in most situations the waste streams are less complex, fewer regulations apply, and the political environment is simpler. The techniques being developed are also generally applicable to policy and planning decision support systems in the chemical process industry

  18. Rade-aid: an operational tool for decision-makers

    International Nuclear Information System (INIS)

    Wagenaar, G.; van den Bosch, C.J.H.; Ehrhardt, J.; Steinhauer, C.; Morrey, M.; Robinson, C.A.

    1991-01-01

    If an accidental release of radionuclides occurs, decisions on countermeasures are required. Since the making of a decision involves many competing factors (for instance, the health risk versus the costs relating to a countermeasure), the decision-maker faces a problem. The aim of the RADE-AID (Radiological Accident DEcision AIDing) project is the development of a computer decision support system which can be used in the formulation of decisions. The theoretical background of the decision technique and its methods are outlined, together with the practical application of the technique in the form of the software package developed. Both the benefits of formal techniques and computerized tools in this field are discussed. In order to explore the appropriateness of the decision technique for the management of radiological emergencies, illustrative, but stylized, applications were carried out. Conclusions from these applications are discussed

  19. System Sketch: A Visualization Tool to Improve Community Decision Making

    Science.gov (United States)

    Making decisions in coastal and estuarine management requires a comprehensive understanding of the linkages between environmental, social, and economic systems. SystemSketch is a web-based scoping tool designed to assist resource managers in characterizing their systems, explorin...

  20. A Gaussian decision-support tool for engineering design process

    NARCIS (Netherlands)

    Rajabali Nejad, Mohammadreza; Spitas, Christos

    2013-01-01

    Decision-making in design is of great importance, resulting in success or failure of a system (Liu et al., 2010; Roozenburg and Eekels, 1995; Spitas, 2011a). This paper describes a robust decision-support tool for engineering design process, which can be used throughout the design process in either

  1. Decision or no decision: how do patient-physician interactions end and what matters?

    Science.gov (United States)

    Tai-Seale, Ming; Bramson, Rachel; Bao, Xiaoming

    2007-03-01

    A clearly stated clinical decision can induce a cognitive closure in patients and is an important investment in the end of patient-physician communications. Little is known about how often explicit decisions are made in primary care visits. To use an innovative videotape analysis approach to assess physicians' propensity to state decisions explicitly, and to examine the factors influencing decision patterns. We coded topics discussed in 395 videotapes of primary care visits, noting the number of instances and the length of discussions on each topic, and how discussions ended. A regression analysis tested the relationship between explicit decisions and visit factors such as the nature of topics under discussion, instances of discussion, the amount of time the patient spoke, and competing demands from other topics. About 77% of topics ended with explicit decisions. Patients spoke for an average of 58 seconds total per topic. Patients spoke more during topics that ended with an explicit decision, (67 seconds), compared with 36 seconds otherwise. The number of instances of a topic was associated with higher odds of having an explicit decision (OR = 1.73, p decisions. Although discussions often ended with explicit decisions, there were variations related to the content and dynamics of interactions. We recommend strengthening patients' voice and developing clinical tools, e.g., an "exit prescription," to improving decision making.

  2. Physicians' intentions and use of three patient decision aids

    Directory of Open Access Journals (Sweden)

    Mitchell Susan L

    2007-07-01

    Full Text Available Abstract Background Decision aids are evidence based tools that assist patients in making informed values-based choices and supplement the patient-clinician interaction. While there is evidence to show that decision aids improve key indicators of patients' decision quality, relatively little is known about physicians' acceptance of decision aids or factors that influence their decision to use them. The purpose of this study was to describe physicians' perceptions of three decision aids, their expressed intent to use them, and their subsequent use of them. Methods We conducted a cross-sectional survey of random samples of Canadian respirologists, family physicians, and geriatricians. Three decision aids representing a range of health decisions were evaluated. The survey elicited physicians' opinions on the characteristics of the decision aid and their willingness to use it. Physicians who indicated a strong likelihood of using the decision aid were contacted three months later regarding their actual use of the decision aid. Results Of the 580 eligible physicians, 47% (n = 270 returned completed questionnaires. More than 85% of the respondents felt the decision aid was well developed and that it presented the essential information for decision making in an understandable, balanced, and unbiased manner. A majority of respondents (>80% also felt that the decision aid would guide patients in a logical way, preparing them to participate in decision making and to reach a decision. Fewer physicians ( Conclusion Despite strong support for the format, content, and quality of patient decision aids, and physicians' stated intentions to adopt them into clinical practice, most did not use them within three months of completing the survey. There is a wide gap between intention and behaviour. Further research is required to study the determinants of this intention-behaviour gap and to develop interventions aimed at barriers to physicians' use of decision aids.

  3. Designing decision support tools for targeted N-regulation

    DEFF Research Database (Denmark)

    Christensen, Andreas Aagaard; Piil, Kristoffer; Andersen, Peter Stubkjær

    2017-01-01

    data model for land use data – the dNmark landscape model. Based on input data which is corrected and edited by workshop participants, the tool estimates the effect of potential land use scenarios on nutrient emissions. The tool was tested in 5 scenario workshops in case areas in Denmark in 2016...... in Denmark to develop and improve a functioning decision support tool for landscape scale N-management. The aim of the study is to evaluate how a decision support tool can best be designed in order to enable landscape scale strategic N-management practices. Methods: A prototype GIS-tool for capturing......, storing, editing, displaying and modelling landscape scale farming practices and associated emission consequences was developed. The tool was designed to integrate locally held knowledge with national scale datasets in live scenario situations through the implementation of a flexible, uniform and editable...

  4. Decision support tools for advanced energy management

    International Nuclear Information System (INIS)

    Marik, Karel; Schindler, Zdenek; Stluka, Petr

    2008-01-01

    Rising fuel costs boost energy prices, which is a driving force for improving efficiency of operation of any energy generation facility. This paper focuses on enhancing the operation of distributed integrated energy systems (IES), system that bring together all forms of cooling, heating and power (CCHP) technologies. Described methodology can be applied in power generation and district heating companies, as well as in small-scale systems that supply multiple types of utilities to consumers in industrial, commercial, residential and governmental spheres. Dispatching of such system in an optimal way needs to assess large number of production and purchasing schemes in conditions of continually changing market and variable utility demands influenced by many external factors, very often by weather conditions. The paper describes a combination of forecasting and optimization methods that supports effective decisions in IES system management. The forecaster generates the future most probable utility demand several hours or days ahead, derived from the past energy consumer behaviour. The optimizer generates economically most efficient operating schedule for the IES system that matches these forecasted energy demands and respects expected purchased energy prices. (author)

  5. Pilot study of a point-of-use decision support tool for cancer clinical trials eligibility.

    Science.gov (United States)

    Breitfeld, P P; Weisburd, M; Overhage, J M; Sledge, G; Tierney, W M

    1999-01-01

    Many adults with cancer are not enrolled in clinical trials because caregivers do not have the time to match the patient's clinical findings with varying eligibility criteria associated with multiple trials for which the patient might be eligible. The authors developed a point-of-use portable decision support tool (DS-TRIEL) to automate this matching process. The support tool consists of a hand-held computer with a programmable relational database. A two-level hierarchic decision framework was used for the identification of eligible subjects for two open breast cancer clinical trials. The hand-held computer also provides protocol consent forms and schemas to further help the busy oncologist. This decision support tool and the decision framework on which it is based could be used for multiple trials and different cancer sites.

  6. Physicians' intentions and use of three patient decision aids

    Science.gov (United States)

    Graham, Ian D; Logan, Jo; Bennett, Carol L; Presseau, Justin; O'Connor, Annette M; Mitchell, Susan L; Tetroe, Jacqueline M; Cranney, Ann; Hebert, Paul; Aaron, Shawn D

    2007-01-01

    Background Decision aids are evidence based tools that assist patients in making informed values-based choices and supplement the patient-clinician interaction. While there is evidence to show that decision aids improve key indicators of patients' decision quality, relatively little is known about physicians' acceptance of decision aids or factors that influence their decision to use them. The purpose of this study was to describe physicians' perceptions of three decision aids, their expressed intent to use them, and their subsequent use of them. Methods We conducted a cross-sectional survey of random samples of Canadian respirologists, family physicians, and geriatricians. Three decision aids representing a range of health decisions were evaluated. The survey elicited physicians' opinions on the characteristics of the decision aid and their willingness to use it. Physicians who indicated a strong likelihood of using the decision aid were contacted three months later regarding their actual use of the decision aid. Results Of the 580 eligible physicians, 47% (n = 270) returned completed questionnaires. More than 85% of the respondents felt the decision aid was well developed and that it presented the essential information for decision making in an understandable, balanced, and unbiased manner. A majority of respondents (>80%) also felt that the decision aid would guide patients in a logical way, preparing them to participate in decision making and to reach a decision. Fewer physicians (<60%) felt the decision aid would improve the quality of patient visits or be easily implemented into practice and very few (27%) felt that the decision aid would save time. Physicians' intentions to use the decision aid were related to their comfort with offering it to patients, the decision aid topic, and the perceived ease of implementing it into practice. While 54% of the surveyed physicians indicated they would use the decision aid, less than a third followed through with this

  7. Decision-making on olympic urban development - multi-actor decision support tool

    NARCIS (Netherlands)

    Heurkens, E.W.T.M.

    Subject of study is the possible organisation of the Olympic Games of 2028 in the Netherlands, as seen from an urban development viewpoint. The project focuses on the decision-making process in the initiative phase. Aim of the project is the development of a decision support tool for the complex,

  8. Patient involvement in health care decision making: a review.

    Science.gov (United States)

    Vahdat, Shaghayegh; Hamzehgardeshi, Leila; Hessam, Somayeh; Hamzehgardeshi, Zeinab

    2014-01-01

    Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions. Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making. To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article. BASED ON THE REVIEW OF ARTICLES AND BOOKS, TOPICS WERE DIVIDED INTO SIX GENERAL CATEGORIES: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making. IN MOST STUDIES, FACTORS INFLUENCING PATIENT PARTICIPATION CONSISTED OF: factors associated with health care professionals such as doctor-patient relationship, recognition of patient's knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services.

  9. A review of features in Internet consumer health decision-support tools.

    Science.gov (United States)

    Schwitzer, Gary

    2002-01-01

    Over the past decade, health care consumers have begun to benefit from new Web-based communications tools to guide decision making on treatments and tests. Using today's online tools, consumers who have Internet connections can: watch and listen to videos of physicians; watch and hear the stories of other consumers who have faced the same decisions; join an online social support network; receive estimates of their own chances of experiencing various outcomes; and do it all at home. To review currently-available Internet consumer health decision-support tools. Five Web sites offering consumer health decision-support tools are analyzed for their use of 4 key Web-enabled features: the presentation of outcomes probability data tailored to the individual user; the use of videotaped patient interviews in the final product to convey the experiences of people who have faced similar diagnoses in the past; the ability to interact with others in a social support network; and the accessibility of the tool to any health care consumers with an Internet connection. None of the 5 Web sites delivers all 4 target features to all Web users. The reasons for these variations in the use of key Web functionality--features that make the Web distinctive--are not immediately clear. Consumers trying to make health care decisions may benefit from current Web-based decision-support tools. But, variations in Web developers' use of 4 key Web-enabled features leaves the online decision-support experience less than what it could be. Key research questions are identified that could help in the development of new hybrid patient decision-support tools.

  10. A Decision Support Model and Tool to Assist Financial Decision-Making in Universities

    Science.gov (United States)

    Bhayat, Imtiaz; Manuguerra, Maurizio; Baldock, Clive

    2015-01-01

    In this paper, a model and tool is proposed to assist universities and other mission-based organisations to ascertain systematically the optimal portfolio of projects, in any year, meeting the organisations risk tolerances and available funds. The model and tool presented build on previous work on university operations and decision support systems…

  11. Understanding patient perceptions of shared decision making.

    Science.gov (United States)

    Shay, L Aubree; Lafata, Jennifer Elston

    2014-09-01

    This study aims to develop a conceptual model of patient-defined SDM, and understand what leads patients to label a specific, decision-making process as shared. Qualitative interviews were conducted with 23 primary care patients following a recent appointment. Patients were asked about the meaning of SDM and about specific decisions that they labeled as shared. Interviews were coded using qualitative content analysis. Patients' conceptual definition of SDM included four components of an interactive exchange prior to making the decision: both doctor and patient share information, both are open-minded and respectful, patient self-advocacy, and a personalized physician recommendation. Additionally, a long-term trusting relationship helps foster SDM. In contrast, when asked about a specific decision labeled as shared, patients described a range of interactions with the only commonality being that the two parties came to a mutually agreed-upon decision. There is no one-size-fits all process that leads patients to label a decision as shared. Rather, the outcome of "agreement" may be more important than the actual decision-making process for patients to label a decision as shared. Studies are needed to better understand how longitudinal communication between patient and physicians and patient self-advocacy behaviors affect patient perceptions of SDM. Published by Elsevier Ireland Ltd.

  12. Patients' Values in Clinical Decision-Making.

    Science.gov (United States)

    Faggion, Clovis Mariano; Pachur, Thorsten; Giannakopoulos, Nikolaos Nikitas

    2017-09-01

    Shared decision-making involves the participation of patient and dental practitioner. Well-informed decision-making requires that both parties understand important concepts that may influence the decision. This fourth article in a series of 4 aims to discuss the importance of patients' values when a clinical decision is made. We report on how to incorporate important concepts for well-informed, shared decision-making. Here, we present patient values as an important issue, in addition to previously established topics such as the risk of bias of a study, cost-effectiveness of treatment approaches, and a comparison of therapeutic benefit with potential side effects. We provide 2 clinical examples and suggestions for a decision tree, based on the available evidence. The information reported in this article may improve the relationship between patient and dental practitioner, resulting in more well-informed clinical decisions. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. DECISION SUPPORT TOOL FOR RETAIL SHELF SPACE OPTIMIZATION

    OpenAIRE

    B. RAMASESHAN; N. R. ACHUTHAN; R. COLLINSON

    2008-01-01

    Efficient allocation of shelf space and product assortment can significantly improve a retailer's profitability. This paper addresses the problem from the perspective of an independent franchise retailer. A Category Management Decision Support Tool (CMDST) is proposed that efficiently generates optimal shelf space allocations and product assortments by using the existing scarce resources, resulting in increased profitability. CMDST utilizes two practical integrated category management models ...

  14. A Debate and Decision-Making Tool for Enhanced Learning

    Science.gov (United States)

    López Garcia, Diego A.; Mateo Sanguino, Tomás de J.; Cortés Ancos, Estefania; Fernández de Viana González, Iñaki

    2016-01-01

    Debates have been used to develop critical thinking within teaching environments. Many learning activities are configured as working groups, which use debates to make decisions. Nevertheless, in a classroom debate, only a few students can participate; large work groups are similarly limited. Whilst the use of web tools would appear to offer a…

  15. Interactive Decision-Support Tool for Risk-Based Radiation Therapy Plan Comparison for Hodgkin Lymphoma

    DEFF Research Database (Denmark)

    Brodin, N. Patrik; Maraldo, Maja V.; Aznar, Marianne C.

    2014-01-01

    PURPOSE: To present a novel tool that allows quantitative estimation and visualization of the risk of various relevant normal tissue endpoints to aid in treatment plan comparison and clinical decision making in radiation therapy (RT) planning for Hodgkin lymphoma (HL). METHODS AND MATERIALS...... and a volumetric modulated arc therapy plan for a patient with mediastinal HL. CONCLUSION: This multiple-endpoint decision-support tool provides quantitative risk estimates to supplement the clinical judgment of the radiation oncologist when comparing different RT options....... of dose-response curves to drive the reoptimization of a volumetric modulated arc therapy treatment plan for an HL patient with head-and-neck involvement. We also use this decision-support tool to visualize and quantitatively evaluate the trade-off between a 3-dimensional conformal RT plan...

  16. Decision support and data warehousing tools boost competitive advantage.

    Science.gov (United States)

    Waldo, B H

    1998-01-01

    The ability to communicate across the care continuum is fast becoming an integral component of the successful health enterprise. As integrated delivery systems are formed and patient care delivery is restructured, health care professionals must be able to distribute, access, and evaluate information across departments and care settings. The Aberdeen Group, a computer and communications research and consulting organization, believes that "the single biggest challenge for next-generation health care providers is to improve on how they consolidate and manage information across the continuum of care. This involves building a strategic warehouse of clinical and financial information that can be shared and leveraged by health care professionals, regardless of the location or type of care setting" (Aberdeen Group, Inc., 1997). The value and importance of data and systems integration are growing. Organizations that create a strategy and implement DSS tools to provide decision-makers with the critical information they need to face the competition and maintain quality and costs will have the advantage.

  17. Guidance Tools for Use in Nuclear Material Management Decisions Making

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, G. V.; Baker, D. J.; Sorenson, K. B.; Boeke, S. G.

    2002-02-26

    This paper describes the results of Recommendation 14 of the Integrated Nuclear Materials Management Plan (INMMP) which was the product of a management initiative at the highest levels of the Department of Energy responding to a congressional directive to accelerate the work of achieving integration and cutting long-term costs associated with the management of nuclear materials, with the principal focus on excess materials. The INMMP provided direction to ''Develop policy-level decision support tools to support long-term planning and decision making.'' To accomplish this goal a team from the Savannah River Site, Sandia National Laboratories, Idaho National Engineering and Environmental Laboratory (INEEL), and the U.S. Department of Energy experienced in the decision-making process developed a Guidebook to Decision-Making Methods. The goal of the team organized to implement Recommendation 14 was to instill transparency, consistency, rigor, and discipline in the DOE decision process. The guidebook introduces a process and a selection of proven methods for disciplined decision-making so that the results are clearer, more transparent, and easier for reviewers to understand and accept. It was written to set a standard for a consistent decision process.

  18. CorRECTreatment: a web-based decision support tool for rectal cancer treatment that uses the analytic hierarchy process and decision tree.

    Science.gov (United States)

    Suner, A; Karakülah, G; Dicle, O; Sökmen, S; Çelikoğlu, C C

    2015-01-01

    The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians' decision making. The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratiodecisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options.

  19. Decision modelling tools for utilities in the deregulated energy market

    Energy Technology Data Exchange (ETDEWEB)

    Makkonen, S. [Process Vision Oy, Helsinki (Finland)

    2005-07-01

    , strategic decision support has also faced new challenges. This thesis introduces two applications involving multiple criteria decision making methods. The first application explores the decision making problem caused by the introduction of 'green' electricity that creates additional value for renewable energy. In this problem the stochastic multicriteria acceptability analysis method (SMAA) is applied. The second strategic multi-criteria decision making study discusses two different energy-related operations research problems: the elements of risk analysis in the energy field and the evaluation of different choices with a decision support tool accommodating incomplete preference information to help energy companies to select a proper risk management system. The application is based on the rank inclusion in criteria hierarchies (RICH) method. (orig.)

  20. OPTIMIZING USABILITY OF AN ECONOMIC DECISION SUPPORT TOOL: PROTOTYPE OF THE EQUIPT TOOL.

    Science.gov (United States)

    Cheung, Kei Long; Hiligsmann, Mickaël; Präger, Maximilian; Jones, Teresa; Józwiak-Hagymásy, Judit; Muñoz, Celia; Lester-George, Adam; Pokhrel, Subhash; López-Nicolás, Ángel; Trapero-Bertran, Marta; Evers, Silvia M A A; de Vries, Hein

    2018-01-01

    Economic decision-support tools can provide valuable information for tobacco control stakeholders, but their usability may impact the adoption of such tools. This study aims to illustrate a mixed-method usability evaluation of an economic decision-support tool for tobacco control, using the EQUIPT ROI tool prototype as a case study. A cross-sectional mixed methods design was used, including a heuristic evaluation, a thinking aloud approach, and a questionnaire testing and exploring the usability of the Return of Investment tool. A total of sixty-six users evaluated the tool (thinking aloud) and completed the questionnaire. For the heuristic evaluation, four experts evaluated the interface. In total twenty-one percent of the respondents perceived good usability. A total of 118 usability problems were identified, from which twenty-six problems were categorized as most severe, indicating high priority to fix them before implementation. Combining user-based and expert-based evaluation methods is recommended as these were shown to identify unique usability problems. The evaluation provides input to optimize usability of a decision-support tool, and may serve as a vantage point for other developers to conduct usability evaluations to refine similar tools before wide-scale implementation. Such studies could reduce implementation gaps by optimizing usability, enhancing in turn the research impact of such interventions.

  1. Decision support tool for diagnosing the source of variation

    Science.gov (United States)

    Masood, Ibrahim; Azrul Azhad Haizan, Mohamad; Norbaya Jumali, Siti; Ghazali, Farah Najihah Mohd; Razali, Hazlin Syafinaz Md; Shahir Yahya, Mohd; Azlan, Mohd Azwir bin

    2017-08-01

    Identifying the source of unnatural variation (SOV) in manufacturing process is essential for quality control. The Shewhart control chart patterns (CCPs) are commonly used to monitor the SOV. However, a proper interpretation of CCPs associated to its SOV requires a high skill industrial practitioner. Lack of knowledge in process engineering will lead to erroneous corrective action. The objective of this study is to design the operating procedures of computerized decision support tool (DST) for process diagnosis. The DST is an embedded tool in CCPs recognition scheme. Design methodology involves analysis of relationship between geometrical features, manufacturing process and CCPs. The DST contents information about CCPs and its possible root cause error and description on SOV phenomenon such as process deterioration in tool bluntness, offsetting tool, loading error, and changes in materials hardness. The DST will be useful for an industrial practitioner in making effective troubleshooting.

  2. Collaboration and decision making tools for mobile groups

    International Nuclear Information System (INIS)

    Abrahamyan, S.; Balyan, S.; Degtyarev, A.; Ter-Minasyan, H.

    2017-01-01

    Nowadays the use of distributed collaboration tools is widespread in many areas of people activity. But lack of mobility and certain equipment dependence create difficulties and decelerate development and integration of such technologies. Also, mobile technologies allow individuals to interact with each other without need of traditional office spaces and regardless of location. Hence, realization of special infrastructures on mobile platforms with the help of ad hoc wireless local networks could eliminate hardware attachment and be also useful in terms of scientific approach. Solutions from basic internet messengers to complex software for online collaboration equipment in large-scale workgroups are implementations of tools based on mobile infrastructures. Despite growth of mobile infrastructures, applied distributed solutions in group decision-making and e-collaboration are not common. In this article we propose software complex for real-time collaboration and decision-making based on mobile devices, describe its architecture and evaluate performance.

  3. Demonstration of Decision Support Tools for Sustainable Development

    Energy Technology Data Exchange (ETDEWEB)

    Shropshire, David Earl; Jacobson, Jacob Jordan; Berrett, Sharon; Cobb, D. A.; Worhach, P.

    2000-11-01

    The Demonstration of Decision Support Tools for Sustainable Development project integrated the Bechtel/Nexant Industrial Materials Exchange Planner and the Idaho National Engineering and Environmental Laboratory System Dynamic models, demonstrating their capabilities on alternative fuel applications in the Greater Yellowstone-Teton Park system. The combined model, called the Dynamic Industrial Material Exchange, was used on selected test cases in the Greater Yellow Teton Parks region to evaluate economic, environmental, and social implications of alternative fuel applications, and identifying primary and secondary industries. The test cases included looking at compressed natural gas applications in Teton National Park and Jackson, Wyoming, and studying ethanol use in Yellowstone National Park and gateway cities in Montana. With further development, the system could be used to assist decision-makers (local government, planners, vehicle purchasers, and fuel suppliers) in selecting alternative fuels, vehicles, and developing AF infrastructures. The system could become a regional AF market assessment tool that could help decision-makers understand the behavior of the AF market and conditions in which the market would grow. Based on this high level market assessment, investors and decision-makers would become more knowledgeable of the AF market opportunity before developing detailed plans and preparing financial analysis.

  4. Modelling elderly cardiac patients decision making using Cognitive Work Analysis: identifying requirements for patient decision aids.

    Science.gov (United States)

    Dhukaram, Anandhi Vivekanandan; Baber, Chris

    2015-06-01

    Patients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs. This paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making. This study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise. The results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use. CWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Conceptual air sparging decision tool in support of the development of an air sparging optimization decision tool

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-09-01

    The enclosed document describes a conceptual decision tool (hereinafter, Tool) for determining applicability of and for optimizing air sparging systems. The Tool was developed by a multi-disciplinary team of internationally recognized experts in air sparging technology, lead by a group of project and task managers at Parsons Engineering Science, Inc. (Parsons ES). The team included Mr. Douglas Downey and Dr. Robert Hinchee of Parsons ES, Dr. Paul Johnson of Arizona State University, Dr. Richard Johnson of Oregon Graduate Institute, and Mr. Michael Marley of Envirogen, Inc. User Community Panel Review was coordinated by Dr. Robert Siegrist of Colorado School of Mines (also of Oak Ridge National Laboratory) and Dr. Thomas Brouns of Battelle/Pacific Northwest Laboratory. The Tool is intended to provide guidance to field practitioners and environmental managers for evaluating the applicability and optimization of air sparging as remedial action technique.

  6. Human Decision Processes: Implications for SSA Support Tools

    Science.gov (United States)

    Picciano, P.

    2013-09-01

    Despite significant advances in computing power and artificial intelligence (AI), few critical decisions are made without a human decision maker in the loop. Space Situational Awareness (SSA) missions are both critical and complex, typically adhering to the human-in-the-loop (HITL) model. The collection of human operators injects a needed diversity of expert knowledge, experience, and authority required to successfully fulfill SSA tasking. A wealth of literature on human decision making exists citing myriad empirical studies and offering a varied set of prescriptive and descriptive models of judgment and decision making (Hastie & Dawes, 2001; Baron, 2000). Many findings have been proven sufficiently robust to allow information architects or system/interface designers to take action to improve decision processes. For the purpose of discussion, these concepts are bifurcated in two groups: 1) vulnerabilities to mitigate, and 2) capabilities to augment. These vulnerabilities and capabilities refer specifically to the decision process and should not be confused with a shortcoming or skill of a specific human operator. Thus the framing of questions and orders, the automated tools with which to collaborate, priming and contextual data, and the delivery of information all play a critical role in human judgment and choice. Evaluating the merits of any decision can be elusive; in order to constrain this discussion, ‘rational choice' will tend toward the economic model characteristics such as maximizing utility and selection consistency (e.g., if A preferred to B, and B preferred to C, than A should be preferred to C). Simple decision models often encourage one to list the pros and cons of a decision, perhaps use a weighting schema, but one way or another weigh the future benefit (or harm) of making a selection. The result (sought by the rationalist models) should drive toward higher utility. Despite notable differences in researchers' theses (to be discussed in the full

  7. Integrated environmental decision support tool based on GIS technology

    International Nuclear Information System (INIS)

    Doctor, P.G.; O'Neil, T.K.; Sackschewsky, M.R.; Becker, J.M.; Rykiel, E.J.; Walters, T.B.; Brandt, C.A.; Hall, J.A.

    1995-01-01

    Environmental restoration and management decisions facing the US Department of Energy require balancing trade-offs between diverse land uses and impacts over multiple spatial and temporal scales. Many types of environmental data have been collected for the Hanford Site and the Columbia River in Washington State over the past fifty years. Pacific Northwest National Laboratory (PNNL) is integrating these data into a Geographic Information System (GIS) based computer decision support tool. This tool provides a comprehensive and concise description of the current environmental landscape that can be used to evaluate the ecological and monetary trade-offs between future land use, restoration and remediation options before action is taken. Ecological impacts evaluated include effects to individual species of concern and habitat loss and fragmentation. Monetary impacts include those associated with habitat mitigation. The tool is organized as both a browsing tool for educational purposes, and as a framework that leads a project manager through the steps needed to be in compliance with environmental requirements

  8. [Decision making in the elderly: which tools for its evaluation by the clinician?].

    Science.gov (United States)

    Hommet, Caroline; Constans, Thierry; Atanasova, Boriana; Mondon, Karl

    2010-09-01

    Numerous decision-making situations occur in the activities of daily living. The consequences of the decision-making capacity disturbances may have a great impact on the patient's autonomy, financial management, and his or her reaction to a diagnosis as well as the ability to accept a therapeutic option or give informed consent. Decision-making is a complex and multi-dimensional process and brings into play attention, memory and executive functions, which are processed in the prefrontal cortex, particularly vulnerable in aging. A better comprehension of the mechanisms of decision-making, and of the resulting social consequences of their dysfunction may improve autonomy of the elderly. Unfortunately, we still lack appropriate tools to explore decision-making in routine practice.

  9. Shared decision making, paternalism and patient choice.

    Science.gov (United States)

    Sandman, Lars; Munthe, Christian

    2010-03-01

    In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship.

  10. Shared decision-making and patient autonomy.

    Science.gov (United States)

    Sandman, Lars; Munthe, Christian

    2009-01-01

    In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice.

  11. A Customized Drought Decision Support Tool for Hsinchu Science Park

    Science.gov (United States)

    Huang, Jung; Tien, Yu-Chuan; Lin, Hsuan-Te; Liu, Tzu-Ming; Tung, Ching-Pin

    2016-04-01

    Climate change creates more challenges for water resources management. Due to the lack of sufficient precipitation in Taiwan in fall of 2014, many cities and counties suffered from water shortage during early 2015. Many companies in Hsinchu Science Park were significantly influenced and realized that they need a decision support tool to help them managing water resources. Therefore, a customized computer program was developed, which is capable of predicting the future status of public water supply system and water storage of factories when the water rationing is announced by the government. This program presented in this study for drought decision support (DDSS) is a customized model for a semiconductor company in the Hsinchu Science Park. The DDSS is programmed in Java which is a platform-independent language. System requirements are any PC with the operating system above Windows XP and an installed Java SE Runtime Environment 7. The DDSS serves two main functions. First function is to predict the future storage of Baoshan Reservoir and Second Baoshan Reservoir, so to determine the time point of water use restriction in Hsinchu Science Park. Second function is to use the results to help the company to make decisions to trigger their response plans. The DDSS can conduct real-time scenario simulations calculating the possible storage of water tank for each factory with pre-implementation and post-implementation of those response plans. In addition, DDSS can create reports in Excel to help decision makers to compare results between different scenarios.

  12. A Decision Support Tool for Transient Stability Preventive Control

    DEFF Research Database (Denmark)

    Pertl, Michael; Weckesser, Johannes Tilman Gabriel; Rezkalla, Michel M.N.

    2017-01-01

    The paper presents a decision support tool for transient stability preventive control contributing to increased situation awareness of control room operators by providing additional information about the state of the power system in terms of transient stability. A time-domain approach is used...... a predefined minimum critical clearing time for faults at all buses is proposed, while costs are minimized. The results of the assessment are presented to the control room operator, who decides to accept the suggested dispatch or to repeat the assessment considering additional user-specific constraints...

  13. Collaboration and decision making tools for mobile groups

    Science.gov (United States)

    Abrahamyan, Suren; Balyan, Serob; Ter-Minasyan, Harutyun; Degtyarev, Alexander

    2017-12-01

    Nowadays the use of distributed collaboration tools is widespread in many areas of people activity. But lack of mobility and certain equipment-dependency creates difficulties and decelerates development and integration of such technologies. Also mobile technologies allow individuals to interact with each other without need of traditional office spaces and regardless of location. Hence, realization of special infrastructures on mobile platforms with help of ad-hoc wireless local networks could eliminate hardware-attachment and be useful also in terms of scientific approach. Solutions from basic internet-messengers to complex software for online collaboration equipment in large-scale workgroups are implementations of tools based on mobile infrastructures. Despite growth of mobile infrastructures, applied distributed solutions in group decisionmaking and e-collaboration are not common. In this article we propose software complex for real-time collaboration and decision-making based on mobile devices, describe its architecture and evaluate performance.

  14. Decision Support Tool for Prioritization of Surveillance and Maintenance Investment

    International Nuclear Information System (INIS)

    Velez, L.Y.; Conley, T.B.

    2009-01-01

    The Department of Energy (DOE) currently faces a difficult task in the disposition of the numerous excess or to-be excessed facilities owned by the Department. Many of these facilities are in various physical conditions and contain potentially hazardous nuclear, chemical, radiological or industrial materials left behind as a byproduct of nuclear weapons production, nuclear powered naval vessels and commercial nuclear energy production. During the last period of a facility's life cycle, it is important that surveillance and maintenance (S and M) be adequate to maintain the facility within an appropriate safety envelope. Inadequate investment in maintenance can cause facilities to deteriorate to the point they are unsafe for human entry. Too often this can mean tremendous increases to cost during deactivation and decommissioning (D and D). However, experiences often show that once buildings have been declared excess and enter the transition phase (as defined in DOE G 430.1-5 Transition Implementation Guide), maintenance budgets are drastically reduced. This is justified by the desire to not spend money 'on a building that is being torn down'. The objective of this study was to provide the U.S. Department of Energy (DOE) Environmental Management (EM) federal project directors and their contractors with a decision support tool to aid in prioritizing S and M investment across a site's excess facilities so that the limited budget available can be used most effectively. The analytical hierarchy process (AHP), a multi-criteria decision making method developed by Dr. Thomas Saaty in the 1970's, was used to derive the weight of importance of a defined list of risk-based criteria and typical S and M activities. A total of 10 facilities at the Oak Ridge National Laboratory (ORNL) varying in perceived hazards and conditions were chosen to test the tool by evaluating them with respect to each risk criterion and combining these results with the weight of importance of the S and M

  15. BUSINESS INTELLIGENCE TOOLS FOR DATA ANALYSIS AND DECISION MAKING

    Directory of Open Access Journals (Sweden)

    DEJAN ZDRAVESKI

    2011-04-01

    Full Text Available Every business is dynamic in nature and is affected by various external and internal factors. These factors include external market conditions, competitors, internal restructuring and re-alignment, operational optimization and paradigm shifts in the business itself. New regulations and restrictions, in combination with the above factors, contribute to the constant evolutionary nature of compelling, business-critical information; the kind of information that an organization needs to sustain and thrive. Business intelligence (“BI” is broad term that encapsulates the process of gathering information pertaining to a business and the market it functions in. This information when collated and analyzed in the right manner, can provide vital insights into the business and can be a tool to improve efficiency, reduce costs, reduce time lags and bring many positive changes. A business intelligence application helps to achieve precisely that. Successful organizations maximize the use of their data assets through business intelligence technology. The first data warehousing and decision support tools introduced companies to the power and benefits of accessing and analyzing their corporate data. Business users at every level found new, more sophisticated ways to analyze and report on the information mined from their vast data warehouses.Choosing a Business Intelligence offering is an important decision for an enterprise, one that will have a significant impact throughout the enterprise. The choice of a BI offering will affect people up and down the chain of command (senior management, analysts, and line managers and across functional areas (sales, finance, and operations. It will affect business users, application developers, and IT professionals. BI applications include the activities of decision support systems (DSS, query and reporting, online analyticalprocessing (OLAP, statistical analysis, forecasting, and data mining. Another way of phrasing this is

  16. PATIENT-CENTERED DECISION MAKING: LESSONS FROM MULTI-CRITERIA DECISION ANALYSIS FOR QUANTIFYING PATIENT PREFERENCES.

    Science.gov (United States)

    Marsh, Kevin; Caro, J Jaime; Zaiser, Erica; Heywood, James; Hamed, Alaa

    2018-01-01

    Patient preferences should be a central consideration in healthcare decision making. However, stories of patients challenging regulatory and reimbursement decisions has led to questions on whether patient voices are being considered sufficiently during those decision making processes. This has led some to argue that it is necessary to quantify patient preferences before they can be adequately considered. This study considers the lessons from the use of multi-criteria decision analysis (MCDA) for efforts to quantify patient preferences. It defines MCDA and summarizes the benefits it can provide to decision makers, identifies examples of MCDAs that have involved patients, and summarizes good practice guidelines as they relate to quantifying patient preferences. The guidance developed to support the use of MCDA in healthcare provide some useful considerations for the quantification of patient preferences, namely that researchers should give appropriate consideration to: the heterogeneity of patient preferences, and its relevance to decision makers; the cognitive challenges posed by different elicitation methods; and validity of the results they produce. Furthermore, it is important to consider how the relevance of these considerations varies with the decision being supported. The MCDA literature holds important lessons for how patient preferences should be quantified to support healthcare decision making.

  17. Facilitating knowledge transfer: decision support tools in environment and health.

    Science.gov (United States)

    Liu, Hai-Ying; Bartonova, Alena; Neofytou, Panagiotis; Yang, Aileen; Kobernus, Michael J; Negrenti, Emanuele; Housiadas, Christos

    2012-06-28

    The HENVINET Health and Environment Network aimed to enhance the use of scientific knowledge in environmental health for policy making. One of the goals was to identify and evaluate Decision Support Tools (DST) in current use. Special attention was paid to four "priority" health issues: asthma and allergies, cancer, neurodevelopment disorders, and endocrine disruptors.We identified a variety of tools that are used for decision making at various levels and by various stakeholders. We developed a common framework for information acquisition about DSTs, translated this to a database structure and collected the information in an online Metadata Base (MDB).The primary product is an open access web-based MDB currently filled with 67 DSTs, accessible through the HENVINET networking portal http://www.henvinet.eu and http://henvinet.nilu.no. Quality assurance and control of the entries and evaluation of requirements to use the DSTs were also a focus of the work. The HENVINET DST MDB is an open product that enables the public to get basic information about the DSTs, and to search the DSTs using pre-designed attributes or free text. Registered users are able to 1) review and comment on existing DSTs; 2) evaluate each DST's functionalities, and 3) add new DSTs, or change the entry for their own DSTs. Assessment of the available 67 DSTs showed: 1) more than 25% of the DSTs address only one pollution source; 2) 25% of the DSTs address only one environmental stressor; 3) almost 50% of the DSTs are only applied to one disease; 4) 41% of the DSTs can only be applied to one decision making area; 5) 60% of the DSTs' results are used only by national authority and/or municipality/urban level administration; 6) almost half of the DSTs are used only by environmental professionals and researchers. This indicates that there is a need to develop DSTs covering an increasing number of pollution sources, environmental stressors and health end points, and considering links to other 'Driving

  18. Combining multi-criteria decision analysis and mini-health technology assessment: A funding decision-support tool for medical devices in a university hospital setting.

    Science.gov (United States)

    Martelli, Nicolas; Hansen, Paul; van den Brink, Hélène; Boudard, Aurélie; Cordonnier, Anne-Laure; Devaux, Capucine; Pineau, Judith; Prognon, Patrice; Borget, Isabelle

    2016-02-01

    At the hospital level, decisions about purchasing new and oftentimes expensive medical devices must take into account multiple criteria simultaneously. Multi-criteria decision analysis (MCDA) is increasingly used for health technology assessment (HTA). One of the most successful hospital-based HTA approaches is mini-HTA, of which a notable example is the Matrix4value model. To develop a funding decision-support tool combining MCDA and mini-HTA, based on Matrix4value, suitable for medical devices for individual patient use in French university hospitals - known as the IDA tool, short for 'innovative device assessment'. Criteria for assessing medical devices were identified from a literature review and a survey of 18 French university hospitals. Weights for the criteria, representing their relative importance, were derived from a survey of 25 members of a medical devices committee using an elicitation technique involving pairwise comparisons. As a test of its usefulness, the IDA tool was applied to two new drug-eluting beads (DEBs) for transcatheter arterial chemoembolization. The IDA tool comprises five criteria and weights for each of two over-arching categories: risk and value. The tool revealed that the two new DEBs conferred no additional value relative to DEBs currently available. Feedback from participating decision-makers about the IDA tool was very positive. The tool could help to promote a more structured and transparent approach to HTA decision-making in French university hospitals. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Expert System Application of Forward Chaining and Certainty Factors Method for The Decision of Contraception Tools

    Science.gov (United States)

    Prambudi, Dwi Arief; Widodo, Catur Edi; Widodo, Aris Puji

    2018-02-01

    The choice of contraceptive tools is not an easy thing because the risks or effects will give impact on the body that never using it previously. in the other side, there is no contraception always suit for everybody because the circumstances of each body is different, so the extensive knowledge must be needed to know the advantages and disadvantages of each contraceptive tools then adjusted to the user's body.The expert system for contraceptive tools uses Forward Chaining search method combined with Certainty Factors Method. These method value the patient's indication. The Expert system gives the output data which define the kind of tool uses of the patient. the results obtained will be able to help people to find indications that lead to appropriate contraceptive tools and advice or suggestions about these tools. The success rate of the contraceptive tools decision experienced by experienced by the user by using forward chaining combined with the CF computation method is also influenced by the number of indication criteria selected by the user. Based on testing that has been done, expert system contraception tools has accuracy level equal to 75%.

  20. Shared decision making and patient decision aids: knowledge, attitudes, and practices among Hawai'i physicians.

    Science.gov (United States)

    Alden, Dana L; Friend, John; Chun, Maria B J

    2013-11-01

    As the health care field moves toward patient-centered care (PCC), increasing emphasis has been placed on the benefits of patient decision aids for promoting shared decision making (SDM). This study provides a baseline measure of knowledge, attitudes, and practices (KAP) among Hawai'i's physicians with respect to patient decision aids (DAs). Physicians throughout the State of Hawai'i were invited to complete a survey assessing their knowledge, attitudes, and practices with respect to the clinical use of DAs. One hundred and seventy four valid surveys were analyzed. Reported awareness and use of DAs were low, but recognition of the benefits of SDM and openness to the use of DAs were very high. The leading perceived barriers to the implementation of DAs were lack of awareness, lack of resources, and limited physician time to learn about DA technology. However, a significant majority of the respondents reported that DAs could empower patients by improving knowledge (88%), increasing satisfaction with the consultation process (81%), and increasing compliance (74%). Among physicians currently employing DAs, use of brochures or options matrix sheets was the most common aid tool. However, leading recommended DA formats were paper-based brochures for clinic use (75%) and interactive online website programs for outside clinic use (73.5%). Given growing emphasis on the PCC model and the recognized desire of many patients to participate in the medical decision making process, positive responses toward SDM and the use of DAs by Hawai'i physicians are promising.

  1. New decision support tool for acute lymphoblastic leukemia classification

    Science.gov (United States)

    Madhukar, Monica; Agaian, Sos; Chronopoulos, Anthony T.

    2012-03-01

    In this paper, we build up a new decision support tool to improve treatment intensity choice in childhood ALL. The developed system includes different methods to accurately measure furthermore cell properties in microscope blood film images. The blood images are exposed to series of pre-processing steps which include color correlation, and contrast enhancement. By performing K-means clustering on the resultant images, the nuclei of the cells under consideration are obtained. Shape features and texture features are then extracted for classification. The system is further tested on the classification of spectra measured from the cell nuclei in blood samples in order to distinguish normal cells from those affected by Acute Lymphoblastic Leukemia. The results show that the proposed system robustly segments and classifies acute lymphoblastic leukemia based on complete microscopic blood images.

  2. Veterans Like Me: Formative evaluation of a patient decision aid design.

    Science.gov (United States)

    Gibson, Bryan; Butler, Jorie; Doyon, Katherine; Ellington, Lee; Bray, Bruce E; Zeng, Qing

    2017-07-01

    Patient decision aids are tools intended to facilitate shared decision-making. Currently development of a patient decision aid is resource intensive: it requires a decision-specific review of the scientific literature by experts to ascertain the potential outcomes under different treatments. The goal of this project was to conduct a formative evaluation of a generalizable, scalable decision aid component we call Veterans Like Me (VLme). VLme mines EHR data to present the outcomes of individuals "like you" on different treatments to the user. These outcome are presented through a combination of an icon array and simulated narratives. Twenty-six patients participated in semi-structured interviews intended to elicit feedback on the tool's functional and interface design. The interview focused on the filters users desired with which to make cases similar to them, the kinds of outcomes they wanted presented, and their envisioned use of the tool. The interview also elicited participants information needs and salient factors related to the therapeutic decision. The interview transcripts were analyzed using an iteratively refined coding schema and content analysis. . Participants generally expressed enthusiasm for the tool's design and functionality. Our analysis identified desired filters for users to view patients like themselves, outcome types that should be included in future iterations of the tool (e.g. patient reported outcomes), and information needs that need to be addressed for patients to effectively participate in shared decision making. Implications for the integration of our findings into the design of patient decision aids are discussed. Published by Elsevier Inc.

  3. System dynamics models as decision-making tools in agritourism

    Directory of Open Access Journals (Sweden)

    Jere Jakulin Tadeja

    2016-12-01

    Full Text Available Agritourism as a type of niche tourism is a complex and softly defined phaenomenon. The demands for fast and integrated decision regarding agritourism and its interconnections with environment, economy (investments, traffic and social factors (tourists is urgent. Many different methodologies and methods master softly structured questions and dilemmas with global and local properties. Here we present methods of systems thinking and system dynamics, which were first brought into force in the educational and training area in the form of different computer simulations and later as tools for decision-making and organisational re-engineering. We develop system dynamics models in order to present accuracy of methodology. These models are essentially simple and can serve only as describers of the activity of basic mutual influences among variables. We will pay the attention to the methodology for parameter model values determination and the so-called mental model. This one is the basis of causal connections among model variables. At the end, we restore a connection between qualitative and quantitative models in frame of system dynamics.

  4. BUILDING PATIENT LOYALTY USING ONLINE TOOLS

    Directory of Open Access Journals (Sweden)

    Vladoi Anca Daniela

    2010-07-01

    Full Text Available The aim of the paper is to present the online tools used by private healthcare organizations in order to generate patient loyalty. The research emphases a comparative analyze between the Romanian and other European countries private healthcare organizations referring to online tools used by these organizations on their websites to generate patient loyalty.

  5. A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.

    Science.gov (United States)

    Wey, Andrew; Salkowski, Nicholas; Kremers, Walter K; Schaffhausen, Cory R; Kasiske, Bertram L; Israni, Ajay K; Snyder, Jon J

    2018-04-01

    We developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and we characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). For accepted offers, Cox proportional hazards models estimated these probabilities using transplanted kidneys. For declined offers, these probabilities were estimated by considering the experience of similar candidates who declined offers and the probability that declining would lead to these outcomes. We randomly selected 5000 declined offers and estimated these probabilities 3 years post-offer had the offers been accepted or declined. Predicted outcomes for declined offers were well calibrated (offers been accepted, the probabilities of graft survival and patient survival were typically higher. However, these advantages attenuated or disappeared with higher KDPI, candidate priority, and local donor supply. Donor pool restrictions were associated with worse 3-year outcomes, especially for candidates with high allocation priority. The kidney offer acceptance decision tool could inform offer acceptance by characterizing the potential risk-benefit trade-off associated with accepting or declining an offer. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  6. NOAA Climate Information and Tools for Decision Support Services

    Science.gov (United States)

    Timofeyeva, M. M.; Higgins, W.; Strager, C.; Horsfall, F. M.

    2013-12-01

    provision of information that will help guide long-term preparedness for severe weather events and extreme conditions as well as climate variability and change GFCS recently summarized examples of existing initiatives to advance provision of climate services in the 2012 publication Climate ExChange. In this publication, NWS introduced the new Local Climate Analysis Tool (LCAT), a tool that is used to conduct local climate studies that are needed to create efficient and reliable guidance for DSS. LCAT allows for analyzing trends in local climate variables and identifying local impacts of climate variability (e.g., ENSO) on weather and water conditions. In addition to LCAT, NWS, working in partnership with the North East Regional Climate center, released xmACIS version 2, a climate data mining tool, for NWS field operations. During this talk we will demonstrate LCAT and xmACIS as well as outline several examples of their application to DSS and its potential use for achieving GFCS goals. The examples include LCAT-based temperature analysis for energy decisions, guidance on weather and water events leading to increased algal blooms and red tide months in advance, local climate sensitivities to droughts, probabilities of hot/cold conditions and their potential impacts on agriculture and fish kills or fish stress.

  7. Usability Testing of a Complex Clinical Decision Support Tool in the Emergency Department: Lessons Learned.

    Science.gov (United States)

    Press, Anne; McCullagh, Lauren; Khan, Sundas; Schachter, Andy; Pardo, Salvatore; McGinn, Thomas

    2015-09-10

    As the electronic health record (EHR) becomes the preferred documentation tool across medical practices, health care organizations are pushing for clinical decision support systems (CDSS) to help bring clinical decision support (CDS) tools to the forefront of patient-physician interactions. A CDSS is integrated into the EHR and allows physicians to easily utilize CDS tools. However, often CDSS are integrated into the EHR without an initial phase of usability testing, resulting in poor adoption rates. Usability testing is important because it evaluates a CDSS by testing it on actual users. This paper outlines the usability phase of a study, which will test the impact of integration of the Wells CDSS for pulmonary embolism (PE) diagnosis into a large urban emergency department, where workflow is often chaotic and high stakes decisions are frequently made. We hypothesize that conducting usability testing prior to integration of the Wells score into an emergency room EHR will result in increased adoption rates by physicians. The objective of the study was to conduct usability testing for the integration of the Wells clinical prediction rule into a tertiary care center's emergency department EHR. We conducted usability testing of a CDS tool in the emergency department EHR. The CDS tool consisted of the Wells rule for PE in the form of a calculator and was triggered off computed tomography (CT) orders or patients' chief complaint. The study was conducted at a tertiary hospital in Queens, New York. There were seven residents that were recruited and participated in two phases of usability testing. The usability testing employed a "think aloud" method and "near-live" clinical simulation, where care providers interacted with standardized patients enacting a clinical scenario. Both phases were audiotaped, video-taped, and had screen-capture software activated for onscreen recordings. Phase I: Data from the "think-aloud" phase of the study showed an overall positive outlook on

  8. Randomized controlled trial of a video decision support tool for cardiopulmonary resuscitation decision making in advanced cancer.

    Science.gov (United States)

    Volandes, Angelo E; Paasche-Orlow, Michael K; Mitchell, Susan L; El-Jawahri, Areej; Davis, Aretha Delight; Barry, Michael J; Hartshorn, Kevan L; Jackson, Vicki Ann; Gillick, Muriel R; Walker-Corkery, Elizabeth S; Chang, Yuchiao; López, Lenny; Kemeny, Margaret; Bulone, Linda; Mann, Eileen; Misra, Sumi; Peachey, Matt; Abbo, Elmer D; Eichler, April F; Epstein, Andrew S; Noy, Ariela; Levin, Tomer T; Temel, Jennifer S

    2013-01-20

    Decision making regarding cardiopulmonary resuscitation (CPR) is challenging. This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer. We performed a randomized controlled trial of 150 patients with advanced cancer from four oncology centers. Participants in the control arm (n = 80) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation. Participants in the intervention arm (n = 70) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient. The primary outcome was participants' preference for or against CPR measured immediately after exposure to either modality. Secondary outcomes were participants' knowledge of CPR (score range of 0 to 4, with higher score indicating more knowledge) and comfort with video. The mean age of participants was 62 years (standard deviation, 11 years); 49% were women, 44% were African American or Latino, and 47% had lung or colon cancer. After the verbal narrative, in the control arm, 38 participants (48%) wanted CPR, 41 (51%) wanted no CPR, and one (1%) was uncertain. In contrast, in the intervention arm, 14 participants (20%) wanted CPR, 55 (79%) wanted no CPR, and 1 (1%) was uncertain (unadjusted odds ratio, 3.5; 95% CI, 1.7 to 7.2; P advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative.

  9. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi.

    Directory of Open Access Journals (Sweden)

    Glyn Elwyn

    Full Text Available To describe the development, validation and inter-rater reliability of an instrument to measure the quality of patient decision support technologies (decision aids.Scale development study, involving construct, item and scale development, validation and reliability testing.There has been increasing use of decision support technologies--adjuncts to the discussions clinicians have with patients about difficult decisions. A global interest in developing these interventions exists among both for-profit and not-for-profit organisations. It is therefore essential to have internationally accepted standards to assess the quality of their development, process, content, potential bias and method of field testing and evaluation.Scale development study, involving construct, item and scale development, validation and reliability testing.Twenty-five researcher-members of the International Patient Decision Aid Standards Collaboration worked together to develop the instrument (IPDASi. In the fourth Stage (reliability study, eight raters assessed thirty randomly selected decision support technologies.IPDASi measures quality in 10 dimensions, using 47 items, and provides an overall quality score (scaled from 0 to 100 for each intervention. Overall IPDASi scores ranged from 33 to 82 across the decision support technologies sampled (n = 30, enabling discrimination. The inter-rater intraclass correlation for the overall quality score was 0.80. Correlations of dimension scores with the overall score were all positive (0.31 to 0.68. Cronbach's alpha values for the 8 raters ranged from 0.72 to 0.93. Cronbach's alphas based on the dimension means ranged from 0.50 to 0.81, indicating that the dimensions, although well correlated, measure different aspects of decision support technology quality. A short version (19 items was also developed that had very similar mean scores to IPDASi and high correlation between short score and overall score 0.87 (CI 0.79 to 0.92.This work

  10. The Decision Tree: A Tool for Achieving Behavioral Change.

    Science.gov (United States)

    Saren, Dru

    1999-01-01

    Presents a "Decision Tree" process for structuring team decision making and problem solving about specific student behavioral goals. The Decision Tree involves a sequence of questions/decisions that can be answered in "yes/no" terms. Questions address reasonableness of the goal, time factors, importance of the goal, responsibilities, safety,…

  11. Selecting a risk-based tool to aid in decision making

    Energy Technology Data Exchange (ETDEWEB)

    Bendure, A.O.

    1995-03-01

    Selecting a risk-based tool to aid in decision making is as much of a challenge as properly using the tool once it has been selected. Failure to consider customer and stakeholder requirements and the technical bases and differences in risk-based decision making tools will produce confounding and/or politically unacceptable results when the tool is used. Selecting a risk-based decisionmaking tool must therefore be undertaken with the same, if not greater, rigor than the use of the tool once it is selected. This paper presents a process for selecting a risk-based tool appropriate to a set of prioritization or resource allocation tasks, discusses the results of applying the process to four risk-based decision-making tools, and identifies the ``musts`` for successful selection and implementation of a risk-based tool to aid in decision making.

  12. Adapting Scott and Bruce's General Decision-Making Style Inventory to Patient Decision Making in Provider Choice.

    Science.gov (United States)

    Fischer, Sophia; Soyez, Katja; Gurtner, Sebastian

    2015-05-01

    Research testing the concept of decision-making styles in specific contexts such as health care-related choices is missing. Therefore, we examine the contextuality of Scott and Bruce's (1995) General Decision-Making Style Inventory with respect to patient choice situations. Scott and Bruce's scale was adapted for use as a patient decision-making style inventory. In total, 388 German patients who underwent elective joint surgery responded to a questionnaire about their provider choice. Confirmatory factor analyses within 2 independent samples assessed factorial structure, reliability, and validity of the scale. The final 4-dimensional, 13-item patient decision-making style inventory showed satisfactory psychometric properties. Data analyses supported reliability and construct validity. Besides the intuitive, dependent, and avoidant style, a new subdimension, called "comparative" decision-making style, emerged that originated from the rational dimension of the general model. This research provides evidence for the contextuality of decision-making style to specific choice situations. Using a limited set of indicators, this report proposes the patient decision-making style inventory as valid and feasible tool to assess patients' decision propensities. © The Author(s) 2015.

  13. Towards life-cycle awareness in decision support tools for engineering design

    OpenAIRE

    Nergård, Henrik; Sandberg, Marcus; Larsson, Tobias

    2009-01-01

    In this paper a decision support tool with the focus on how to generate and visualize decision base coupled to the business agreement is outlined and discussed. Decision support tools for the early design phases are few and especially tools that visualize the readiness level of activities throughout the product life-cycle. Aiming for the sustainable society there is an indication that business-to-business manufacturers move toward providing a function rather than selling off the hardware and ...

  14. Tools to support important technical decisions during accident conditions

    International Nuclear Information System (INIS)

    Tenschert, J.; Bergiers, C.

    2008-01-01

    To handle design basis and beyond design basis accidents with intact reactor core, Nuclear Power Plants are using Emergency Operating Procedures (EOP) that they may have developed based on the generic Westinghouse Emergency Response Guidelines. Even though the EOPs are very directive, some questions are left to external support, i.e. to a team of persons constituting the so-called Technical Support Center (TSC). The Pressurized Water Reactor Owner Group (PWROG, previously Westinghouse Owner Group, WOG) has developed a TSC manual to support this group in their decision making process. Because of the specific and particular design of the Beznau NPP (KKB) Safety Systems, development of a plant-specific TSC manual required a lot of additions compared to the generic material. This plant-specific TSC manual is a helpful tool for the Site Emergency Director (SED) of the KKB to better evaluate issues and potential concerns arising while executing the EOPs. The majority of considered issues are relevant for beyond design basis accidents and external events. (orig.)

  15. Development and commissioning of decision support tools for sewerage management.

    Science.gov (United States)

    Manic, G; Printemps, C; Zug, M; Lemoine, C

    2006-01-01

    Managing sewerage systems is a highly complex task due to the dynamic nature of the facilities. Their performance strongly depends on the know-how applied by the operators. In order to define optimal operational settings, two decision support tools based on mathematical models have been developed. Moreover, easy-to-use interfaces have been created as well, aiding operators who presumably do not have the necessary skills to use modelling software. The two developed programs simulate the behaviour of both wastewater treatment plants (WWTP) and sewer network systems, respectively. They have essentially the same structure, including raw data management and statistical analysis, a simulation layer using the application programming interface of the applied software and a layer responsible for the representation of the obtained results. Four user modes are provided in the two software including the simulation of historical data using the applied and novel operational settings, as well as modes concerning prediction of possible operation periods and updates. Concerning the WWTP software, it was successfully installed in Nantes (France) in June 2004. Moreover, the one managing sewer networks has been deployed in Saint-Malo (France) in January 2005. This paper presents the structure of the developed software and the first results obtained during the commissioning phase.

  16. Value Tools in Managed Care Decision Making: Current Hurdles and Future Opportunities.

    Science.gov (United States)

    Schafer, Jeremy; Galante, Dominic; Shafrin, Jason

    2017-06-01

    Organizations such as the National Comprehensive Cancer Network, American Society of Clinical Oncology, Institute for Clinical and Economic Review, and Memorial Sloan Kettering have created distinct tools to help different stakeholders assess the value of oncology treatments. However, the oncology value tools were not necessarily created for payers, and it is unclear whether payers are using these tools as part of their drug management process. To understand what value tools payers are using in oncology management and what benefits and shortcomings the tools may have from the payer perspective. A survey targeting drug coverage decision makers at health plans was conducted in August 2016. Respondents attesting to using 2 or more value tools in drug management were eligible for an additional in-depth interview to understand the respondents' perceived benefits and shortcomings of current value tools. Respondents also were asked to describe desired attributes of a hypothetical payer-centric value tool. A total of 28 respondents representing approximately 160 million commercially insured medical lives completed the survey. Twenty respondents (71%) reported using at least 1 value tool in their drug management process. Twelve respondents (43%) used at least 2 tools, and 4 respondents (14%) used at least 3 tools. A total of 6 respondents were selected for in-depth interviews. Interviewees praised value tools for advancing the discussion on drug value and incorporating clinical evidence. However, interviewees felt available value tools varied on providing firm recommendations and relevant price benchmarks. Respondents most commonly recommended the following attributes of a proposed payer-centric value framework: taking a firm position on product value; product comparisons in lieu of comparative clinical trials; web-based tool access; and tool updates at least quarterly. Interview respondents also expressed some support for allowing manipulation of inputs and inclusion of

  17. Development of transportation asset management decision support tools : final report.

    Science.gov (United States)

    2017-08-09

    This study developed a web-based prototype decision support platform to demonstrate the benefits of transportation asset management in monitoring asset performance, supporting asset funding decisions, planning budget tradeoffs, and optimizing resourc...

  18. Decision support for patient care: implementing cybernetics.

    Science.gov (United States)

    Ozbolt, Judy; Ozdas, Asli; Waitman, Lemuel R; Smith, Janis B; Brennan, Grace V; Miller, Randolph A

    2004-01-01

    The application of principles and methods of cybernetics permits clinicians and managers to use feedback about care effectiveness and resource expenditure to improve quality and to control costs. Keys to the process are the specification of therapeutic goals and the creation of an organizational culture that supports the use of feedback to improve care. Daily feedback on the achievement of each patient's therapeutic goals provides tactical decision support, enabling clinicians to adjust care as needed. Monthly or quarterly feedback on aggregated goal achievement for all patients on a clinical pathway provides strategic decision support, enabling clinicians and managers to identify problems with supposed "best practices" and to test hypotheses about solutions. Work is underway at Vanderbilt University Medical Center to implement feedback loops in care and management processes and to evaluate the effects.

  19. Addressing health literacy in patient decision aids

    Science.gov (United States)

    2013-01-01

    Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and 2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations. Methods We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews. Results Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies

  20. Shared decision making after severe stroke-How can we improve patient and family involvement in treatment decisions?

    Science.gov (United States)

    Visvanathan, Akila; Dennis, Martin; Mead, Gillian; Whiteley, William N; Lawton, Julia; Doubal, Fergus Neil

    2017-12-01

    People who are well may regard survival with disability as being worse than death. However, this is often not the case when those surviving with disability (e.g. stroke survivors) are asked the same question. Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. Therefore, clinicians need to support patients and families in making informed decisions about the use of these treatments, in a process termed shared decision making. This is challenging after acute stroke: there is prognostic uncertainty, patients are often too unwell to participate in decision making, and proxies may not know the patients' expressed wishes (i.e. values). Patients' values also change over time and in different situations. There is limited evidence on successful methods to facilitate this process. Changes targeted at components of shared decision making (e.g. decision aids to provide information and discussing patient values) increase patient satisfaction. How this influences decision making is unclear. Presumably, a "shared decision-making tool" that introduces effective changes at various stages in this process might be helpful after acute stroke. For example, by complementing professional judgement with predictions from prognostic models, clinicians could provide information that is more accurate. Decision aids that are personalized may be helpful. Further qualitative research can provide clinicians with a better understanding of patient values and factors influencing this at different time points after a stroke. The evaluation of this tool in its success to achieve outcomes consistent with patients' values may require more than one clinical trial.

  1. Sharing clinical decisions for multimorbidity case management using social network and open-source tools.

    Science.gov (United States)

    Martínez-García, Alicia; Moreno-Conde, Alberto; Jódar-Sánchez, Francisco; Leal, Sandra; Parra, Carlos

    2013-12-01

    Social networks applied through Web 2.0 tools have gained importance in health domain, because they produce improvements on the communication and coordination capabilities among health professionals. This is highly relevant for multimorbidity patients care because there is a large number of health professionals in charge of patient care, and this requires to obtain clinical consensus in their decisions. Our objective is to develop a tool for collaborative work among health professionals for multimorbidity patient care. We describe the architecture to incorporate decision support functionalities in a social network tool to enable the adoption of shared decisions among health professionals from different care levels. As part of the first stage of the project, this paper describes the results obtained in a pilot study about acceptance and use of the social network component in our healthcare setting. At Virgen del Rocío University Hospital we have designed and developed the Shared Care Platform (SCP) to provide support in the continuity of care for multimorbidity patients. The SCP has two consecutively developed components: social network component, called Clinical Wall, and Clinical Decision Support (CDS) system. The Clinical Wall contains a record where health professionals are able to debate and define shared decisions. We conducted a pilot study to assess the use and acceptance of the SCP by healthcare professionals through questionnaire based on the theory of the Technology Acceptance Model. In March 2012 we released and deployed the SCP, but only with the social network component. The pilot project lasted 6 months in the hospital and 2 primary care centers. From March to September 2012 we created 16 records in the Clinical Wall, all with a high priority. A total of 10 professionals took part in the exchange of messages: 3 internists and 7 general practitioners generated 33 messages. 12 of the 16 record (75%) were answered by the destination health professionals

  2. Personalized prophylactic anticoagulation decision analysis in patients with membranous nephropathy

    Science.gov (United States)

    Lee, Taewoo; Biddle, Andrea K.; Lionaki, Sofia; Derebail, Vimal K.; Barbour, Sean J.; Tannous, Sameer; Hladunewich, Michelle A.; Hu, Yichun; Poulton, Caroline J.; Mahoney, Shannon L.; Jennette, J. Charles; Hogan, Susan L.; Falk, Ronald J.; Cattran, Daniel C.; Reich, Heather N.; Nachman, Patrick H.

    2014-01-01

    Primary membranous nephropathy is associated with increased risk of venous thromboembolic events, which are inversely correlated with serum albumin levels. To evaluate the potential benefit of prophylactic anticoagulation (venous thromboembolic events prevented) relative to the risk (major bleeds), we constructed a Markov decision model. The venous thromboembolic event risk according to serum albumin was obtained from an inception cohort of 898 patients with primary membranous nephropathy. Risk estimates of hemorrhage were obtained from a systematic literature review. Benefit-to-risk ratios were predicted according to bleeding risk and serum albumin. This ratio increased with worsening hypoalbuminemia from 4.5:1 for an albumin under 3 g/dl to 13.1:1 for an albumin under 2 g/dl in patients at low bleeding risk. Patients at intermediate bleeding risk with an albumin under 2 g/dl have a moderately favorable benefit-to-risk ratio (under 5:1). Patients at high bleeding risk are unlikely to benefit from prophylactic anticoagulation regardless of albuminemia. Probabilistic sensitivity analysis, to account for uncertainty in risk estimates, confirmed these trends. From these data, we constructed a tool to estimate the likelihood of benefit based on an individual’s bleeding risk profile, serum albumin level, and acceptable benefit-to-risk ratio (http://www.gntools.com). This tool provides an approach to the decision of prophylactic anticoagulation personalized to the individual’s needs and adaptable to dynamic changes in health status and risk profile. PMID:24336031

  3. An image-guided radiotherapy decision support framework incorporating a Bayesian network and visualization tool.

    Science.gov (United States)

    Hargrave, Catriona; Deegan, Timothy; Bednarz, Tomasz; Poulsen, Michael; Harden, Fiona; Mengersen, Kerrie

    2018-05-17

    To describe a Bayesian network (BN) and complementary visualization tool that aim to support decision-making during online cone-beam computed tomography (CBCT)-based image-guided radiotherapy (IGRT) for prostate cancer patients. The BN was created to represent relationships between observed prostate, proximal seminal vesicle (PSV), bladder and rectum volume variations, an image feature alignment score (FAS TV _ OAR ), delivered dose, and treatment plan compliance (TPC). Variables influencing tumor volume (TV) targeting accuracy such as intrafraction motion, and contouring and couch shift errors were also represented. A score of overall TPC (FAS global ) and factors such as image quality were used to inform the BN output node providing advice about proceeding with treatment. The BN was quantified using conditional probabilities generated from published studies, FAS TV _ OAR /global modeling, and a survey of IGRT decision-making practices. A new IGRT visualization tool (IGRT REV ), in the form of Mollweide projection plots, was developed to provide a global summary of residual errors after online CBCT-planning CT registration. Sensitivity and scenario analyses were undertaken to evaluate the performance of the BN and the relative influence of the network variables on TPC and the decision to proceed with treatment. The IGRT REV plots were evaluated in conjunction with the BN scenario testing, using additional test data generated from retrospective CBCT-planning CT soft-tissue registrations for 13/36 patients whose data were used in the FAS TV _ OAR /global modeling. Modeling of the TV targeting errors resulted in a very low probability of corrected distances between the CBCT and planning CT prostate or PSV volumes being within their thresholds. Strength of influence evaluation with and without the BN TV targeting error nodes indicated that rectum- and bladder-related network variables had the highest relative importance. When the TV targeting error nodes were excluded

  4. A free software tool for the development of decision support systems

    Directory of Open Access Journals (Sweden)

    COLONESE, G

    2008-06-01

    Full Text Available This article describes PostGeoOlap, a free software open source tool for decision support that integrates OLAP (On-Line Analytical Processing and GIS (Geographical Information Systems. Besides describing the tool, we show how it can be used to achieve effective and low cost decision support that is adequate for small and medium companies and for small public offices.

  5. FRAMEWORK FOR ENVIRONMENTAL DECISION-MAKING, FRED: A TOOL FOR ENVIRONMENTALLY-PREFERABLE PURCHASING

    Science.gov (United States)

    In support of the Environmentally Preferable Purchasing Program of the US EPA, the Systems Analysis Branch has developed a decision-making tool based on life cycle assessment. This tool, the Framework for Responsible Environmental Decision-making or FRED streamlines LCA by choosi...

  6. The Assessment of Burden of COPD (ABC) tool : a shared decision-making instrument that is predictive of healthcare costs

    NARCIS (Netherlands)

    Rutten-vanMolken, Maureen P. H. M.; Goossens, Lucas M A; Boland, Melinde R. S.; Donkers, Bas; Jonker, Marcel F.; Slok, Annerika H. M.; Salome, Philippe L.; van Schayck, Constant; In 't Veen, Johannes C C M; Stolk, Elly A.

    2017-01-01

    Background: The Assessment of Burden of COPD (ABC) tool is an instrument that supports shared decision making between patients and physicians. It includes a coloured balloon diagram to visualize a patient’s scores on a questionnaire about the experienced burden of COPD and several objective severity

  7. Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow.

    Science.gov (United States)

    Effken, Judith A; Brewer, Barbara B; Logue, Melanie D; Gephart, Sheila M; Verran, Joyce A

    2011-10-01

    To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain. Data for the WDA were obtained from semi-structured interviews with nurse managers, division directors, CNOs, and other managers (n = 20) on 10 patient care units in three Arizona hospitals. The WDA described the nurse manager's environment in terms of the constraints it imposes on the nurse manager's ability to achieve targeted outcomes through organizational goals and priorities, functions, processes, as well as work objects and resources (e.g., people, equipment, technology, and data). Constraints were identified and summarized through qualitative thematic analysis. The results highlight the competing priorities, and external and internal constraints that today's nurse managers must satisfy as they try to improve quality and safety outcomes on their units. Nurse managers receive a great deal of data, much in electronic format. Although dashboards were perceived as helpful because they integrated some data elements, no decision support tools were available to help nurse managers with planning or answering "what if" questions. The results suggest both the need for additional decision support to manage the growing complexity of the environment, and the constraints the environment places on the design of that technology if it is to be effective. Limitations of the study include the small homogeneous sample and the reliance on interview data targeting safety and quality. Copyright © 2011

  8. The Role of Heuristic Methods as a Decision-Making Tool in Aggregate Production Planning

    OpenAIRE

    Mahmood B. Ridha

    2015-01-01

    This study aims to explain the role of heuristic methods in the decision making process and as a tool for knowledge capture. As a result, we conclude that heuristic methods give better support to the decision maker than mathematical models in many cases especially when time and cost are critical factors in decision making.

  9. A decision tool for selecting trench cap designs

    Energy Technology Data Exchange (ETDEWEB)

    Paige, G.B.; Stone, J.J.; Lane, L.J. [USDA-ARS, Tucson, AZ (United States)] [and others

    1995-12-31

    A computer based prototype decision support system (PDSS) is being developed to assist the risk manager in selecting an appropriate trench cap design for waste disposal sites. The selection of the {open_quote}best{close_quote} design among feasible alternatives requires consideration of multiple and often conflicting objectives. The methodology used in the selection process consists of: selecting and parameterizing decision variables using data, simulation models, or expert opinion; selecting feasible trench cap design alternatives; ordering the decision variables and ranking the design alternatives. The decision model is based on multi-objective decision theory and uses a unique approach to order the decision variables and rank the design alternatives. Trench cap designs are evaluated based on federal regulations, hydrologic performance, cover stability and cost. Four trench cap designs, which were monitored for a four year period at Hill Air Force Base in Utah, are used to demonstrate the application of the PDSS and evaluate the results of the decision model. The results of the PDSS, using both data and simulations, illustrate the relative advantages of each of the cap designs and which cap is the {open_quotes}best{close_quotes} alternative for a given set of criteria and a particular importance order of those decision criteria.

  10. Pregnancy outcomes in Ghana : Relavance of clinical decision making support tools for frontline providers of care

    OpenAIRE

    Amoakoh-Coleman, M.

    2016-01-01

    Ghana’s slow progress towards attaining millennium development goal 5 has been associated with gaps in quality of care, particularly quality of clinical decision making for clients. This thesis reviews the relevance and effect of clinical decision making support tools on pregnancy outcomes. Relevance of three clinical decision making support tools available to frontline providers of care in the Greater Accra region is discussed. These are routine maternal health service delivery data populati...

  11. Applying an ethical decision-making tool to a nurse management dilemma.

    Science.gov (United States)

    Toren, Orly; Wagner, Nurith

    2010-05-01

    This article considers ethical dilemmas that nurse managers may confront and suggests an ethical decision-making model that could be used as a tool for resolving such dilemmas. The focus of the article is on the question: Can nurse managers choose the ethically right solution in conflicting situations when nurses' rights collide with patients' rights to quality care in a world of cost-effective and economic constraint? Managers' responsibility is to ensure and facilitate a safe and ethical working environment in which nurses are able to give quality care to their patients. In nursing it is frequently declared that managers' main obligations are to patients' needs and their rights to receive quality care. However, managers' ethical responsibilities are not only to patients but also to the nurses working in their institution. This article describes a real (but disguised) situation from an Israeli health care context to illustrate the dilemmas that may arise. The question is posed of whether nurse managers can maintain patients' and nurses' rights and, at the same time, fulfill their obligation to the conflicting demands of the organization. The article also offers a way to solve conflict by using an ethical decision-making model.

  12. Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Dirk T Ubbink

    2008-11-01

    Full Text Available Dirk T Ubbink1,2, Anouk M Knops1, Sjaak Molenaar1, Astrid Goossens11Department of Quality Assurance and Process Innovation and 2Department of Surgery, Academic Medical Center, Amsterdam, The NetherlandsObjective: To design, develop, and evaluate an evidence-based decision aid (DA for patients with an asymptomatic abdominal aortic aneurysm (AAA to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation and to help them make a shared decision.Methods: A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS. Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool.Results: A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients.Conclusion: This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values.Keywords: decision support techniques, research design, program development, abdominal aortic aneurysm, decision making

  13. Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence.

    Science.gov (United States)

    Stein, Bradley D; Kogan, Jane N; Mihalyo, Mark J; Schuster, James; Deegan, Patricia E; Sorbero, Mark J; Drake, Robert E

    2013-04-01

    Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.

  14. Decision support tools in conservation: a workshop to improve user-centred design

    Directory of Open Access Journals (Sweden)

    David Rose

    2017-09-01

    Full Text Available A workshop held at the University of Cambridge in May 2017 brought developers, researchers, knowledge brokers, and users together to discuss user-centred design of decision support tools. Decision support tools are designed to take users through logical decision steps towards an evidence-informed final decision. Although they may exist in different forms, including on paper, decision support tools are generally considered to be computer- (online, software or app-based. Studies have illustrated the potential value of decision support tools for conservation, and there are several papers describing the design of individual tools. Rather less attention, however, has been placed on the desirable characteristics for use, and even less on whether tools are actually being used in practice. This is concerning because if tools are not used by their intended end user, for example a policy-maker or practitioner, then its design will have wasted resources. Based on an analysis of papers on tool use in conservation, there is a lack of social science research on improving design, and relatively few examples where users have been incorporated into the design process. Evidence from other disciplines, particularly human-computer interaction research, illustrates that involving users throughout the design of decision support tools increases the relevance, usability, and impact of systems. User-centred design of tools is, however, seldom mentioned in the conservation literature. The workshop started the necessary process of bringing together developers and users to share knowledge about how to conduct good user-centred design of decision support tools. This will help to ensure that tools are usable and make an impact in conservation policy and practice.

  15. A shared decision-making tool for obstructive sleep apnea without tonsillar hypertrophy: A randomized controlled trial.

    Science.gov (United States)

    Bergeron, Mathieu; Duggins, Angela L; Cohen, Aliza P; Tiemeyer, Karin; Mullen, Lisa; Crisalli, Joseph; McArthur, Angela; Ishman, Stacey L

    2018-04-01

    Shared decision-making is a process whereby patients and clinicians jointly establish a treatment plan integrating clinical evidence and patient values and preferences. Although this approach has been successfully employed in numerous medical disciplines, often using shared decision-making tools, otolaryngologic research assessing its use is scant. Our primary objective was therefore to determine if the tools we developed reduced decisional conflict for children with obstructive sleep apnea without tonsillar hypertrophy. Prospective, single-blind, randomized controlled trial. We enrolled consecutive patients meeting inclusion criteria who were referred to our multidisciplinary upper airway center. Study patients used a shared decision-making tool whereas controls did not. Measures of decisional conflict (SURE [Sure of myself, Understanding information, Risk benefit ratio, Encouragement], CollaboRATE, and the Decisional Conflict Scale [DCS]) were obtained pre- and postvisit. We assessed 50 families (study group = 24, controls = 26). The mean age was 8.8 ± 6.6 years, 44% were female, 86% were white, and the mean obstructive apnea-hypopnea index was 12.7 ± 15.6 events/hour. The previsit mean DCS score was similar for controls (42.7) and study patients (40.8) (P = .38). The postvisit mean DCS score for controls was 13.3 and for study patients 6.1 (P = .034). Improvement in this score was greater in the study group (P = .03). At previsit evaluation, 63% of controls and 58% of study patients were unsure about their options. Postvisit, this improved to 4.1% and 0%, respectively. Families counseled regarding treatment options using shared decision-making tools had significantly less decisional conflict than those who did not use these tools. These positive outcomes suggest that clinicians should consider integrating this approach into clinical practice. 1b. Laryngoscope, 128:1007-1015, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Understanding patients' decisions. Cognitive and emotional perspectives.

    Science.gov (United States)

    Redelmeier, D A; Rozin, P; Kahneman, D

    1993-07-07

    To describe ways in which intuitive thought processes and feelings may lead patients to make suboptimal medical decisions. Review of past studies from the psychology literature. Intuitive decision making is often appropriate and results in reasonable choices; in some situations, however, intuitions lead patients to make choices that are not in their best interests. People sometimes treat safety and danger categorically, undervalue the importance of a partial risk reduction, are influenced by the way in which a problem is framed, and inappropriately evaluate an action by its subsequent outcome. These strategies help explain examples where risk perceptions conflict with standard scientific analyses. In the domain of emotions, people tend to consider losses as more significant than the corresponding gains, are imperfect at predicting future preferences, distort their memories of past personal experiences, have difficulty resolving inconsistencies between emotions and rationality, and worry with an intensity disproportionate to the actual danger. In general, such intangible aspects of clinical care have received little attention in the medical literature. We suggest that an awareness of how people reason is an important clinical skill that can be promoted by knowledge of selected past studies in psychology.

  17. Exploring the impact of a decision support intervention on vascular access decisions in chronic hemodialysis patients: study protocol

    Directory of Open Access Journals (Sweden)

    Donnelly Sandra

    2011-02-01

    Full Text Available Abstract Background In patients with Stage 5 Chronic Kidney Disease who require renal replacement therapy a major decision concerns modality choice. However, many patients defer the decision about modality choice or they have an urgent or emergent need of RRT, which results in them starting hemodialysis with a Central Venous Catheter. Thereafter, efforts to help patients make more timely decisions about access choices utilizing education and resource allocation strategies met with limited success resulting in a high prevalent CVC use in Canada. Providing decision support tailored to meet patients' decision making needs may improve this situation. The Registered Nurses Association of Ontario has developed a clinical practice guideline to guide decision support for adults living with Chronic Kidney Disease (Decision Support for Adults with Chronic Kidney Disease. The purpose of this study is to determine the impact of implementing selected recommendations this guideline on priority provincial targets for hemodialysis access in patients with Stage 5 CKD who currently use Central Venous Catheters for vascular access. Methods/Design A non-experimental intervention study with repeated measures will be conducted at St. Michaels Hospital in Toronto, Canada. Decisional conflict about dialysis access choice will be measured using the validated SURE tool, an instrument used to identify decisional conflict. Thereafter a tailored decision support intervention will be implemented. Decisional conflict will be re-measured and compared with baseline scores. Patients and staff will be interviewed to gain an understanding of how useful this intervention was for them and whether it would be feasible to implement more widely. Quantitative data will be analyzed using descriptive and inferential statistics. Statistical significance of difference between means over time for aggregated SURE scores (pre/post will be assessed using a paired t-test. Qualitative analysis

  18. Genetic Stratification in Myeloid Diseases: From Risk Assessment to Clinical Decision Support Tool

    Directory of Open Access Journals (Sweden)

    Yishai Ofran

    2014-10-01

    Full Text Available Genetic aberrations have become a dominant factor in the stratification of myeloid malignancies. Cytogenetic and a few mutation studies are the backbone of risk assessment models of myeloid malignancies which are a major consideration in clinical decisions, especially patient assignment for allogeneic stem cell transplantation. Progress in our understanding of the genetic basis of the pathogenesis of myeloid malignancies and the growing capabilities of mass sequencing may add new roles for the clinical usage of genetic data. A few recently identified mutations recognized to be associated with specific diseases or clinical scenarios may soon become part of the diagnostic criteria of such conditions. Mutational studies may also advance our capabilities for a more efficient patient selection process, assigning the most effective therapy at the best timing for each patient. The clinical utility of genetic data is anticipated to advance further with the adoption of deep sequencing and next-generation sequencing techniques. We herein suggest some future potential applications of sequential genetic data to identify pending deteriorations at time points which are the best for aggressive interventions such as allogeneic stem cell transplantation. Genetics is moving from being mostly a prognostic factor to becoming a multitasking decision support tool for hematologists. Physicians must pay attention to advances in molecular hematology as it will soon be accessible and influential for most of our patients.

  19. Decision support tools : midterm review report Knowledge for Climate Theme 8

    NARCIS (Netherlands)

    Ierland, van E.C.

    2012-01-01

    The KfC program Decision Support Tools aims at improving tools for design and evaluation of adaptation strategies with a special focus on spatial planning and cross cutting issues. The program focuses on three core elements 1. tools for formulation of the adaptation task, based on climate scenarios

  20. Capacity for Preferences: Respecting Patients with Compromised Decision-Making.

    Science.gov (United States)

    Wasserman, Jason Adam; Navin, Mark Christopher

    2018-05-01

    When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient's best interests. We argue that, even when there is input from a surrogate, patient preferences should be an additional source of guidance for decisions about patients who lack decision-making capacity. Our proposal builds on other efforts to help patients who lack decision-making capacity provide input into decisions about their care. For example, "supported," "assisted," or "guided" decision-making models reflect a commitment to humanistic patient engagement and create a more supportive process for patients, families, and health care teams. But often, they are supportive processes for guiding a patient toward a decision that the surrogate or team believes to be in the patient's medical best interests. Another approach holds that taking seriously the preferences of such a patient can help surrogates develop a better account of what the patient's treatment choices would have been if the patient had retained decision-making capacity; the surrogate then must try to integrate features of the patient's formerly rational self with the preferences of the patient's currently compromised self. Patients who lack decision-making capacity are well served by these efforts to solicit and use their preferences to promote best interests or to craft would-be autonomous patient images for use by surrogates. However, we go further: the moral reasons for valuing the preferences of patients without decision-making capacity are not reducible to either best-interests or (surrogate) autonomy considerations but can be grounded in the values of liberty and respect for persons. This has

  1. Shared decision-making in stroke: an evolving approach to improved patient care.

    Science.gov (United States)

    Armstrong, Melissa J

    2017-06-01

    Shared decision-making (SDM) occurs when patients, families and clinicians consider patients' values and preferences alongside the best medical evidence and partner to make the best decision for a given patient in a specific scenario. SDM is increasingly promoted within Western contexts and is also being explored outside such settings, including in China. SDM and tools to promote SDM can improve patients' knowledge/understanding, participation in the decision-making process, satisfaction and trust in the healthcare team. SDM has also proposed long-term benefits to patients, clinicians, organisations and healthcare systems. To successfully perform SDM, clinicians must know their patients' values and goals and the evidence underlying different diagnostic and treatment options. This is relevant for decisions throughout stroke care, from thrombolysis to goals of care, diagnostic assessments, rehabilitation strategies, and secondary stroke prevention. Various physician, patient, family, cultural and system barriers to SDM exist. Strategies to overcome these barriers and facilitate SDM include clinician motivation, patient participation, adequate time and tools to support the process, such as decision aids. Although research about SDM in stroke care is lacking, decision aids are available for select decisions, such as anticoagulation for stroke prevention in atrial fibrillation. Future research is needed regarding both cultural aspects of successful SDM and application of SDM to stroke-specific contexts.

  2. Modelling Financial-Accounting Decisions by Means of OLAP Tools

    Directory of Open Access Journals (Sweden)

    Diana Elena CODREAN

    2011-03-01

    Full Text Available At present, one can say that a company’s good running largely depends on the information quantity and quality it relies on when making decisions. The information needed to underlie decisions and be obtained due to the existence of a high-performing information system which makes it possible for the data to be shown quickly, synthetically and truly, also providing the opportunity for complex analyses and predictions. In such circumstances, computerized accounting systems, too, have grown their complexity by means of data analyzing information solutions such as OLAP and Data Mining which help perform a multidimensional analysis of financial-accounting data, potential frauds can be detected and data hidden information can be revealed, trends for certain indicators can be set up, therefore ensuring useful information to a company’s decision making.

  3. Making interactive decision support for patients a reality.

    NARCIS (Netherlands)

    Evans, R.W.; Elwyn, G.; Edwards, A.

    2004-01-01

    Interactive decision support applications might help patients to make difficult decisions about their health care. They lie in the context of traditional decision aids, which are known to have effects on a number of patient outcomes, including knowledge and decisional conflict. The problem of

  4. Decision to resuscitate or not in patients with chronic diseases

    DEFF Research Database (Denmark)

    Saltbæk, Lena; Tvedegaard, Erling

    2012-01-01

    Do-not-resuscitate (DNR) decisions are frequently made without informing the patients. We attempt to determine whether patients and physicians wish to discuss the DNR decision, who they think, should be the final decision maker and whether they agree on the indication for cardiopulmonary...... resuscitation (CPR) in case of cardiac arrest....

  5. On developing a prospecting tool for wind industry and policy decision support

    International Nuclear Information System (INIS)

    McKeown, Charles; Adelaja, Adesoji; Calnin, Benjamin

    2011-01-01

    This paper presents the rudiments of a Wind Prospecting Tool designed to inform private and public decision makers involved in wind industry development in reducing transaction costs associated with identifying areas of mutual focus within a state. The multiple layer decision support framework has proven to be valuable to industry, state government and local decision makers. Information on wind resources, land availability, potential land costs, potential NIMBYism concerns and economic development potential were integrated to develop a framework for decision support. The paper also highlights implications for decision support research and the role of higher education in providing anticipatory science to enhance private and public choices in economic development. - Research Highlights: →In this paper we explore the building and value of a wind industry location decision support tool. →We examine the development process from the industry perspective. →We discuss the creation of a decision support tool that was designed for industry, state policy makers and local decision makers. →We build a model framework for wind prospecting decision support. →Finally we discuss the impact on local and state decision making as a result of being informed by science based decision support.

  6. The neglected topic: presentation of cost information in patient decision AIDS.

    Science.gov (United States)

    Blumenthal-Barby, J S; Robinson, Emily; Cantor, Scott B; Naik, Aanand D; Russell, Heidi Voelker; Volk, Robert J

    2015-05-01

    Costs are an important component of patients' decision making, but a comparatively underemphasized aspect of formal shared decision making. We hypothesized that decision aids also avoid discussion of costs, despite their being tools designed to facilitate shared decision making about patient-centered outcomes. We sought to define the frequency of cost-related information and identify the common modes of presenting cost and cost-related information in the 290 decision aids catalogued in the Ottawa Hospital Research Institute's Decision Aid Library Inventory (DALI) system. We found that 56% (n = 161) of the decision aids mentioned cost in some way, but only 13% (n = 37) gave a specific price or range of prices. We identified 9 different ways in which cost was mentioned. The most common approach was as a "pro" of one of the treatment options (e.g., "you avoid the cost of medication"). Of the 37 decision aids that gave specific prices or ranges of prices for treatment options, only 2 were about surgery decisions despite the fact that surgery decision aids were the most common. Our findings suggest that presentation of cost information in decision aids is highly variable. Evidence-based guidelines should be developed by the International Patient Decision Aid Standards (IPDAS) Collaboration. © The Author(s) 2015.

  7. A Decision Support Tool For Thrift Savings Plan Investors

    National Research Council Canada - National Science Library

    Blanchette, Christopher

    2004-01-01

    .... These funds give investors the opportunity to diversify among a wide range of securities. This thesis examines the funds offered by the plan and creates a portfolio selection tool that uses investor inputs...

  8. Data access and decision tools for coastal water resources management

    Science.gov (United States)

    US EPA has supported the development of numerous models and tools to support implementation of environmental regulations. However, transfer of knowledge and methods from detailed technical models to support practical problem solving by local communities and watershed or coastal ...

  9. Decision-making among patients and their family in ALS care: a review.

    Science.gov (United States)

    Foley, Geraldine; Hynes, Geralyn

    2018-05-01

    Practice guidelines in ALS care emphasise the role of the patient and their family in the decision-making process. We aimed to examine the ALS patient/family relationship in the decision-making process and to ascertain how patients and their family can shape one another's decisions pertaining to care. We conducted a review of peer-reviewed empirical research, published in full and in English between January 2007 and January 2017, relating to care decision-making among ALS patients and their family. Database sources included: Medline; CINAHL; AMED; PsycINFO; PsycARTICLES; and Social Sciences Full Text. A narrative synthesis was undertaken. Forty-seven studies from the empirical literature were extracted. The family viewpoint was captured primarily from family members with direct care-giving duties. Patients' cognitive status was not routinely assessed. The findings revealed that the decision-making process in ALS care can be contoured by patients' and family caregivers' perceived responsibilities to one another and to the wider family. Greater attention to family member roles beyond the primary caregiver role is needed. Strategies that integrate cognitively-impaired patients into the family decision-making process require investigation. Identification of the domains in which ALS patients and their family members support one another in the decision-making process could facilitate the development of patient/family decision-making tools in ALS care.

  10. Data for decision making: strategic information tools for hospital management during a pandemic.

    Science.gov (United States)

    Farias, Daniel R; Raffo, Lucrecia; Bacigalupo, Silvia; Cremaschi, Maria; Vence, Liliana; Ramos, Susana; Salguero, Ana; Claudio, Martin; Meites, Elissa; Cubito, Alejandro

    2010-10-01

    During the 2009 influenza A (H1N1) pandemic, Argentina's Hospital Nacional Profesor Alejandro Posadas, a referral center in the capital province of Buenos Aires, treated a large urban patient population. Beginning in April, after severe influenza had been reported in North America but before any suspected cases of H1N1 had been reported in Argentina, the authors formed a pandemic planning committee to direct our hospital's response. An important strategy of the management team was to create a single daily monitoring tool that could integrate multiple information sources. We describe our pandemic planning strategy so that it may serve as a template for other hospitals. We describe our integrated data management system and the indicators it measured. We also describe the iterative process used to develop these tools and the current versions we use in surveillance for possible new waves of pandemic influenza. We present 3 examples of strategic decision making applied to data from our integrated information system. Daily pandemic surveillance data motivated the planning committee to reallocate hospital resources to care for patients during the peak pandemic period. This report illustrates the importance of pandemic planning and advanced integrated information tools for management of a health care facility during a pandemic.

  11. A conceptual tool for improving rangeland management decision ...

    African Journals Online (AJOL)

    ... the LLM concept should be seen as a continuous and evolving learning process that will be updated over the long term through decision support to include several other components essential to implement effective and sustainable rangeland management practices by local land users. Keywords: desertification; indicators ...

  12. Decision-support tool for management of miombo woodlands: a ...

    African Journals Online (AJOL)

    The model complexity is well adapted to the data quality and abundance, and it is dependent on proxies of some main drivers of the dynamic processes. The development of the matrix model is a step forward facilitating better decisions in the management of miombo woodlands. However, data ranges used for calibrating ...

  13. Supporting decision making by a critical thinking tool

    NARCIS (Netherlands)

    Dongen, C.J.G. van; Schraagen, J.M.C.; Eikelboom, A.; Brake, G.M. te

    2005-01-01

    Building up situation understanding is one of the most difficult tasks in the beginning stages of largescale accidents. As ambiguous information about the events becomes available, decision-makers are often tempted to quickly develop a particular story to explain the observed events. As the accident

  14. Designing Tools for Supporting User Decision-Making in e-Commerce

    Science.gov (United States)

    Sutcliffe, Alistair; Al-Qaed, Faisal

    The paper describes a set of tools designed to support a variety of user decision-making strategies. The tools are complemented by an online advisor so they can be adapted to different domains and users can be guided to adopt appropriate tools for different choices in e-commerce, e.g. purchasing high-value products, exploring product fit to users’ needs, or selecting products which satisfy requirements. The tools range from simple recommenders to decision support by interactive querying and comparison matrices. They were evaluated in a scenario-based experiment which varied the users’ task and motivation, with and without an advisor agent. The results show the tools and advisor were effective in supporting users and agreed with the predictions of ADM (adaptive decision making) theory, on which the design of the tools was based.

  15. The decision-making role of the patient in localised prostate cancer treatment

    Directory of Open Access Journals (Sweden)

    Luke L Wang

    2017-03-01

    Full Text Available Our objective was to review the current literature on patient participation and decision-making in the treatment selection process for localised prostate cancer, and to evaluate capacity for improvement. Methods: 42 articles from our literature search were deemed eligible and relevant for review. We reviewed studies on all facets of the treatment decision-making process with most number of articles (16 on treatment preferences. Results: The majority of the patients prefer an active or collaborative role in decision-making. Patients are seeking information from a myriad of sources but the recommendation from their treating physician is often the most influential on the final decision. Radical prostatectomy is more likely to be selected in patients who view a cure for cancer as being of the utmost importance and radiation therapy is preferred in patients who are concerned about treatment side effects. Conclusion: Currently no ideal tool exists to assist patients in making informed treatment decisions that also takes into account patients’ values and preferences. We encourage collaborative partnership in a multidisciplinary setting to optimise this process and individualised risk-based decision-making tools may provide a better pathway to assist patients reach decisions.

  16. Participatory design of probability-based decision support tools for in-hospital nurses.

    Science.gov (United States)

    Jeffery, Alvin D; Novak, Laurie L; Kennedy, Betsy; Dietrich, Mary S; Mion, Lorraine C

    2017-11-01

    To describe nurses' preferences for the design of a probability-based clinical decision support (PB-CDS) tool for in-hospital clinical deterioration. A convenience sample of bedside nurses, charge nurses, and rapid response nurses (n = 20) from adult and pediatric hospitals completed participatory design sessions with researchers in a simulation laboratory to elicit preferred design considerations for a PB-CDS tool. Following theme-based content analysis, we shared findings with user interface designers and created a low-fidelity prototype. Three major themes and several considerations for design elements of a PB-CDS tool surfaced from end users. Themes focused on "painting a picture" of the patient condition over time, promoting empowerment, and aligning probability information with what a nurse already believes about the patient. The most notable design element consideration included visualizing a temporal trend of the predicted probability of the outcome along with user-selected overlapping depictions of vital signs, laboratory values, and outcome-related treatments and interventions. Participants expressed that the prototype adequately operationalized requests from the design sessions. Participatory design served as a valuable method in taking the first step toward developing PB-CDS tools for nurses. This information about preferred design elements of tools that support, rather than interrupt, nurses' cognitive workflows can benefit future studies in this field as well as nurses' practice. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.

  17. Computer-based tools for decision support at the Hanford Site

    International Nuclear Information System (INIS)

    Doctor, P.G.; Mahaffey, J.A.; Cowley, P.J.; Freshley, M.D.; Hassig, N.L.; Brothers, J.W.; Glantz, C.S.; Strachan, D.M.

    1992-11-01

    To help integrate activities in the environmental restoration and waste management mission of the Hanford Site, the Hanford Integrated Planning Project (HIPP) was established and funded by the US Department of Energy. The project is divided into three key program elements, the first focusing on an explicit, defensible and comprehensive method for evaluating technical options. Based on the premise that computer technology can be used to support the decision-making process and facilitate integration among programs and activities, the Decision Support Tools Task was charged with assessing the status of computer technology for those purposes at the Site. The task addressed two types of tools: tools need to provide technical information and management support tools. Technical tools include performance and risk assessment models, information management systems, data and the computer infrastructure to supports models, data, and information management systems. Management decision support tools are used to synthesize information at a high' level to assist with making decisions. The major conclusions resulting from the assessment are that there is much technical information available, but it is not reaching the decision-makers in a form to be used. Many existing tools provide components that are needed to integrate site activities; however, some components are missing and, more importantly, the ''glue'' or connections to tie the components together to answer decision-makers questions is largely absent. Top priority should be given to decision support tools that support activities given in the TPA. Other decision tools are needed to facilitate and support the environmental restoration and waste management mission

  18. Computer-based tools for decision support at the Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Doctor, P.G.; Mahaffey, J.A.; Cowley, P.J.; Freshley, M.D.; Hassig, N.L.; Brothers, J.W.; Glantz, C.S.; Strachan, D.M.

    1992-11-01

    To help integrate activities in the environmental restoration and waste management mission of the Hanford Site, the Hanford Integrated Planning Project (HIPP) was established and funded by the US Department of Energy. The project is divided into three key program elements, the first focusing on an explicit, defensible and comprehensive method for evaluating technical options. Based on the premise that computer technology can be used to support the decision-making process and facilitate integration among programs and activities, the Decision Support Tools Task was charged with assessing the status of computer technology for those purposes at the Site. The task addressed two types of tools: tools need to provide technical information and management support tools. Technical tools include performance and risk assessment models, information management systems, data and the computer infrastructure to supports models, data, and information management systems. Management decision support tools are used to synthesize information at a high' level to assist with making decisions. The major conclusions resulting from the assessment are that there is much technical information available, but it is not reaching the decision-makers in a form to be used. Many existing tools provide components that are needed to integrate site activities; however, some components are missing and, more importantly, the glue'' or connections to tie the components together to answer decision-makers questions is largely absent. Top priority should be given to decision support tools that support activities given in the TPA. Other decision tools are needed to facilitate and support the environmental restoration and waste management mission.

  19. Computer-based tools for decision support at the Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Doctor, P.G.; Mahaffey, J.A.; Cowley, P.J.; Freshley, M.D.; Hassig, N.L.; Brothers, J.W.; Glantz, C.S.; Strachan, D.M.

    1992-11-01

    To help integrate activities in the environmental restoration and waste management mission of the Hanford Site, the Hanford Integrated Planning Project (HIPP) was established and funded by the US Department of Energy. The project is divided into three key program elements, the first focusing on an explicit, defensible and comprehensive method for evaluating technical options. Based on the premise that computer technology can be used to support the decision-making process and facilitate integration among programs and activities, the Decision Support Tools Task was charged with assessing the status of computer technology for those purposes at the Site. The task addressed two types of tools: tools need to provide technical information and management support tools. Technical tools include performance and risk assessment models, information management systems, data and the computer infrastructure to supports models, data, and information management systems. Management decision support tools are used to synthesize information at a high` level to assist with making decisions. The major conclusions resulting from the assessment are that there is much technical information available, but it is not reaching the decision-makers in a form to be used. Many existing tools provide components that are needed to integrate site activities; however, some components are missing and, more importantly, the ``glue`` or connections to tie the components together to answer decision-makers questions is largely absent. Top priority should be given to decision support tools that support activities given in the TPA. Other decision tools are needed to facilitate and support the environmental restoration and waste management mission.

  20. The emergency patient's participation in medical decision-making.

    Science.gov (United States)

    Wang, Li-Hsiang; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Han, Chin-Yen; Liu, Hsueh-Erh

    2016-09-01

    The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. The findings fill a gap in knowledge about the decision-making process among emergency patients. The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff. © 2016 John Wiley & Sons Ltd.

  1. System and method for integrating hazard-based decision making tools and processes

    Science.gov (United States)

    Hodgin, C Reed [Westminster, CO

    2012-03-20

    A system and method for inputting, analyzing, and disseminating information necessary for identified decision-makers to respond to emergency situations. This system and method provides consistency and integration among multiple groups, and may be used for both initial consequence-based decisions and follow-on consequence-based decisions. The system and method in a preferred embodiment also provides tools for accessing and manipulating information that are appropriate for each decision-maker, in order to achieve more reasoned and timely consequence-based decisions. The invention includes processes for designing and implementing a system or method for responding to emergency situations.

  2. DECISION IN ACCOUNTING USING TOOLS IT&C

    Directory of Open Access Journals (Sweden)

    MARES MARIUS DANIEL

    2014-07-01

    Full Text Available Taking a management decision is usually a complex endeavour with many stages. Gathering and assimilating information supposes perception processes based on attitudes which are determined by the values and fundamental beliefs of the individual. These values and beliefs are in a large degree tributary to the national culture to which we belong. The role of cultural particularities in forming perceptions becomes a priority of the economic agents, the manager being the catalyst of information, involved in the integration, administering and updating pertinent information, from the thousands of data available by using IT&C. The quality of the decision depends on the qualities, knowledge and aptitudes of the manager, and this is why it is a good idea to attract a greater number of specialists in the decisional process.

  3. Education tools for dynamic Bayesian decision-making

    Czech Academy of Sciences Publication Activity Database

    Suzdaleva, Evgenia; Nedoma, Petr

    2006-01-01

    Roč. 5, č. 3 (2006), s. 288-295 ISSN 1790-1979 R&D Projects: GA ČR GP201/06/P434; GA ČR GA102/03/0049 Institutional research plan: CEZ:AV0Z10750506 Keywords : educational system * Bayesian decision-making * probabilistic mixtures Subject RIV: JC - Computer Hardware ; Software http://library.utia.cas.cz/prace/20060144.pdf

  4. Spatio-temporal reasoning and decision support tools

    OpenAIRE

    Renso, Chiara; Wachowicz, Monica

    2014-01-01

    Currently, mobility data is revolutionizing the traditional fields of spatio-temporal reasoning and decision making analysis, not only to scale-up to the large and growing data volumes, but also to address complex questions related to change, trends, duration, and evolution. In mobility data, space and time are inextricably linked, since humans, robots and systems that dynamically act, and interact within social networks, are embedded in space, and any change is often the result of actions an...

  5. A simple tool to help decision making in infrastructure planning and ...

    African Journals Online (AJOL)

    2006-10-04

    Oct 4, 2006 ... a tool to help decision making for planning and management of phytotreatment ... mental studies aimed at the quantitative estimation of biologi- cal processes .... water has been simulated with a logistic model assuming an.

  6. Decision support tools to support the operations of traffic management centers (TMC)

    Science.gov (United States)

    2011-01-31

    The goal of this project is to develop decision support tools to support traffic management operations based on collected intelligent transportation system (ITS) data. The project developments are in accordance with the needs of traffic management ce...

  7. Portfolio Management Decision Support Tools Analysis Relating to Management Value Metrics

    National Research Council Canada - National Science Library

    Goodson, Christopher J; Knutson, Richard D

    2007-01-01

    .... The results of this research will assist MDA managers, and operational leaders, in making portfolio management decisions for allocating resources to create the correct support tools for MDA processes...

  8. Patient decision making: strategies for diabetes diet adherence intervention.

    Science.gov (United States)

    Kavookjian, Jan; Berger, Bruce A; Grimley, Diane M; Villaume, William A; Anderson, Heidi M; Barker, Kenneth N

    2005-09-01

    Patient self-care is critical in controlling diabetes and its complications. Lack of diet adherence is a particular challenge to effective diabetes intervention. The Transtheoretical Model (TTM) of Change, decision-making theory, and self-efficacy have contributed to successful tailoring of interventions in many target behaviors. The purpose of this study was to develop a diagnostic tool, including TTM measures for the stages of change, decisional balance, and self-efficacy, that pharmacists involved in diabetes intervention can use for patients resistant to a diet regimen. A questionnaire was developed through a literature review, interviews with diabetic patients, an expert panel input, and pretesting. Cross-sectional implementation of the questionnaire among a convenience sample of 193 type 1 and type 2 diabetic patients took place at 4 patient care sites throughout the southeastern United States. Validated measures were used to collect respondent self-report for the TTM variables and for demographic and diabetes history variables. Social desirability was also assessed. Relationships among TTM measures for diet adherence generally replicated those established for other target behaviors. Salient items were identified as potential facilitators (decisional balance pros) or barriers (decisional balance cons and self-efficacy tempting situations) to change. Social desirability exhibited a statistically significant relationship with patient report of diet adherence, with statistically significant differences in mean social desirability across race categories. The TTM measures for the stages of change, decisional balance, and self-efficacy are useful for making decisions on individually tailored interventions for diet adherence, with caution asserted about the potential of diabetes patients to self-report the target behavior in a socially desirable manner. Future research directions, implications, and limitations of the findings are also presented.

  9. Decision-Making Tool for Cost-Efficient and Environmentally Friendly Wood Mobilisation

    OpenAIRE

    Matevž Triplat; Peter Prislan; Nike Krajnc

    2015-01-01

    Background and Purpose: With development of forest management technologies, the efficiency of wood production was significantly improved, and thus the impact on forests has changed as well. The article presents a practical decision-making tool for selection of most suitable harvesting system, considering given terrain as well as expected soil conditions on harvesting sites. The decision-making tool should support cost-efficient and environmentally friendly mobilisation of wood. Materials a...

  10. Doing Academic Planning: Effective Tools for Decision Making.

    Science.gov (United States)

    Nedwek, Brian P., Ed.

    This sourcebook was designed to provide academic planners with the tools to perform core functions and activities that facilitate the transformation of higher education institutions from provider-centered cultures and organizations to learner-centered franchises. The readings examine partnerships and alliances needed for higher education to…

  11. Risk based decision tool for space exploration missions

    Science.gov (United States)

    Meshkat, Leila; Cornford, Steve; Moran, Terrence

    2003-01-01

    This paper presents an approach and corresponding tool to assess and analyze the risks involved in a mission during the pre-phase A design process. This approach is based on creating a risk template for each subsystem expert involved in the mission design process and defining appropriate interactions between the templates.

  12. Pregnancy outcomes in Ghana : Relavance of clinical decision making support tools for frontline providers of care

    NARCIS (Netherlands)

    Amoakoh-Coleman, M.

    2016-01-01

    Ghana’s slow progress towards attaining millennium development goal 5 has been associated with gaps in quality of care, particularly quality of clinical decision making for clients. This thesis reviews the relevance and effect of clinical decision making support tools on pregnancy

  13. Assessing Sustainability of Coral Reef Ecosystem Services using a Spatially-Explicit Decision Support Tool

    Science.gov (United States)

    Forecasting and communicating the potential outcomes of decision options requires support tools that aid in evaluating alternative scenarios in a user-friendly context and that highlight variables relevant to the decision options and valuable stakeholders. Envision is a GIS-base...

  14. Achieving informed decision-making for net zero energy buildings design using building performance simulation tools

    NARCIS (Netherlands)

    Attia, S.G.; Gratia, E.; De Herde, A.; Hensen, J.L.M.

    2013-01-01

    Building performance simulation (BPS) is the basis for informed decision-making of Net Zero Energy Buildings (NZEBs) design. This paper aims to investigate the use of building performance simulation tools as a method of informing the design decision of NZEBs. The aim of this study is to evaluate the

  15. Dutch gas distribution grid goes green: decision support tool for local biogas utilization

    NARCIS (Netherlands)

    Weidenaar, Teade; Hoekstra, Sipke; Wolters, Mannes

    2011-01-01

    A Decision Support Tool (DST) has been developed that will aid Distribution Service Operators (DSOs) in their decision making process on which investments to make in the gas distribution grid in order to facilitate the use of biogas. The DST considers both the conversion of biogas to electricity as

  16. ADVISHE: A new tool to report validation of health-economic decision models

    NARCIS (Netherlands)

    Vemer, P.; Corro Ramos, I.; Van Voorn, G.; Al, M.J.; Feenstra, T.L.

    2014-01-01

    Background: Modelers and reimbursement decision makers could both profit from a more systematic reporting of the efforts to validate health-economic (HE) models. Objectives: Development of a tool to systematically report validation efforts of HE decision models and their outcomes. Methods: A gross

  17. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers

    Science.gov (United States)

    2013-01-01

    Background Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients’ risk perception and leads to better informed decision making. This paper summarises current “best practices” in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. Method An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a “state of the art” summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. Results The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid “1 in x” formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. Conclusion A substantial and

  18. Gaps in tools assessing the energy implications of renovation versus rebuilding decisions

    DEFF Research Database (Denmark)

    Goldstein, Benjamin Paul; Herbøl, Mads; Meza, Maria Josefina Figueroa

    2013-01-01

    to evaluate project level energy-related decisions than at larger scales. Information gaps identified within assessment tools lead to uncertainty for decision makers about which option improves energy efficiency. In the case of a number of large-scale EU building renovating/renewing projects these tools have......The state of building stocks changes over time. Owners and municipalities face the choice to renovate or rebuild buildings to improve energy efficiency. This review addresses how current sustainability assessment tools support these decisions. It finds that advanced tools are better tailored...... been scarcely used or merely suggested during planning. Recent advances in sustainability assessment tools can begin to close some of the existing knowledge gaps, while incentives and stricter legislation may improve their usage rates....

  19. Developing shape analysis tools to assist complex spatial decision making

    Energy Technology Data Exchange (ETDEWEB)

    Mackey, H.E. [Westinghouse Savannah River Company, AIKEN, SC (United States); Ehler, G.B.; Cowen, D. [South Carolina Univ., Columbia, SC (United States)

    1996-05-31

    The objective of this research was to develop and implement a shape identification measure within a geographic information system, specifically one that incorporates analytical modeling for site location planning. The application that was developed incorporated a location model within a raster-based GIS, which helped address critical performance issues for the decision support system. Binary matrices, which approximate the object`s geometrical form, are passed over the grided data structure and allow identification of irregular and regularly shaped objects. Lastly, the issue of shape rotation is addressed and is resolved by constructing unique matrices corresponding to the object`s orientation

  20. The metabolic score: A decision making tool in diabetes care.

    Science.gov (United States)

    Kalra, Sanjay; Gupta, Yashdeep

    2015-11-01

    The heterogeneity of diabetes mellitus, and the various metabolic abnormalities associated with it, are well known. Current management guidelines used to help choose glucose-lowering drugs in diabetes mellitus describe various drug classes in detail, but do not take the overall metabolic profile into consideration. To help physicians choose appropriate oral therapy, we propose a discrete metabolic score, based upon the presence and absence of metabolic comorbidities included in the definition of metabolic syndrome. This communication describes how to choose an appropriate oral antidiabetic drug using such a score. The metabolic score based decision making aid should be able to prove its utility in all health care settings, especially resource constrained societies.

  1. Developing shape analysis tools to assist complex spatial decision making

    International Nuclear Information System (INIS)

    Mackey, H.E.; Ehler, G.B.; Cowen, D.

    1996-01-01

    The objective of this research was to develop and implement a shape identification measure within a geographic information system, specifically one that incorporates analytical modeling for site location planning. The application that was developed incorporated a location model within a raster-based GIS, which helped address critical performance issues for the decision support system. Binary matrices, which approximate the object's geometrical form, are passed over the grided data structure and allow identification of irregular and regularly shaped objects. Lastly, the issue of shape rotation is addressed and is resolved by constructing unique matrices corresponding to the object's orientation

  2. Decision making in patients with temporal lobe epilepsy.

    Science.gov (United States)

    Labudda, Kirsten; Frigge, Kristina; Horstmann, Simone; Aengenendt, Joerg; Woermann, Friedrich G; Ebner, Alois; Markowitsch, Hans J; Brand, Matthias

    2009-01-01

    The mesiotemporal lobe is involved in decision making processes because bilateral amygdala damage can cause impairments in decision making that is mainly based on the processing of emotional feedback. In addition to executive functions, previous studies have suggested the involvement of feedback processing in decision making under risk when explicit information about consequences and their probabilities is provided. In the current study, we investigated whether unilateral mesiotemporal damage, comprising of the hippocampus and/or the amygdala, results in alterations of both kinds of decision making. For this purpose, we preoperatively examined 20 patients with refractory unilateral mesiotemporal lobe epilepsy (TLE) and a comparison group (CG) of 20 healthy volunteers with the Iowa Gambling Task to assess decision making based on feedback processing, the Game of Dice Task to assess decision making under risk, and with a neuropsychological test battery. Results indicate that TLE patients performed normally in decision making under risk, but can exhibit disturbances in decision making on the Iowa Gambling Task. A subgroup analysis revealed that those patients with a preference for the disadvantageous alternatives performed worse on executive subcomponents and had seizure onset at an earlier age in comparison to the patient subgroup without disadvantageous decision making. Furthermore, disadvantageous decision making can emerge in patients with selective hippocampal sclerosis not extended to the amygdala. Thus, our results demonstrate for the first time that presurgical patients with TLE can have selective reductions in decision making and that these deficits can result from hippocampal lesions without structural amygdala abnormalities.

  3. Energy Signal Tool for Decision Support in Building Energy Systems

    Energy Technology Data Exchange (ETDEWEB)

    Henze, G. P.; Pavlak, G. S.; Florita, A. R.; Dodier, R. H.; Hirsch, A. I.

    2014-12-01

    A prototype energy signal tool is demonstrated for operational whole-building and system-level energy use evaluation. The purpose of the tool is to give a summary of building energy use which allows a building operator to quickly distinguish normal and abnormal energy use. Toward that end, energy use status is displayed as a traffic light, which is a visual metaphor for energy use that is either substantially different from expected (red and yellow lights) or approximately the same as expected (green light). Which light to display for a given energy end use is determined by comparing expected to actual energy use. As expected, energy use is necessarily uncertain; we cannot choose the appropriate light with certainty. Instead, the energy signal tool chooses the light by minimizing the expected cost of displaying the wrong light. The expected energy use is represented by a probability distribution. Energy use is modeled by a low-order lumped parameter model. Uncertainty in energy use is quantified by a Monte Carlo exploration of the influence of model parameters on energy use. Distributions over model parameters are updated over time via Bayes' theorem. The simulation study was devised to assess whole-building energy signal accuracy in the presence of uncertainty and faults at the submetered level, which may lead to tradeoffs at the whole-building level that are not detectable without submetering.

  4. Decision-Making Tools and Their Influence on Caseworkers' Room for Discretion

    DEFF Research Database (Denmark)

    Høybye-Mortensen, Line Matilde

    2015-01-01

    One of the cornerstones in the provision of social services in modern welfare states is decision making about who is eligible for particular services or benefits. Here, the central decision maker is the caseworker who assesses clients’ needs and obligations. In response to concerns regarding...... of thirty group interviews with caseworkers. Even though all of the tools are in the shape of a form that is to be filled in, differences are found across decision-making tools. For instance, it seems as though forms based on a theoretical foundation have greater impact on caseworkers’ room for discretion...

  5. Decision aids for patients facing a surgical treatment decision: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Knops, Anouk M.; Legemate, Dink A.; Goossens, Astrid; Bossuyt, Patrick M. M.; Ubbink, Dirk T.

    2013-01-01

    To summarize the evidence available on the effects of decision aids in surgery. When consenting to treatment, few patients adequately understand their treatment options. To help patients make deliberate treatment choices, decision aids provide evidence-based information on the disease, treatment

  6. Cognitive-emotional decision making (CEDM): a framework of patient medical decision making.

    Science.gov (United States)

    Power, Tara E; Swartzman, Leora C; Robinson, John W

    2011-05-01

    Assistance for patients faced with medical decisions has largely focussed on the clarification of information and personal values. Our aim is to draw on the decision research describing the role of emotion in combination with health behaviour models to provide a framework for conceptualizing patient decisions. A review of the psychological and medical decision making literature concerned with the role of emotion/affect in decision making and health behaviours. Emotion plays an influential role in decision making. Both current and anticipated emotions play a motivational role in choice. Amalgamating these findings with that of Leventhal's (1970) SRM provide a framework for thinking about the influence of emotion on a patient medical decision. Our framework suggests that a patient must cope with four sets of elements. The first two relate to the need to manage the cognitive and emotional aspects of the health threat. The second set relate to the management of the cognitive and emotional elements of the decision, itself. The framework provides a way for practitioners and researchers to frame thinking about a patient medical decision in order to assist the patient in clarifying decisional priorities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  7. Requirements for advanced decision support tools in future distribution network planning

    NARCIS (Netherlands)

    Grond, M.O.W.; Morren, J.; Slootweg, J.G.

    2013-01-01

    This paper describes the need and requirements for advanced decision support tools in future network planning from a distribution network operator perspective. The existing tools will no longer be satisfactory for future application due to present developments in the electricity sector that increase

  8. The financial management as a tool for development investment decision

    Directory of Open Access Journals (Sweden)

    Damnjanović Radovan M.

    2017-01-01

    Full Text Available Investment decisions, which influence the investment of financial resources to achieve economic, non-economic, or of both objectives and effects in the future, the central subject of financial management. Using the methods of financial mathematics can predict the effects of the investment which is from the standpoint of efficiency ratings are expressed in the form of cash future income. Periods, the investments and the use of investment, may be the same or different lengths. From an economic standpoint it is desirable that the period of the investment is short, and the economic effects of the eyelids investments as long as possible. For an investment is said to be cost-effective or cost-effective if the current value of the investment is less than the present value of income from investments.

  9. Usability evaluation of a clinical decision support tool for osteoporosis disease management

    Directory of Open Access Journals (Sweden)

    Newton David

    2010-12-01

    Full Text Available Abstract Background Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines are available, patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions and a series of focus groups were used to develop a functional multifaceted tool that can support clinical decision-making in osteoporosis disease management at the point of care. The objective of our study was to assess how well the prototype met functional goals and usability needs. Methods We conducted a usability study for each component of the tool--the Best Practice Recommendation Prompt (BestPROMPT, the Risk Assessment Questionnaire (RAQ, and the Customised Osteoporosis Education (COPE sheet--using the framework described by Kushniruk and Patel. All studies consisted of one-on-one sessions with a moderator using a standardised worksheet. Sessions were audio- and video-taped and transcribed verbatim. Data analysis consisted of a combination of qualitative and quantitative analyses. Results In study 1, physicians liked that the BestPROMPT can provide customised recommendations based on risk factors identified from the RAQ. Barriers included lack of time to use the tool, the need to alter clinic workflow to enable point-of-care use, and that the tool may disrupt the real reason for the visit. In study 2, patients completed the RAQ in a mean of 6 minutes, 35 seconds. Of the 42 critical incidents, 60% were navigational and most occurred when the first nine participants were using the stylus pen; no critical incidents were observed with the last six participants that used the touch screen. Patients thought that the RAQ questions were easy to read and understand, but they found it difficult to initiate the questionnaire. Suggestions for improvement included improving aspects of the interface and navigation. The results of study 3 showed that most patients were able

  10. Clinical decision-making tools for exam selection, reporting and dose tracking

    International Nuclear Information System (INIS)

    Brink, James A.

    2014-01-01

    Although many efforts have been made to reduce the radiation dose associated with individual medical imaging examinations to ''as low as reasonably achievable,'' efforts to ensure such examinations are performed only when medically indicated and appropriate are equally if not more important. Variations in the use of ionizing radiation for medical imaging are concerning, regardless of whether they occur on a local, regional or national basis. Such variations among practices can be reduced with the use of decision support tools at the time of order entry. These tools help reduce radiation exposure among practices through the appropriate use of medical imaging. Similarly, adoption of best practices among imaging facilities can be promoted through tracking the radiation exposure among imaging patients. Practices can benchmark their aggregate radiation exposures for medical imaging through the use of dose index registries. However several variables must be considered when contemplating individual patient dose tracking. The specific dose measures and the variation among them introduced by variations in body habitus must be understood. Moreover the uncertainties in risk estimation from dose metrics related to age, gender and life expectancy must also be taken into account. (orig.)

  11. Clinical decision-making tools for exam selection, reporting and dose tracking

    Energy Technology Data Exchange (ETDEWEB)

    Brink, James A. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2014-10-15

    Although many efforts have been made to reduce the radiation dose associated with individual medical imaging examinations to ''as low as reasonably achievable,'' efforts to ensure such examinations are performed only when medically indicated and appropriate are equally if not more important. Variations in the use of ionizing radiation for medical imaging are concerning, regardless of whether they occur on a local, regional or national basis. Such variations among practices can be reduced with the use of decision support tools at the time of order entry. These tools help reduce radiation exposure among practices through the appropriate use of medical imaging. Similarly, adoption of best practices among imaging facilities can be promoted through tracking the radiation exposure among imaging patients. Practices can benchmark their aggregate radiation exposures for medical imaging through the use of dose index registries. However several variables must be considered when contemplating individual patient dose tracking. The specific dose measures and the variation among them introduced by variations in body habitus must be understood. Moreover the uncertainties in risk estimation from dose metrics related to age, gender and life expectancy must also be taken into account. (orig.)

  12. [Barriers and facilitators to implementing shared decision-making in oncology: Patient perceptions].

    Science.gov (United States)

    Ortega-Moreno, M; Padilla-Garrido, N; Huelva-López, L; Aguado-Correa, F; Bayo-Calero, J; Bayo-Lozano, E

    To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented. A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators. More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors. The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Lean production tools and decision latitude enable conditions for innovative learning in organizations: a multilevel analysis.

    Science.gov (United States)

    Fagerlind Ståhl, Anna-Carin; Gustavsson, Maria; Karlsson, Nadine; Johansson, Gun; Ekberg, Kerstin

    2015-03-01

    The effect of lean production on conditions for learning is debated. This study aimed to investigate how tools inspired by lean production (standardization, resource reduction, visual monitoring, housekeeping, value flow analysis) were associated with an innovative learning climate and with collective dispersion of ideas in organizations, and whether decision latitude contributed to these associations. A questionnaire was sent out to employees in public, private, production and service organizations (n = 4442). Multilevel linear regression analyses were used. Use of lean tools and decision latitude were positively associated with an innovative learning climate and collective dispersion of ideas. A low degree of decision latitude was a modifier in the association to collective dispersion of ideas. Lean tools can enable shared understanding and collective spreading of ideas, needed for the development of work processes, especially when decision latitude is low. Value flow analysis played a pivotal role in the associations. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  14. Decision-Making Capacity for Chemotherapy and Associated Factors in Newly Diagnosed Patients with Lung Cancer.

    Science.gov (United States)

    Ogawa, Asao; Kondo, Kyoko; Takei, Hiroyuki; Fujisawa, Daisuke; Ohe, Yuichiro; Akechi, Tatsuo

    2018-04-01

    The objective of this study was to assess decision-making capacity in patients newly diagnosed with lung cancer, clinical factors associated with impaired capacity, and physicians' perceptions of patients' decision-making capacity. We recruited 122 patients newly diagnosed with lung cancer. One hundred fourteen completed the assessment. All patients were receiving a combination of treatments (e.g., chemotherapy, chemo-radiotherapy, or targeted therapy). Decision-making capacity was assessed using the MacArthur Competence Tool for Treatment. Cognitive impairment, depressive symptoms, and frailty were also evaluated. Physicians' perceptions were compared with the ascertainments. Twenty-seven (24%, 95% confidence interval [CI], 16-31) patients were judged to have incapacity. Clinical teams had difficulty in judging six (22.2%) patients for incapacity. Logistic regression identified frailty (odds ratio, 3.51; 95% CI, 1.13-10.8) and cognitive impairment (odds ratio, 5.45; 95% CI, 1.26-23.6) as the factors associated with decision-making incapacity. Brain metastasis, emphysema, and depression were not associated with decision-making incapacity. A substantial proportion of patients diagnosed with lung cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients. Decision-making capacity is the cornerstone of clinical practice. A substantial proportion of patients with cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients. © AlphaMed Press 2017.

  15. Energy life-cycle analysis modeling and decision support tool

    Energy Technology Data Exchange (ETDEWEB)

    Hoza, M.; White, M.E.

    1993-06-01

    As one of DOE`s five multi-program national laboratories, Pacific Northwest Laboratory (PNL) develops and deploys technology for national missions in energy and the environment. The Energy Information Systems Group, within the Laboratory`s Computer Sciences Department, focuses on the development of the computational and data communications infrastructure and automated tools for the Transmission and Distribution energy sector and for advanced process engineering applications. The energy industry is being forced to operate in new ways and under new constraints. It is in a reactive mode, reacting to policies and politics, and to economics and environmental pressures. The transmission and distribution sectors are being forced to find new ways to maximize the use of their existing infrastructure, increase energy efficiency, and minimize environmental impacts, while continuing to meet the demands of an ever increasing population. The creation of a sustainable energy future will be a challenge for both the soft and hard sciences. It will require that we as creators of our future be bold in the way we think about our energy future and aggressive in its development. The development of tools to help bring about a sustainable future will not be simple either. The development of ELCAM, for example, represents a stretch for the computational sciences as well as for each of the domain sciences such as economics, which will have to be team members.

  16. "Think aloud" and "Near live" usability testing of two complex clinical decision support tools.

    Science.gov (United States)

    Richardson, Safiya; Mishuris, Rebecca; O'Connell, Alexander; Feldstein, David; Hess, Rachel; Smith, Paul; McCullagh, Lauren; McGinn, Thomas; Mann, Devin

    2017-10-01

    Low provider adoption continues to be a significant barrier to realizing the potential of clinical decision support. "Think Aloud" and "Near Live" usability testing were conducted on two clinical decision support tools. Each was composed of an alert, a clinical prediction rule which estimated risk of either group A Streptococcus pharyngitis or pneumonia and an automatic order set based on risk. The objective of this study was to further understanding of the facilitators of usability and to evaluate the types of additional information gained from proceeding to "Near Live" testing after completing "Think Aloud". This was a qualitative observational study conducted at a large academic health care system with 12 primary care providers. During "Think Aloud" testing, participants were provided with written clinical scenarios and asked to verbalize their thought process while interacting with the tool. During "Near Live" testing participants interacted with a mock patient. Morae usability software was used to record full screen capture and audio during every session. Participant comments were placed into coding categories and analyzed for generalizable themes. Themes were compared across usability methods. "Think Aloud" and "Near Live" usability testing generated similar themes under the coding categories visibility, workflow, content, understand-ability and navigation. However, they generated significantly different themes under the coding categories usability, practical usefulness and medical usefulness. During both types of testing participants found the tool easier to use when important text was distinct in its appearance, alerts were passive and appropriately timed, content was up to date, language was clear and simple, and each component of the tool included obvious indicators of next steps. Participant comments reflected higher expectations for usability and usefulness during "Near Live" testing. For example, visit aids, such as automatically generated order sets

  17. Promoting energy efficiency investments with risk management decision tools

    International Nuclear Information System (INIS)

    Jackson, Jerry

    2010-01-01

    This paper reviews current capital budgeting practices and their impact on energy efficiency investments. The prevalent use of short payback 'rule-of-thumb' requirements to screen efficiency projects for risk is shown to bias investment choices towards 'sure bet' investments bypassing many profitable efficiency investment options. A risk management investment strategy is presented as an alternative to risk avoidance practices applied with payback thresholds. The financial industry risk management tool Value-at-Risk is described and extended to provide an Energy-Budgets-at-Risk or EBaR risk management analysis to convey more accurate energy efficiency investment risk information. The paper concludes with recommendations to expand the use of Value-at-Risk-type energy efficiency analysis.

  18. A Framework for Evaluating the Cost-Effectiveness of Patient Decision Aids: A Case Study Using Colorectal Cancer Screening

    Science.gov (United States)

    Cantor, Scott B.; Rajan, Tanya; Linder, Suzanne K.; Volk, Robert J.

    2017-01-01

    Objective Patient decision aids are important tools for facilitating balanced, evidence-based decision making. However, the potential of decision aids to lower health care utilization and costs is uncertain; few studies have investigated the cost-effectiveness of decision aids that change patient behavior. Using an example of a decision aid for colorectal cancer screening, we provide a framework for analyzing the cost-effectiveness of decision aids. Methods A decision-analytic model with two strategies (decision aid or no decision aid) was used to calculate expected costs in U.S. dollars and benefits measured in life-years saved (LYS). Data from a systematic review of ten studies about decision aid effectiveness was used to calculate the percentage increase in the number of people choosing screening instead of no screening. We then calculated the incremental cost per LYS with the use of the decision aid. Results The no decision aid strategy had an expected cost of $3,023 and yielded 18.19 LYS. The decision aid strategy cost $3,249 and yielded 18.20 LYS. The incremental cost-effectiveness ratio for the decision aid strategy was $36,126 per LYS. Results were sensitive to the cost of the decision aid and the percentage change in behavior caused by the decision aid. Conclusions This study provides proof-of-concept evidence for future studies examining the cost-effectiveness of decision aids. The results suggest that decision aids can be beneficial and cost-effective. PMID:25979678

  19. Model for nuclear proliferation resistance analysis using decision making tools

    International Nuclear Information System (INIS)

    Ko, Won Il; Kim, Ho Dong; Yang, Myung Seung

    2003-06-01

    The nuclear proliferation risks of nuclear fuel cycles is being considered as one of the most important factors in assessing advanced and innovative nuclear systems in GEN IV and INPRO program. They have been trying to find out an appropriate and reasonable method to evaluate quantitatively several nuclear energy system alternatives. Any reasonable methodology for integrated analysis of the proliferation resistance, however, has not yet been come out at this time. In this study, several decision making methods, which have been used in the situation of multiple objectives, are described in order to see if those can be appropriately used for proliferation resistance evaluation. Especially, the AHP model for quantitatively evaluating proliferation resistance is dealt with in more detail. The theoretical principle of the method and some examples for the proliferation resistance problem are described. For more efficient applications, a simple computer program for the AHP model is developed, and the usage of the program is introduced here in detail. We hope that the program developed in this study could be useful for quantitative analysis of the proliferation resistance involving multiple conflict criteria

  20. Decision analytic tools for resolving uncertainty in the energy debate

    International Nuclear Information System (INIS)

    Renn, O.

    1986-01-01

    Within the context of a Social Compatibility Study on Energy Supply Systems a complex decision making model was used to incorporate scientific expertize and public participation into the process of policy formulation and evaluation. The study was directed by the program group ''Technology and Society'' of the Nuclear Research Centre Juelich. It consisted of three parts: First, with the aid of value tree analysis the whole spectrum of concern and dimensions relevant to the energy issue in Germany was collected and structured in a combined value tree representing the values and criteria of nine important interest groups in the Federal Republic of Germany. Second, the revealed criteria were translated into indicators. Four different energy scenarios were evaluated with respect to each indicator making use of physical measurement, literature review and expert surveys. Third, the weights for each indicator were elicited by interviewing randomly chosen citizens. Those citizens were informed about the scenarios and their impacts prior to the weighting process in a four day seminar. As a result most citizens favoured more moderate energy scenarios assigning high priority to energy conservation. Nuclear energy was perceived as necessary energy source in the long run, but should be restricted to meet only the demand that cannot be covered by other energy means. (orig.)

  1. Model for nuclear proliferation resistance analysis using decision making tools

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Won Il; Kim, Ho Dong; Yang, Myung Seung

    2003-06-01

    The nuclear proliferation risks of nuclear fuel cycles is being considered as one of the most important factors in assessing advanced and innovative nuclear systems in GEN IV and INPRO program. They have been trying to find out an appropriate and reasonable method to evaluate quantitatively several nuclear energy system alternatives. Any reasonable methodology for integrated analysis of the proliferation resistance, however, has not yet been come out at this time. In this study, several decision making methods, which have been used in the situation of multiple objectives, are described in order to see if those can be appropriately used for proliferation resistance evaluation. Especially, the AHP model for quantitatively evaluating proliferation resistance is dealt with in more detail. The theoretical principle of the method and some examples for the proliferation resistance problem are described. For more efficient applications, a simple computer program for the AHP model is developed, and the usage of the program is introduced here in detail. We hope that the program developed in this study could be useful for quantitative analysis of the proliferation resistance involving multiple conflict criteria.

  2. Augmented cognition tool for rapid military decision making.

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Shawn Ellis; Bernard, Michael Lewis; Verzi, Stephen J.; Dubicka, Irene; Vineyard, Craig Michael

    2011-10-01

    This report describes the laboratory directed research and development work to model relevant areas of the brain that associate multi-modal information for long-term storage for the purpose of creating a more effective, and more automated, association mechanism to support rapid decision making. Using the biology and functionality of the hippocampus as an analogy or inspiration, we have developed an artificial neural network architecture to associate k-tuples (paired associates) of multimodal input records. The architecture is composed of coupled unimodal self-organizing neural modules that learn generalizations of unimodal components of the input record. Cross modal associations, stored as a higher-order tensor, are learned incrementally as these generalizations form. Graph algorithms are then applied to the tensor to extract multi-modal association networks formed during learning. Doing so yields a novel approach to data mining for knowledge discovery. This report describes the neurobiological inspiration, architecture, and operational characteristics of our model, and also provides a real world terrorist network example to illustrate the model's functionality.

  3. A web-based tool to support shared decision making for people with a psychotic disorder: randomized controlled trial and process evaluation.

    Science.gov (United States)

    van der Krieke, Lian; Emerencia, Ando C; Boonstra, Nynke; Wunderink, Lex; de Jonge, Peter; Sytema, Sjoerd

    2013-10-07

    Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes. This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders. The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation. In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical

  4. Measuring and monitoring energy access: Decision-support tools for policymakers in Africa

    International Nuclear Information System (INIS)

    Hailu, Yohannes G.

    2012-01-01

    A significant number of African States have adapted energy access targets. In evaluating progress towards these goals, measuring and monitoring energy access becomes relevant. This paper reviews energy access indicators and identifies their utility and challenges in their application. By focusing on Africa, a broader framework for energy access measurement and monitoring is discussed, along with implementation barriers and potential solutions. To demonstrate the utility of energy access decision-support tool in Africa, a scenario analysis in five regional energy pools is conducted using the Energy Spending Model tool. Institutionalizing monitoring and decision-support tools can provide valuable feedback to policymakers aiming to design and implement effective energy access programs serving a growing population in Africa. - Highlights: ► Most African countries have adapted energy access targets. ► To monitor and evaluate performance, monitoring and decision-support tools are required. ► Framework for tool development should consider data, cost, political and other factors. ► Implementation constraints include technical, data, resource and urban/rural issues. ► Electricity Spending Needs model is one decision support tool that ties access targets to investment needs. ► Monitoring tools provide crucial feedback on Africa's energy access progress.

  5. Enhancing shared decision making through assessment of patient-clinician concordance on decision quality

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Selby, Warwick; Salkeld, Glenn

    to quantify, document, and suggest how future dyadic decisions can be enhanced by criterion prioritisation. Associations between patient’s MDQ-W before, and MDQ-R after consultation with their clinician were analysed along with patient scores from the Satisfaction With Decision (SWD) instrument. Results...... and clinician using the dually-personalised decomposable MyDecisionQuality (MDQ) instrument. This has the potential to guide future work on optimising dyad-specific patient-clinician communication for shared decision making and informed consent....

  6. 5As Team obesity intervention in primary care: development and evaluation of shared decision-making weight management tools.

    Science.gov (United States)

    Osunlana, A M; Asselin, J; Anderson, R; Ogunleye, A A; Cave, A; Sharma, A M; Campbell-Scherer, D L

    2015-08-01

    Despite several clinical practice guidelines, there remains a considerable gap in prevention and management of obesity in primary care. To address the need for changing provider behaviour, a randomized controlled trial with convergent mixed method evaluation, the 5As Team (5AsT) study, was conducted. As part of the 5AsT intervention, the 5AsT tool kit was developed. This paper describes the development process and evaluation of these tools. Tools were co-developed by the multidisciplinary research team and the 5AsT, which included registered nurses/nurse practitioners (n = 15), mental health workers (n = 7) and registered dieticians (n = 7), who were previously randomized to the 5AsT intervention group at a primary care network in Edmonton, Alberta, Canada. The 5AsT tool development occurred through a practice/implementation-oriented, need-based, iterative process during learning collaborative sessions of the 5AsT intervention. Feedback during tool development was received through field notes and final provider evaluation was carried out through anonymous questionnaires. Twelve tools were co-developed with 5AsT. All tools were evaluated as either 'most useful' or 'moderately useful' in primary care practice by the 5AsT. Four key findings during 5AsT tool development were the need for: tools that were adaptive, tools to facilitate interdisciplinary practice, tools to help patients understand realistic expectations for weight loss and shared decision-making tools for goal setting and relapse prevention. The 5AsT tools are primary care tools which extend the utility of the 5As of obesity management framework in clinical practice. © 2015 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity.

  7. Bone quality: educational tools for patients, physicians, and educators.

    Science.gov (United States)

    Shams, Junaid; Spitzer, Allison B; Kennelly, Ann M; Tosi, Laura L

    2011-08-01

    Defining bone quality remains elusive. From a patient perspective bone quality can best be defined as an individual's likelihood of sustaining a fracture. Fracture risk indicators and performance measures can help clinicians better understand individual fracture risk. Educational resources such as the Web can help clinicians and patients better understand fracture risk, communicate effectively, and make decisions concerning diagnosis and treatment. We examined four questions: What tools can be used to identify individuals at high risk for fracture? What clinical performance measures are available? What strategies can help ensure that patients at risk for fracture are identified? What are some authoritative Web sites for educating providers and patients about bone quality? Using Google, PUBMED, and trademark names, we reviewed the literature using the terms "bone quality" and "osteoporosis education." Web site legitimacy was evaluated using specific criteria. Educational Web sites were limited to English-language sites sponsored by nonprofit organizations The Fracture Risk Assessment Tool® (FRAX®) and the Fracture Risk Calculator (FRC) are reliable means of assessing fracture risk. Performance measures relating to bone health were developed by the AMA convened Physician Consortium for Performance Improvement® and are included in the Physician Quality Reporting Initiative. In addition, quality measures have been developed by the Joint Commission. Strategies for identifying individuals at risk include designating responsibility for case finding and intervention, evaluating secondary causes of osteoporosis, educating patients and providers, performing cost-effectiveness evaluation, and using information technology. An abundance of authoritative educational Web sites exists for providers and patients. Effective clinical indicators, performance measures, and educational tools to better understand and identify fracture risk are now available. The next challenge is to

  8. Longitudinal adoption rates of complex decision support tools in primary care.

    Science.gov (United States)

    McCullagh, Lauren; Mann, Devin; Rosen, Lisa; Kannry, Joseph; McGinn, Thomas

    2014-12-01

    Translating research findings into practice promises to standardise care. Translation includes the integration of evidence-based guidelines at the point of care, discerning the best methods to disseminate research findings and models to sustain the implementation of best practices.By applying usability testing to clinical decision support(CDS) design, overall adoption rates of 60% can be realised.What has not been examined is how long adoption rates are sustained and the characteristics associated with long-term use. We conducted secondary analysis to decipher the factors impacting sustained use of CD Stools. This study was a secondary data analysis from a clinical trial conducted at an academic institution in New York City. Study data was identified patients electronic health records (EHR). The trial was to test the implementation of an integrated clinical prediction rule(iCPR) into the EHR. The primary outcome variable was iCPR tool acceptance of the tool. iCPR tool completion and iCPR smartest completion were additional outcome variables of interest. The secondary aim was to examine user characteristics associated with iCPR tool use in later time periods. Characteristics of interest included age, resident year, use of electronic health records (yes/no) and use of best practice alerts (BPA) (yes/no). Generalised linear mixed models (GLiMM) were used to compare iCPR use over time for each outcome of interest: namely, iCPR acceptance, iCPR completion and iCPR smartset completion.GLiMM was also used to examine resident characteristics associated with iCPR tool use in later time periods; specifically, intermediate and long-term (ie, 90+days). The tool was accepted, on average, 82.18% in the first 90 days (short-term period). The use decreases to 56.07% and 45.61% in intermediate and long-term time periods, respectively. There was a significant association between iCPR tool completion and time periods(pknowledge of the clinical prediction rule, or gained clinical

  9. Data access and decision tools for coastal water resources ...

    Science.gov (United States)

    US EPA has supported the development of numerous models and tools to support implementation of environmental regulations. However, transfer of knowledge and methods from detailed technical models to support practical problem solving by local communities and watershed or coastal management organizations remains a challenge. We have developed the Estuary Data Mapper (EDM) to facilitate data discovery, visualization and access to support environmental problem solving for coastal watersheds and estuaries. EDM is a stand-alone application based on open-source software which requires only internet access for operation. Initially, development of EDM focused on delivery of raw data streams from distributed web services, ranging from atmospheric deposition to hydrologic, tidal, and water quality time series, estuarine habitat characteristics, and remote sensing products. We have transitioned to include access to value-added products which provide end-users with results of future scenario analysis, facilitate extension of models across geographic regions, and/or promote model interoperability. Here we present three examples: 1) the delivery of input data for the development of seagrass models across estuaries, 2) scenarios illustrating the implications of riparian buffer management (loss or restoration) for stream thermal regimes and fish communities, and 3) access to hydrology model outputs to foster connections across models at different scales, ultimately feeding

  10. Decision-Making Tool for Cost-Efficient and Environmentally Friendly Wood Mobilisation

    Directory of Open Access Journals (Sweden)

    Matevž Triplat

    2015-06-01

    Full Text Available Background and Purpose: With development of forest management technologies, the efficiency of wood production was significantly improved, and thus the impact on forests has changed as well. The article presents a practical decision-making tool for selection of most suitable harvesting system, considering given terrain as well as expected soil conditions on harvesting sites. The decision-making tool should support cost-efficient and environmentally friendly mobilisation of wood. Materials and Methods: The presented decision-making tool is based on ground bearing capacities (relevant environmental parameter and nominal ground pressure (harvesting system characteristics. Soil and terrain (slope characteristics were taken into account for selection of the most suitable harvesting system. Three-step methodological approach was suggested, where soil and terrain conditions were defined in first step, while harvesting system were described using wood process charts (“functiogramms” in second step. In final step ecological and technological requirements were matched. Results: To exemplify the three-step methodology, a decision-making tool was prepared for the three selected harvesting systems. The proposed harvesting systems differ in technological, ecological and economic aspects, but each is limited by at least one of the aspect. Conclusions: The decision-making tool in combination with the presented wood process charts (“functiogramms” can simplify and facilitate forest production planning, although it can also be used in case of unforeseen event e.g. changing of soil moisture, machinery failure and insufficient current capacities. Considering the envisaged quantities and types of forest wooden assortments, it is possible to use the decision-making tool for a basic selection of most appropriate harvesting systems. The main idea behind the suggested three step methodological approach is that forest workers can prepare individual decision

  11. Augmenting communication and decision making in the intensive care unit with a cardiopulmonary resuscitation video decision support tool: a temporal intervention study.

    Science.gov (United States)

    McCannon, Jessica B; O'Donnell, Walter J; Thompson, B Taylor; El-Jawahri, Areej; Chang, Yuchiao; Ananian, Lillian; Bajwa, Ednan K; Currier, Paul F; Parikh, Mihir; Temel, Jennifer S; Cooper, Zara; Wiener, Renda Soylemez; Volandes, Angelo E

    2012-12-01

    Effective communication between intensive care unit (ICU) providers and families is crucial given the complexity of decisions made regarding goals of therapy. Using video images to supplement medical discussions is an innovative process to standardize and improve communication. In this six-month, quasi-experimental, pre-post intervention study we investigated the impact of a cardiopulmonary resuscitation (CPR) video decision support tool upon knowledge about CPR among surrogate decision makers for critically ill adults. We interviewed surrogate decision makers for patients aged 50 and over, using a structured questionnaire that included a four-question CPR knowledge assessment similar to those used in previous studies. Surrogates in the post-intervention arm viewed a three-minute video decision support tool about CPR before completing the knowledge assessment and completed questions about perceived value of the video. We recruited 23 surrogates during the first three months (pre-intervention arm) and 27 surrogates during the latter three months of the study (post-intervention arm). Surrogates viewing the video had more knowledge about CPR (p=0.008); average scores were 2.0 (SD 1.1) and 2.9 (SD 1.2) (out of a total of 4) in pre-intervention and post-intervention arms. Surrogates who viewed the video were comfortable with its content (81% very) and 81% would recommend the video. CPR preferences for patients at the time of ICU discharge/death were distributed as follows: pre-intervention: full code 78%, DNR 22%; post-intervention: full code 59%, DNR 41% (p=0.23).

  12. An economic theory of patient decision-making.

    Science.gov (United States)

    Stewart, Douglas O; DeMarco, Joseph P

    2005-01-01

    Patient autonomy, as exercised in the informed consent process, is a central concern in bioethics. The typical bioethicist's analysis of autonomy centers on decisional capacity--finding the line between autonomy and its absence. This approach leaves unexplored the structure of reasoning behind patient treatment decisions. To counter that approach, we present a microeconomic theory of patient decision-making regarding the acceptable level of medical treatment from the patient's perspective. We show that a rational patient's desired treatment level typically departs from the level yielding an absence of symptoms, the level we call ideal. This microeconomic theory demonstrates why patients have good reason not to pursue treatment to the point of absence of physical symptoms. We defend our view against possible objections that it is unrealistic and that it fails to adequately consider harm a patient may suffer by curtailing treatment. Our analysis is fruitful in various ways. It shows why decisions often considered unreasonable might be fully reasonable. It offers a theoretical account of how physician misinformation may adversely affect a patient's decision. It shows how billing costs influence patient decision-making. It indicates that health care professionals' beliefs about the 'unreasonable' attitudes of patients might often be wrong. It provides a better understanding of patient rationality that should help to ensure fuller information as well as increased respect for patient decision-making.

  13. Patient decision aids in routine maternity care: Benefits, barriers, and new opportunities.

    Science.gov (United States)

    Stevens, Gabrielle; Thompson, Rachel; Watson, Bernadette; Miller, Yvette D

    2016-02-01

    Participation in decision-making, supported by comprehensive and quality information provision, is increasingly emphasised as a priority for women in maternity care. Patient decision aids are tools that can offer women greater access to information and guidance to participate in maternity care decision-making. Relative to their evaluation in controlled settings, the implementation of patient decision aids in routine maternity care has received little attention and our understanding of which approaches may be effective is limited. This paper critically discusses the application of patient decision aids in routine maternity care and explores viable solutions for promoting their successful uptake. A range of patient decision aids have been developed for use within maternity care, and controlled trials have highlighted their positive impact on the decision-making process for women. Nevertheless, evidence of successful patient decision aid implementation in real world health care settings is lacking due to practical and ideological barriers that exist. Patient-directed social marketing campaigns are a relatively novel approach to patient decision aid delivery that may facilitate their adoption in maternity care, at least in the short-term, by overcoming common implementation barriers. Social marketing may also be particularly well suited to maternity care, given the unique characteristics of this health context. The potential of social marketing campaigns to facilitate patient decision aid adoption in maternity care highlights the need for pragmatic trials to evaluate their effectiveness. Identifying which sub-groups of women are more or less likely to respond to these strategies will further direct implementation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  14. Development of a patient decision aid for prevention of myocardial infarction in type 2 diabetes - rationale, design and pilot testing.

    Science.gov (United States)

    Lenz, Matthias; Kasper, Jürgen; Mühlhauser, Ingrid

    2009-10-19

    Development and testing of a decision aid about prevention of myocardial infarction for persons with type 2 diabetes. Development and testing were guided by the UK Medical Research Council's guidance for the development and evaluation of complex interventions. This comprised a systematic literature review, a focus group of 9 potential providers, modelling a prototype, interviews to qualitatively explore understanding and additional information needs, and revision of the decision aid. The decision aid includes evidence-based information, a tool for individual risk-assessment, worksheets, and an action plan. Five diabetes educators and 15 patients underwent two 60-minutes face-to-face interviews, firstly browsing the decision aid for the first time and then after using it. Both groups differed in their ratings. Overall, the decision aid was rated to present essential information in a complex but understandable and unbiased manner. Difficulties involved understanding of terminology and risk interpretation. "Social status as a risk factor" was the most challenged content by educators but considered as highly important by patients. The risk assessment tool was used inadequately. 5 patients allocated themselves into false risk categories. After revision of the tool, all 12 patients who were recruited for reassessment used the tool correctly. The decision aid was evaluated with diabetes educators and patients. Qualitative data analysis revealed aspects for revision. The decision aid is planned to be part of a shared decision making programme, comprising a strategy for patient counselling and educational modules addressed to providers. Quantitative evaluation is required to assess its effectiveness.

  15. EPIQR - a decision making tool for apartment building refurbishment

    Energy Technology Data Exchange (ETDEWEB)

    Caccavelli, D. [Centre Scientifique et Technique du Batiment, Cedex (France); Balaras, C. [National Observatory of Athens, Athens (Greece); Bluyssen, P. [TNO Building and Construction Research, Delft (Netherlands); Flourentzou, F. [Ecole Polytechnique Federale de Lausanne, Lausanne (France); Jaggs, M. [Building Research Establishment, Watford (United Kingdom); Wetzel, C. [Fraunhofer-Institut fur Bauphysik, Holzkirchen (Germany); Wittchen, K. [Danish Building Reasearch Institute, Hoersholm (Denmark)

    1999-11-01

    In a large majority of European countries, the amount of the maintenance and refurbishment works represents nearly 50% of the total amount spent in the building sector. New requirements are being added to the necessity of maintaining or re-establishing the building stock`s usage value. They are linked to the determination to reduce energy consumption, pollutant emissions, work site wastes, to improve the Indoor Environment Quality and all the modern conveniences inside apartment. Aware of this matter, the European Community has launched a two-year European research project, entitled EPIQR (Energy Performance, Indoor Environmental Quality, Retrofit) involving seven research institutions in the frame of the JOULE III programme. The purpose is to give architects and contracting authorities a multimedia tool to enable them to simultaneously grasp the whole process of apartment building refurbishment or retrofit. It has a number of functions: Assess the building`s degradation state based on a technical diagnosis after a standardised and complete inspection of the building; Prepare work proposals. These take into account not only the renovation of the building but also the improvement of the energy performance and IEQ; Estimate the costs corresponding to these works. A data base, containing the costs of 800 refurbishment works, provides a fast estimate of the total amount of the works being considered; Estimate the evolution of the degradation of the components if none of the works were to be carried out, as well as the refurbishment costs which would result. This paper provides an overview of the EPIQR methodology and the final deliverables of the project. (au)

  16. Testing an Irrigation Decision Support Tool for California Specialty Crops

    Science.gov (United States)

    Johnson, L.; Cahn, M.; Benzen, S.; Zaragoza, I.; Murphy, L.; Melton, F. S.; Martin, F.; Quackenbush, A.; Lockhart, T.

    2015-12-01

    Estimation of crop evapotranspiration supports efficiency of irrigation water management, which in turn can mitigate nitrate leaching, groundwater depletion, and provide energy savings. Past research in California and elsewhere has revealed strong relationships between photosynthetically active vegetation fraction (Fc) and crop evapotranspiration (ETc). Additional research has shown the potential of monitoring Fc by satellite remote sensing. The U.C. Cooperative Extension developed and operates CropManage (CM) as on-line database irrigation (and nitrogen) scheduling tool. CM accounts for the rapid growth and typically brief cycle of cool-season vegetables, where Fc and fraction of reference ET can change daily during canopy development. The model automates crop water requirement calculations based on reference ET data collected by California Dept. Water Resources. Empirically-derived equations are used to estimate daily Fc time-series for a given crop type primarily as a function of planting date and expected harvest date. An application programming interface (API) is under development to provide a check on modeled Fc of current crops and facilitate CM expansion to new crops. The API will enable CM to extract field scale Fc observations from NASA's Satellite Irrigation Management Support (SIMS). SIMS is mainly Landsat based and currently monitors Fc over about 8 million irrigation acres statewide, with potential for adding data from ESA/Sentinel for improved temporal resolution. In the current study, a replicated irrigation trial was performed on romaine lettuce at the USDA Agricultural Research Station in Salinas, CA. CropManage recommendations were used to guide water treatments by drip irrigation at 50%, 75%, 100% ETc replacement levels, with an added treatment at 150% ET representing grower standard practice. Experimental results indicate that yields from the 100% and 150% treatments were not significantly different and were in-line with industry average, while

  17. Deferential vulnerability and patient decision-making

    African Journals Online (AJOL)

    2017-12-01

    Dec 1, 2017 ... cultures where certain hierarchical systems exist within the family or community. ... as a community, as opposed to a Western individualistic decision ... according to some ethicists, it is considered autonomous behaviour.

  18. Impaired social decision making in patients with major depressive disorder.

    Science.gov (United States)

    Wang, Yun; Zhou, Yuan; Li, Shu; Wang, Peng; Wu, Guo-Wei; Liu, Zhe-Ning

    2014-01-23

    Abnormal decision-making processes have been observed in patients with major depressive disorder (MDD). However, it is unresolved whether MDD patients show abnormalities in decision making in a social interaction context, in which decisions have actual influences on both the self-interests of the decision makers per se and those of their partners. Using a well-studied ultimatum game (UG), which is frequently used to investigate social interaction behavior, we examined whether MDD can be associated with abnormalities in social decision-making behavior by comparing the acceptance rates of MDD patients (N = 14) with those of normal controls (N = 19). The acceptance rates of the patients were lower than those of the normal controls. Additionally, unfair proposals were accepted at similar rates from computer partners and human partners in the MDD patients, unlike the acceptance rates in the normal controls, who were able to discriminatively treat unfair proposals from computer partners and human partners. Depressed patients show abnormal decision-making behavior in a social interaction context. Several possible explanations, such as increased sensitivity to fairness, negative emotional state and disturbed affective cognition, have been proposed to account for the abnormal social decision-making behavior in patients with MDD. This aberrant social decision-making behavior may provide a new perspective in the search to find biomarkers for the diagnosis and prognosis of MDD.

  19. DECIDE: a Decision Support Tool to Facilitate Parents' Choices Regarding Genome-Wide Sequencing.

    Science.gov (United States)

    Birch, Patricia; Adam, S; Bansback, N; Coe, R R; Hicklin, J; Lehman, A; Li, K C; Friedman, J M

    2016-12-01

    We describe the rationale, development, and usability testing for an integrated e-learning tool and decision aid for parents facing decisions about genome-wide sequencing (GWS) for their children with a suspected genetic condition. The online tool, DECIDE, is designed to provide decision-support and to promote high quality decisions about undergoing GWS with or without return of optional incidental finding results. DECIDE works by integrating educational material with decision aids. Users may tailor their learning by controlling both the amount of information and its format - text and diagrams and/or short videos. The decision aid guides users to weigh the importance of various relevant factors in their own lives and circumstances. After considering the pros and cons of GWS and return of incidental findings, DECIDE summarizes the user's responses and apparent preferred choices. In a usability study of 16 parents who had already chosen GWS after conventional genetic counselling, all participants found DECIDE to be helpful. Many would have been satisfied to use it alone to guide their GWS decisions, but most would prefer to have the option of consulting a health care professional as well to aid their decision. Further testing is necessary to establish the effectiveness of using DECIDE as an adjunct to or instead of conventional pre-test genetic counselling for clinical genome-wide sequencing.

  20. Adult patient decision-making regarding implantation of complex cardiac devices: a scoping review.

    Science.gov (United States)

    Malecki-Ketchell, Alison; Marshall, Paul; Maclean, Joan

    2017-10-01

    Complex cardiac rhythm management device (CRMD) therapy provides an important treatment option for people at risk of sudden cardiac death. Despite the survival benefit, device implantation is associated with significant physical and psychosocial concerns presenting considerable challenges for the decision-making process surrounding CRMD implantation for patients and physicians. The purpose of this scoping review was to explore what is known about how adult (>16 years) patients make decisions regarding implantation of CRMD therapy. Published, peer reviewed, English language studies from 2000 to 2016 were identified in a search across eight healthcare databases. Eligible studies were concerned with patient decision-making for first time device implantation. Quality assessment was completed using the mixed methods appraisal tool for all studies meeting the inclusion criteria. The findings of eight qualitative and seven quantitative studies, including patients who accepted or declined primary or secondary sudden cardiac death prevention devices, were clustered into two themes: knowledge acquisition and the process of decision-making, exposing similarities and distinctions with the treatment decision-making literature. The review revealed some insight in to the way patients approach decision-making but also exposed a lack of clarity and research activity specific to CRMD patients. Further research is recommended to support the development and application of targeted decision support mechanisms.

  1. Evaluation of a clinical decision support tool for osteoporosis disease management: protocol for an interrupted time series design.

    Science.gov (United States)

    Kastner, Monika; Sawka, Anna; Thorpe, Kevin; Chignel, Mark; Marquez, Christine; Newton, David; Straus, Sharon E

    2011-07-22

    Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines on assessing and managing osteoporosis are available, many patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions, a series of mixed-methods studies, and advice from experts in osteoporosis and human-factors engineering were used collectively to develop a multicomponent tool (targeted to family physicians and patients at risk for osteoporosis) that may support clinical decision making in osteoporosis disease management at the point of care. A three-phased approach will be used to evaluate the osteoporosis tool. In phase 1, the tool will be implemented in three family practices. It will involve ensuring optimal functioning of the tool while minimizing disruption to usual practice. In phase 2, the tool will be pilot tested in a quasi-experimental interrupted time series (ITS) design to determine if it can improve osteoporosis disease management at the point of care. Phase 3 will involve conducting a qualitative postintervention follow-up study to better understand participants' experiences and perceived utility of the tool and readiness to adopt the tool at the point of care. The osteoporosis tool has the potential to make several contributions to the development and evaluation of complex, chronic disease interventions, such as the inclusion of an implementation strategy prior to conducting an evaluation study. Anticipated benefits of the tool may be to increase awareness for patients about osteoporosis and its associated risks and provide an opportunity to discuss a management plan with their physician, which may all facilitate patient self-management.

  2. Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review.

    Science.gov (United States)

    Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

    2017-09-01

    Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare". It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning. Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

  3. Optimization of protection as a decision-making tool for radioactive waste disposal

    International Nuclear Information System (INIS)

    Bragg, K.

    1988-03-01

    This paper discusses whether optimization of radiation protection is a workable or helpful concept or tool with respect to decisions in the field of long-term radioactive waste management. Examples of three waste types (high-level, low-level and uranium mine tailings) are used to illustrate that actual decisions are made taking account of more complex factors and that optimization of protection plays a relatively minor role. It is thus concluded that it is not a useful general tool for waste management decision-making. Discussion of the nature of the differences between technical and non-technical factors is also presented along with suggestions to help facilitate future decision-making

  4. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers

    NARCIS (Netherlands)

    Trevena, L.J.; Zikmund-Fisher, B.J.; Edwards, A.; Gaissmaier, W.; Galesic, M.; Han, P.K.J.; King, J.; Lawson, M.L.; Linder, S.K.; Lipkus, I.; Ozanne, E.; Peters, E.; Timmermans, D.R.M.; Woloshin, S.

    2013-01-01

    Background: Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients' risk perception and leads to better informed decision

  5. Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial.

    Science.gov (United States)

    Rapoport, Mark J; Zucchero Sarracini, Carla; Kiss, Alex; Lee, Linda; Byszewski, Anna; Seitz, Dallas P; Vrkljan, Brenda; Molnar, Frank; Herrmann, Nathan; Tang-Wai, David F; Frank, Christopher; Henry, Blair; Pimlott, Nicholas; Masellis, Mario; Naglie, Gary

    2018-05-25

    Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ

  6. Engaging patients in health care decisions in the emergency department through shared decision-making: a systematic review.

    Science.gov (United States)

    Flynn, Darren; Knoedler, Meghan A; Hess, Erik P; Murad, M Hassan; Erwin, Patricia J; Montori, Victor M; Thomson, Richard G

    2012-08-01

    Many decisions in the emergency department (ED) may benefit from patient involvement, even though this setting has been considered least conducive to shared decision-making (SDM). The objective was to conduct a systematic review to evaluate the approaches, methods, and tools used to engage patients or their surrogates in SDM in the ED. Five electronic databases were searched in conjunction with contacting content experts, reviewing selected bibliographies, and conducting citation searches using the Web of Knowledge database. Two reviewers independently selected eligible studies that addressed patient involvement and engagement in decision-making in the ED setting via the use of decision support interventions (DSIs), defined as decision aids or decision support designed to communicate probabilistic information on the risks and benefits of treatment options to patients as part of an SDM process. Eligible studies described and assessed at least one of the following outcomes: patient knowledge, experiences and perspectives on participating in treatment or management decisions, clinician or patient satisfaction, preference for involvement and/or degree of engagement in decision-making and treatment preferences, and clinical outcomes (e.g., rates of hospital admission/readmission, rates of medical or surgical interventions). Two reviewers extracted data on study characteristics, methodologic quality, and outcomes. The authors also assessed the extent to which SDM interventions adhered to good practice for the presentation of information on outcome probabilities (eight probability items from the International Patient Decision Aid Standards Instrument [IPDASi]) and had comprehensive development processes. Five studies met inclusion criteria and were synthesized using a narrative approach. Each study was of satisfactory methodologic quality and used a DSI to engage patients or their surrogates in decision-making in the ED across four domains: 1) management options for

  7. Modeling decision making as a support tool for policy making on renewable energy development

    International Nuclear Information System (INIS)

    Cannemi, Marco; García-Melón, Mónica; Aragonés-Beltrán, Pablo; Gómez-Navarro, Tomás

    2014-01-01

    This paper presents the findings of a study on decision making models for the analysis of capital-risk investors’ preferences on biomass power plants projects. The aim of the work is to improve the support tools for policy makers in the field of renewable energy development. Analytic Network Process (ANP) helps to better understand capital-risk investors preferences towards different kinds of biomass fueled power plants. The results of the research allow public administration to better foresee the investors’ reaction to the incentive system, or to modify the incentive system to better drive investors’ decisions. Changing the incentive system is seen as major risk by investors. Therefore, public administration must design better and longer-term incentive systems, forecasting market reactions. For that, two scenarios have been designed, one showing a typical decision making process and another proposing an improved decision making scenario. A case study conducted in Italy has revealed that ANP allows understanding how capital-risk investors interpret the situation and make decisions when investing on biomass power plants; the differences between the interests of public administrations’s and promoters’, how decision making could be influenced by adding new decision criteria, and which case would be ranked best according to the decision models. - Highlights: • We applied ANP to the investors’ preferences on biomass power plants projects. • The aim is to improve the advising tools for renewable energy policy making. • A case study has been carried out with the help of two experts. • We designed two scenarios: decision making as it is and how could it be improved. • Results prove ANP is a fruitful tool enhancing participation and transparency

  8. Ranking of Business Process Simulation Software Tools with DEX/QQ Hierarchical Decision Model.

    Science.gov (United States)

    Damij, Nadja; Boškoski, Pavle; Bohanec, Marko; Mileva Boshkoska, Biljana

    2016-01-01

    The omnipresent need for optimisation requires constant improvements of companies' business processes (BPs). Minimising the risk of inappropriate BP being implemented is usually performed by simulating the newly developed BP under various initial conditions and "what-if" scenarios. An effectual business process simulations software (BPSS) is a prerequisite for accurate analysis of an BP. Characterisation of an BPSS tool is a challenging task due to the complex selection criteria that includes quality of visual aspects, simulation capabilities, statistical facilities, quality reporting etc. Under such circumstances, making an optimal decision is challenging. Therefore, various decision support models are employed aiding the BPSS tool selection. The currently established decision support models are either proprietary or comprise only a limited subset of criteria, which affects their accuracy. Addressing this issue, this paper proposes a new hierarchical decision support model for ranking of BPSS based on their technical characteristics by employing DEX and qualitative to quantitative (QQ) methodology. Consequently, the decision expert feeds the required information in a systematic and user friendly manner. There are three significant contributions of the proposed approach. Firstly, the proposed hierarchical model is easily extendible for adding new criteria in the hierarchical structure. Secondly, a fully operational decision support system (DSS) tool that implements the proposed hierarchical model is presented. Finally, the effectiveness of the proposed hierarchical model is assessed by comparing the resulting rankings of BPSS with respect to currently available results.

  9. Decision-theoretic planning of clinical patient management

    OpenAIRE

    Peek, Niels Bastiaan

    2000-01-01

    When a doctor is treating a patient, he is constantly facing decisions. From the externally visible signs and symptoms he must establish a hypothesis of what might be wrong with the patient; then he must decide whether additional diagnostic procedures are required to verify this hypothesis, whether therapeutic action is necessary, and which post-therapeutic trajectory is to be followed. All these bedside decisions are related to each other, and the whole task of clinical patient management ca...

  10. Semiquantitative Decision Tools for FMD Emergency Vaccination Informed by Field Observations and Simulated Outbreak Data

    DEFF Research Database (Denmark)

    Willeberg, Preben; AlKhamis, Mohammad; Boklund, Anette

    2017-01-01

    We present two simple, semiquantitative model-based decision tools, based on the principle of first 14 days incidence (FFI). The aim is to estimate the likelihood and the consequences, respectively, of the ultimate size of an ongoing FMD epidemic. The tools allow risk assessors to communicate...... and optimize the presentation of the resulting data for urgent decisions to be made by the risk managers, we estimated the sensitivity, specificity, as well as the negative and positive predictive values, using a chosen day-14 outbreak number as predictor of the magnitude of the number of remaining post-day-14...

  11. Developing GIS based decision-making tools in case of radiological contamination of agricultural soil

    International Nuclear Information System (INIS)

    Kepka, Pavel; Brom, Jakub; Prochazka, Jan; Vincikova, Hana; Pecharova, Emilie

    2010-01-01

    A set of supporting tools to help take remedial decisions in case of radiological contamination of agricultural produce is being developed within the EURANOS project. The tools are created in the ArcGIS environment in the Python programming language. So far, a simple model to estimate biomass in the contaminated area has been set up. This module will make it possible to estimate additional parameters, such as activity per kg or amount of waste created, which are useful when taking decision regarding premature crops harvesting. Areas where no remedial action is required can be also identified, of course

  12. User-centered design and the development of patient decision aids: protocol for a systematic review.

    Science.gov (United States)

    Witteman, Holly O; Dansokho, Selma Chipenda; Colquhoun, Heather; Coulter, Angela; Dugas, Michèle; Fagerlin, Angela; Giguere, Anik Mc; Glouberman, Sholom; Haslett, Lynne; Hoffman, Aubri; Ivers, Noah; Légaré, France; Légaré, Jean; Levin, Carrie; Lopez, Karli; Montori, Victor M; Provencher, Thierry; Renaud, Jean-Sébastien; Sparling, Kerri; Stacey, Dawn; Vaisson, Gratianne; Volk, Robert J; Witteman, William

    2015-01-26

    Providing patient-centered care requires that patients partner in their personal health-care decisions to the full extent desired. Patient decision aids facilitate processes of shared decision-making between patients and their clinicians by presenting relevant scientific information in balanced, understandable ways, helping clarify patients' goals, and guiding decision-making processes. Although international standards stipulate that patients and clinicians should be involved in decision aid development, little is known about how such involvement currently occurs, let alone best practices. This systematic review consisting of three interlinked subreviews seeks to describe current practices of user involvement in the development of patient decision aids, compare these to practices of user-centered design, and identify promising strategies. A research team that includes patient and clinician representatives, decision aid developers, and systematic review method experts will guide this review according to the Cochrane Handbook and PRISMA reporting guidelines. A medical librarian will hand search key references and use a peer-reviewed search strategy to search MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, the ACM library, IEEE Xplore, and Google Scholar. We will identify articles across all languages and years describing the development or evaluation of a patient decision aid, or the application of user-centered design or human-centered design to tools intended for patient use. Two independent reviewers will assess article eligibility and extract data into a matrix using a structured pilot-tested form based on a conceptual framework of user-centered design. We will synthesize evidence to describe how research teams have included users in their development process and compare these practices to user-centered design methods. If data permit, we will develop a measure of the user-centeredness of development processes and identify practices that are likely

  13. Electromechanical mapping of the left ventricle : possible tool for online decision making in the catheterization laboratory

    NARCIS (Netherlands)

    Tan, Eng S.; Jessurun, Gillian A. J.; Anthonio, Rutger L.; Slart, Riemer H. J. A.; Zijlstra, Felix; Tio, Rene A.

    Clinical decision making in intervention cardiology often depends on information about the presence of myocardial viability and the extent of ischemia. Especially in the case of an occluded collaterally filled coronary branch, online decision making in selected patients may accelerate and improve

  14. Reconciliation as a tool for decision making within decision tree related to insolvency problems

    Directory of Open Access Journals (Sweden)

    Tomáš Poláček

    2016-05-01

    Full Text Available Purpose of the article: The paper draws on the results of previous studies recoverability of creditor’s claims, where it was research from debtor’s point of view and his/her debts on the Czech Republic financial market. The company, which fell into a bankruptcy hearing, has several legislatively supported options how to deal with this situation and repay creditors money. Each of the options has been specified as a variant of a decisionmaking tree. This paper is focused on third option of evaluation – The reconciliation. The heuristic generates all missing information items. The result is then focused on the comparison and evaluation of the best ways to repay the debt, also including solution for the future continuation of the company currently in liquidation and quantification of percentage refund of creditors claim. A realistic case study is presented in full details. Further introduction of decision making with uncerteinties in insolvency proceedings. Methodology/methods: Solving within decision tree with partially ignorance of probability using reconciliation. Scientific aim: Comparison and evaluation of the best ways to repay the debt, also including solution for the future continuation of the company currently in liquidation and quantification of percentage refund of creditors claim. Findings: Predictions of future actions in dealing with insolvency act and bankruptcy hearing, quicker and more effective agreeing on compromises among all creditors and debtor. Conclusions: Finding a best way and solution of repayment and avoiding of termination for both of interested parties (creditor and debtor.

  15. Development of a decision support tool for the assessment of biofuels

    International Nuclear Information System (INIS)

    Perimenis, Anastasios; Walimwipi, Hartley; Zinoviev, Sergey; Mueller-Langer, Franziska; Miertus, Stanislav

    2011-01-01

    Alternative fuels for the transport sector are gaining growing attention as a means against fossil fuel dependence and towards greener forms of energy. At the same time, however, they are surrounded with doubts concerning sustainability of their production. This work presents the basic framework for a decision support tool to evaluate biofuel production pathways, with the purpose of providing the decision maker with a structured methodology that will lead him to the final decision. The tool integrates the most important aspects along the entire value chain (i.e. from biomass production to biofuel end-use), namely the technical, economic, environmental and social aspect. The tool consists of a computational part, which can be combined with the personal preferences of the user. The analysis provides a score for the respective pathway that can be used to rank different options and select among them the optimal solution. The functionality of the tool has been tested for the case of biodiesel from rapeseed in Germany. - Research highlights: → Structure and framework of a decision support tool for the assessment of biofuels. → Inclusion of economic, environmental and social aspects along the biofuel production chain. → Development of an internal database with relevant information along the chain. → Multi-criteria analysis for the consideration of all relevant criteria. → Incorporation of personal preferences and priorities in the final result.

  16. Exploring the requirements for a decision aid on familial breast cancer in the UK context: a qualitative study with patients referred to a cancer genetics service.

    NARCIS (Netherlands)

    Iredale, R.; Rapport, F.; Sivell, S.; Jones, W.; Edwards, A.; Gray, J.; Elwyn, G.

    2008-01-01

    RATIONALE: Patients concerned about a family history of breast cancer can face difficult decisions about screening, prophylactic surgery and genetic testing. Decision aids can facilitate patient decision making and currently include leaflets and computerized tools. These are largely aimed at the

  17. Patient engagement in healthcare: pathways for effective medical decision making

    Directory of Open Access Journals (Sweden)

    Serena Barello

    2015-04-01

    Full Text Available Making patients protagonists of decisions about their care is a primacy in the 21st century medical ethics. Precisely, to favor shared treatment decisions potentially enables patients’ autonomy and self-determination, and protects patients’ rights to make decisions about their own future care. To fully accomplish this goal, medicine should take into account the complexity of the healthcare decision making processes: patients may experience dilemmas when having to take decisions that not only concern their patient role/identity but also involve the psychosocial impact of treatments on their overall life quality. A deeper understanding of the patients’ expected role in the decision making process across their illness journey may favor the optimal implementation of this practice into the day-to-day medical agenda. In this paper, authors discuss the value of assuming the Patient Health Engagement Model to sustain successful pathways for effective medical decision making throughout the patient’s illness course. This model and its relational implication for the clinical encounter might be the base for an innovative “patient-doctor relational agenda” able to sustain an “engagement-sensitive” medical decision making.

  18. Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study.

    Science.gov (United States)

    Schön, Ulla-Karin; Grim, Katarina; Wallin, Lars; Rosenberg, David; Svedberg, Petra

    2018-12-01

    Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

  19. Value based building renovation - A tool for decision-making and evaluation

    DEFF Research Database (Denmark)

    Jensen, Per Anker; Maslesa, Esmir

    2015-01-01

    Research on the barriers for building renovation in Denmark has revealed that an important obstacle is a lack of simple and holistic tools that can assist stakeholders in prioritisation and decision-making during the early stages of building renovation projects. The purpose of this article...... is to present a tool - RENO-EVALUE, which can be used as decision support for sustainable renovation projects, and for evaluation, during and after building renovations. The tool is a result from the European Eracobuild project ACES - "A concept for promotion of sustainable retrofitting and renovation in early...... stages". This article presents the main result of a work package concerning benefits of renovation. RENO-EVALUE has been developed from four case studies on renovation projects in Denmark, tested and validated on the cases and in a Delphi study. The tool is value based by focusing on the different...

  20. Development of a decision-making tool for reporting drivers with mild dementia and mild cognitive impairment to transportation administrators.

    Science.gov (United States)

    Cameron, Duncan H; Zucchero Sarracini, Carla; Rozmovits, Linda; Naglie, Gary; Herrmann, Nathan; Molnar, Frank; Jordan, John; Byszewski, Anna; Tang-Wai, David; Dow, Jamie; Frank, Christopher; Henry, Blair; Pimlott, Nicholas; Seitz, Dallas; Vrkljan, Brenda; Taylor, Rebecca; Masellis, Mario; Rapoport, Mark J

    2017-09-01

    Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators. A multi-faceted, computerized decision support tool was developed, using a systematic literature and guideline review, expert opinion from an earlier Delphi study, as well as qualitative interviews and focus groups with physicians, caregivers of former drivers with dementia, and transportation administrators. The tool integrates inputs from the physician-user about the patient's clinical and driving history as well as cognitive findings, and it produces a recommendation for reporting to transportation administrators. This recommendation is translated into a customized reporting form for the transportation authority, if applicable, and additional resources are provided for the patient and caregiver. An innovative approach was needed to develop the DD-DT. The literature and guideline review confirmed the algorithm derived from the earlier Delphi study, and barriers identified in the qualitative research were incorporated into the design of the tool.

  1. Checklist and Decision Support in Nutritional Care for Burned Patients

    Science.gov (United States)

    2016-10-01

    able to construct a checklist of a clinical and physiologic model and then a computerised decision support system that will perform two functions: the...the provision of nutritional therapy, and assessment of use by nursing and physician staff KEYWORDS Nutrition, severe burn, decision support... clinical testing. Checklist and Decision Support in Nutritional Care for Burned Patients Proposal Number: 12340011 W81XWH-12-2-0074 PI: Steven E

  2. An Architectural Decision Tool Based on Scenarios and Non-functional Requirements

    OpenAIRE

    Mr. Mahesh Parmar; Prof. W.U. Khan; Dr. Binod Kumar

    2011-01-01

    Software architecture design is often based on architects intuition and previous experience. Little methodological support is available, but there are still no effective solutions to guide the architectural design. The most difficult activity is the transformation from non-functional requirement specification into software architecture. To achieve above things proposed “An Architectural Decision Tool Based on Scenarios and Nonfunctional Requirementsâ€. In this proposed tool scenarios are fi...

  3. Understanding Managers Decision Making Process for Tools Selection in the Core Front End of Innovation

    DEFF Research Database (Denmark)

    Appio, Francesco P.; Achiche, Sofiane; McAloone, Tim C.

    2011-01-01

    New product development (NPD) describes the process of bringing a new product or service to the market. The Fuzzy Front End (FFE) of Innovation is the term describing the activities happening before the product development phase of NPD. In the FFE of innovation, several tools are used to facilita...... hypotheses are tested. A preliminary version of a theoretical model depicting the decision process of managers during tools selection in the FFE is proposed. The theoretical model is built from the constructed hypotheses....

  4. Renovation versus New Construction and Building Decision Tool for Educational Facilities

    OpenAIRE

    Pope, Carrie; Marks, Eric; Back, Edward; Leopard, Tim; Love, Thomas

    2016-01-01

    Renovation of an existing building is an accomplished stem of the construction industry because it supplies financial diversification for construction stakeholders. Although several construction planning tools and stakeholder alignment exercises have been developed, no tool exists to assist project owners to decide between renovating an existing building and new construction with a comprehensive decision criteria. The objective of this research is to create and test a renovation versus new bu...

  5. Creation of an Open Framework for Point-of-Care Computer-Assisted Reporting and Decision Support Tools for Radiologists.

    Science.gov (United States)

    Alkasab, Tarik K; Bizzo, Bernardo C; Berland, Lincoln L; Nair, Sujith; Pandharipande, Pari V; Harvey, H Benjamin

    2017-09-01

    Decreasing unnecessary variation in radiology reporting and producing guideline-concordant reports is fundamental to radiology's success in value-based payment models and good for patient care. In this article, we present an open authoring system for point-of-care clinical decision support tools integrated into the radiologist reporting environment referred to as the computer-assisted reporting and decision support (CAR/DS) framework. The CAR/DS authoring system, described herein, includes: (1) a definition format for representing radiology clinical guidelines as structured, machine-readable Extensible Markup Language documents and (2) a user-friendly reference implementation to test the fidelity of the created definition files with the clinical guideline. The proposed definition format and reference implementation will enable content creators to develop CAR/DS tools that voice recognition software (VRS) vendors can use to extend the commercial tools currently in use. In making the definition format and reference implementation software freely available, we hope to empower individual radiologists, expert groups such as the ACR, and VRS vendors to develop a robust ecosystem of CAR/DS tools that can further improve the quality and efficiency of the patient care that our field provides. We hope that this initial effort can serve as the basis for a community-owned open standard for guideline definition that the imaging informatics and VRS vendor communities will embrace and strengthen. To this end, the ACR Assist™ initiative is intended to make the College's clinical content, including the Incidental Findings Committee White Papers, available for decision support tool creation based upon the herein described CAR/DS framework. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  6. Tools to support GHG emissions reduction : a regional effort, part 1 - carbon footprint estimation and decision support.

    Science.gov (United States)

    2010-09-01

    Tools are proposed for carbon footprint estimation of transportation construction projects and decision support : for construction firms that must make equipment choice and usage decisions that affect profits, project duration : and greenhouse gas em...

  7. Colorectal cancer patients' attitudes towards involvement in decision making.

    Science.gov (United States)

    Beaver, Kinta; Campbell, Malcolm; Craven, Olive; Jones, David; Luker, Karen A; Susnerwala, Shabbir S

    2009-03-01

    To design and administer an attitude rating scale, exploring colorectal cancer patients' views of involvement in decision making. To examine the impact of socio-demographic and/or treatment-related factors on decision making. To conduct principal components analysis to determine if the scale could be simplified into a number of factors for future clinical utility. An attitude rating scale was constructed based on previous qualitative work and administered to colorectal cancer patients using a cross-sectional survey approach. 375 questionnaires were returned (81.7% response). For patients it was important to be informed and involved in the decision-making process. Information was not always used to make decisions as patients placed their trust in medical expertise. Women had more positive opinions on decision making and were more likely to want to make decisions. Written information was understood to a greater degree than verbal information. The scale could be simplified to a number of factors, indicating clinical utility. Few studies have explored the attitudes of colorectal cancer patients towards involvement in decision making. This study presents new insights into how patients view the concept of participation; important when considering current policy imperatives in the UK of involving service users in all aspects of care and treatment.

  8. Intra-annual wave resource characterization for energy exploitation: A new decision-aid tool

    International Nuclear Information System (INIS)

    Carballo, R.; Sánchez, M.; Ramos, V.; Fraguela, J.A.; Iglesias, G.

    2015-01-01

    Highlights: • A decision-aid tool is developed for computing the monthly performance of WECs. • It allows the generation of high-resolution monthly characterization matrices. • The decision-aid tool is implemented to the Death Coast (N Spain). • The monthly matrices can be obtained at any coastal location within the Death Coast. • The tool is applied to a coastal location of a proposed wave farm. - Abstract: The wave energy resource is usually characterized by a significant variability throughout the year. In estimating the power performance of a Wave Energy Converter (WEC) it is fundamental to take into account this variability; indeed, an estimate based on mean annual values may well result in a wrong decision making. In this work, a novel decision-aid tool, iWEDGE (intra-annual Wave Energy Diagram GEnerator) is developed and implemented to a coastal region of interest, the Death Coast (Spain), one of the regions in Europe with the largest wave resource. Following a comprehensive procedure, and based on deep water wave data and high-resolution numerical modelling, this tool provides the monthly high-resolution characterization matrices (or energy diagrams) for any location of interest. In other words, the information required for the accurate computation of the intra-annual performance of any WEC at any location within the region covered is made available. Finally, an application of iWEDGE to the site of a proposed wave farm is presented. The results obtained highlight the importance of the decision-aid tool herein provided for wave energy exploitation

  9. Feasibility of web-based decision aids in neurological patients

    NARCIS (Netherlands)

    van Til, Janine Astrid; Drossaert, Constance H.C.; Renzenbrink, Gerbert J.; Snoek, Govert J.; Dijkstra, Evelien; Stiggelbout, Anne M.; IJzerman, Maarten Joost

    2010-01-01

    Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of

  10. Development of a prototype clinical decision support tool for osteoporosis disease management: a qualitative study of focus groups

    Directory of Open Access Journals (Sweden)

    Newton David

    2010-07-01

    Full Text Available Abstract Background Osteoporosis affects over 200 million people worldwide, and represents a significant cost burden. Although guidelines are available for best practice in osteoporosis, evidence indicates that patients are not receiving appropriate diagnostic testing or treatment according to guidelines. The use of clinical decision support systems (CDSSs may be one solution because they can facilitate knowledge translation by providing high-quality evidence at the point of care. Findings from a systematic review of osteoporosis interventions and consultation with clinical and human factors engineering experts were used to develop a conceptual model of an osteoporosis tool. We conducted a qualitative study of focus groups to better understand physicians' perceptions of CDSSs and to transform the conceptual osteoporosis tool into a functional prototype that can support clinical decision making in osteoporosis disease management at the point of care. Methods The conceptual design of the osteoporosis tool was tested in 4 progressive focus groups with family physicians and general internists. An iterative strategy was used to qualitatively explore the experiences of physicians with CDSSs; and to find out what features, functions, and evidence should be included in a working prototype. Focus groups were conducted using a semi-structured interview guide using an iterative process where results of the first focus group informed changes to the questions for subsequent focus groups and to the conceptual tool design. Transcripts were transcribed verbatim and analyzed using grounded theory methodology. Results Of the 3 broad categories of themes that were identified, major barriers related to the accuracy and feasibility of extracting bone mineral density test results and medications from the risk assessment questionnaire; using an electronic input device such as a Tablet PC in the waiting room; and the importance of including well-balanced information in

  11. Defining criteria related to wastes for use in multi-criteria decision tool for nuclear accidents

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Diogo N.G.; Guimaraes, Jean R.D., E-mail: dneves@biof.ufrj.br, E-mail: jeanrdg@biof.ufrj.br [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Instituto de Biofisica Carlos Chagas Filho; Rochedo, Elaine R.R.; De Luca, Christiano, E-mail: elainerochedo@gmail.com, E-mail: christiano_luca@hotmail.com [Instituto Militar de Engenharia (IME), Rio de Janeiro, RJ (Brazil). Programa de Engenharia Nuclear; Rochedo, Pedro R.R., E-mail: rochedopedro@gmail.com [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Instituto Alberto Luiz Coimbra de Pos-Graduacao e Pesquisa de Engenharia

    2013-07-01

    The selection of protective measures and strategies for remediation of contaminated areas after a nuclear accident must be based on previously established criteria in order to prevent stress of the population and the unnecessary exposure of workers. After a nuclear accident resulting in environmental contamination, decisions on remediation of areas is complex due to the large numbers of factors involved in decontamination processes. This work is part of a project which aims to develop a multi-criteria tool to support a decision-making process in cases of a radiological or a nuclear accident in Brazil. First, a database of remediation strategies for contaminated areas was created. In this process, the most relevant aspects for the implementation of these strategies were considered, including technical criteria regarding aspects related to the generation of wastes in a reference urban area, which are discussed in this paper. The specific objective of this study is to define criteria for the aspects of radioactive wastes, resulted by the implementation of some urban measures, in order to be incorporated in a multi-criteria decision tool. Main aspects considered were the type, the amount and the type of treatment necessary for each procedure. The decontamination procedures are then classified according to the selected criteria in order to feed the multi-criteria decision tool. This paper describes the steps for the establishment of these criteria and evaluates the potential for future applications in order to improve predictions and to support the decisions to be made. (author)

  12. Optimization of protection as a decision-making tool, for radioactive waste disposal

    International Nuclear Information System (INIS)

    Bragg, K.

    1988-01-01

    Politically-based considerations and processes including public perception and confidence appear to be the basis for real decisions affecting waste management activities such as siting, construction, operation and monitoring. Optimization of radiation protection is not a useful general tool for waste disposal decision making. Optimization of radiation protection is essentially a technical tool which can, under appropriate circumstances, provide a clear preference among major management options. The level of discrimination will be case-specific but, in general, only fairly coarse differences can be discriminated. The preferences determined by optimization of protection tend not to be related to the final choices made for disposal of radioactive wastes. Tools such as multi-attribute analysis are very useful as they provide a convenient means to rationalize the real decisions and give them some air of technical respectability. They do not, however, provide the primary basis for the decisions. Technical experts must develop an awareness of the non-technical approach to decision making an attempt to adjust their method of analyses and their presentation of information to encourage dialogue rather than confrontation. Simple expressions of technical information will be needed and the use of analogues should prove helpful

  13. Defining criteria related to wastes for use in multi-criteria decision tool for nuclear accidents

    International Nuclear Information System (INIS)

    Silva, Diogo N.G.; Guimaraes, Jean R.D.; Rochedo, Elaine R.R.; De Luca, Christiano; Rochedo, Pedro R.R.

    2013-01-01

    The selection of protective measures and strategies for remediation of contaminated areas after a nuclear accident must be based on previously established criteria in order to prevent stress of the population and the unnecessary exposure of workers. After a nuclear accident resulting in environmental contamination, decisions on remediation of areas is complex due to the large numbers of factors involved in decontamination processes. This work is part of a project which aims to develop a multi-criteria tool to support a decision-making process in cases of a radiological or a nuclear accident in Brazil. First, a database of remediation strategies for contaminated areas was created. In this process, the most relevant aspects for the implementation of these strategies were considered, including technical criteria regarding aspects related to the generation of wastes in a reference urban area, which are discussed in this paper. The specific objective of this study is to define criteria for the aspects of radioactive wastes, resulted by the implementation of some urban measures, in order to be incorporated in a multi-criteria decision tool. Main aspects considered were the type, the amount and the type of treatment necessary for each procedure. The decontamination procedures are then classified according to the selected criteria in order to feed the multi-criteria decision tool. This paper describes the steps for the establishment of these criteria and evaluates the potential for future applications in order to improve predictions and to support the decisions to be made. (author)

  14. Systematic Review of Decision Aids for Newly Diagnosed Patients with Prostate Cancer Making Treatment Decisions.

    Science.gov (United States)

    Adsul, Prajakta; Wray, Ricardo; Spradling, Kyle; Darwish, Oussama; Weaver, Nancy; Siddiqui, Sameer

    2015-11-01

    Despite established evidence for using patient decision aids, use with newly diagnosed patients with prostate cancer remains limited partly due to variability in aid characteristics. We systematically reviewed decision aids for newly diagnosed patients with prostate cancer. Published peer reviewed journal articles, unpublished literature on the Internet and the Ottawa decision aids web repository were searched to identify decision aids designed for patients with prostate cancer facing treatment decisions. A total of 14 aids were included in study. Supplementary materials on aid development and published studies evaluating the aids were also included. We studied aids designed to help patients make specific choices among options and outcomes relevant to health status that were specific to prostate cancer treatment and in English only. Aids were reviewed for IPDAS (International Patient Decision Aid Standards) and additional standards deemed relevant to prostate cancer treatment decisions. They were also reviewed for novel criteria on the potential for implementation. Acceptable interrater reliability was achieved at Krippendorff α = 0.82. Eight of the 14 decision aids (57.1%) were developed in the United States, 6 (42.8%) were print based, 5 (35.7%) were web or print based and only 4 (28.5%) had been updated since 2013. Ten aids (71.4%) were targeted to prostate cancer stage. All discussed radiation and surgery, 10 (71.4%) discussed active surveillance and/or watchful waiting and 8 (57.1%) discussed hormonal therapy. Of the aids 64.2% presented balanced perspectives on treatment benefits and risks, and/or outcome probabilities associated with each option. Ten aids (71.4%) presented value clarification prompts for patients and steps to make treatment decisions. No aid was tested with physicians and only 4 (28.6%) were tested with patients. Nine aids (64.2%) provided details on data appraisal and 4 (28.6%) commented on the quality of evidence used. Seven of the 8

  15. Selection of a tool to decision making for site selection for high level waste

    International Nuclear Information System (INIS)

    Madeira, J.G.; Alvin, A.C.M.; Martins, V.B.; Monteiro, N.A.

    2016-01-01

    The aim of this paper is to create a panel comparing some of the key decision-making support tools used in situations with the characteristics of the problem of selecting suitable areas for constructing a final deep geologic repository. The tools addressed in this work are also well known and with easy implementation. The decision-making process in matters of this kind is, in general, complex due to its multi-criteria nature and the conflicting opinions of various stakeholders. Thus, a comprehensive study was performed with the literature in this subject, specifically in documents of the International Atomic Energy Agency (IAEA), regarding the importance of the criteria involved in the decision-making process. Therefore, we highlighted six judgment attributes for selecting a decision support tool, suitable for the problem. For this study, we have selected the following multi-criteria tools: AHP, Delphi, Brainstorm, Nominal Group Technique and AHP-Delphi. Finally, the AHP-Delphi method has demonstrated to be more appropriate for managing the inherent multiple attributes to the problem proposed. (authors)

  16. Selection of a tool to support decision making for site selection for high level waste - 15010

    International Nuclear Information System (INIS)

    Madeira, J.G.; Alvim, A.C.M.; Martins, V.B.; Monteiro, N.A.

    2015-01-01

    The aim of this paper is to create a panel comparing some of the key decision-making support tools used in situations with the characteristics of the problem of selecting suitable areas for constructing a final deep geologic repository. The tools presented in this work are also well-known and with easy implementation. The decision making process in issues of this kind is, in general, complex due to its multi-criteria nature and the conflicting opinions of various of stakeholders. Thus a comprehensive study was performed with the literature on this subject, specifically documents of the International Atomic Energy Agency - IAEA, regarding the importance of the criteria involved in the decision making process. Therefore, we highlighted 6 judgments attributes for selecting an adequate support tool: -) transparency and reliability, -) subjectivity, -) updating and adapting, -) multi-criteria analysis, -) ease of deployment, and -) application time. We have selected the following key decision-making support tools: AHP, Delphi, Brainstorm, Nominal Group Technique, and AHP-Delphi. Finally, the AHP-Delphi method has demonstrated to be more appropriate for managing the inherent multiple attributes to the problem proposed

  17. Prototype of a diagnostic decision support tool for structural damage in masonry

    NARCIS (Netherlands)

    De Vent, I.A.E.

    2011-01-01

    This prototype of a diagnostic decision support tool for structural damage in traditional masonry is the result of a PhD research project. The research project has aimed to improve and facilitate the diagnostic process by offering support in the initial phase in which hypotheses are generated. The

  18. An Engineering Educator's Decision Support Tool for Improving Innovation in Student Design Projects

    Science.gov (United States)

    Ozaltin, Nur Ozge; Besterfield-Sacre, Mary; Clark, Renee M.

    2015-01-01

    Learning how to design innovatively is a critical process skill for undergraduate engineers in the 21st century. To this end, our paper discusses the development and validation of a Bayesian network decision support tool that can be used by engineering educators to make recommendations that positively impact the innovativeness of product designs.…

  19. Fuzzy Decision Support for Tools Selection in the Core Front End Activities of New Product Development

    DEFF Research Database (Denmark)

    Achiche, S.; Appio, F.P.; McAloone, Tim C.

    2013-01-01

    models (FDSM) of the discovered relationships. The decision support focuses upon the estimated investment needed for the use of tools during the CFE. The generation of FDSMs is carried out automatically using a specialized genetic algorithm, applied to learning data obtained from five experienced...

  20. Decision-Support Tools and Databases to Inform Regional Stormwater Utility Development in New England

    Science.gov (United States)

    Development of stormwater utilities requires information on existing stormwater infrastructure and impervious cover as well as costs and benefits of stormwater management options. US EPA has developed a suite of databases and tools that can inform decision-making by regional sto...

  1. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices.

    Science.gov (United States)

    Elwyn, G; Edwards, A; Kinnersley, P; Grol, R

    2000-11-01

    Involving patients in healthcare decisions makes a potentially significant and enduring difference to healthcare outcomes. One difficulty (among many) is that the 'involvement' of patients in decisions has been left undefined. It is usually conceptualised as 'patient centredness', which is a broad and variably interpreted concept that is difficult to assess using current tools. This paper attempts to gauge general practitioners' (GPs') attitudes to patient involvement in decision making and their views about the contextual factors, competences, and stages required to achieve shared decisions within consultations. To explore and understand what constitutes the appropriate involvement of patients in decision making within consultations, to consider previous theory in this field, and to propose a set of competences (skills) and steps that would enable clinical practitioners (generalists) to undertake 'shared decision making' in their clinical environment. Qualitative study using focus group interviews of key informants. Experienced GPs with educational roles have positive attitudes to the involvement of patients in decisions, provided the process matches the role individuals wish to play. They perceive some clinical problems as being more suited to a cooperative approach to decision making and conceptualised the existence of professional equipoise towards the existence of legitimate treatment options as an important facilitative factor. A sequence of skills was proposed as follows: 1) implicit or explicit involvement of patients in the decision-making process; 2) explore ideas, fears, and expectations of the problem and possible treatments; 3) portrayal of equipoise and options; 4) identify preferred data format and provide tailor-made information; 5) checking process: understanding of information and reactions (e.g. ideas, fears, and expectations of possible options); 6) acceptance of process and decision making role preference; 7) make, discuss or defer decisions; 8

  2. Development and evaluation of a patient-centred measurement tool for surgeons' non-technical skills.

    Science.gov (United States)

    Yule, J; Hill, K; Yule, S

    2018-06-01

    Non-technical skills are essential for safe and effective surgery. Several tools to assess surgeons' non-technical skills from the clinician's perspective have been developed. However, a reliable measurement tool using a patient-centred approach does not currently exist. The aim of this study was to translate the existing Non-Technical Skills for Surgeons (NOTSS) tool into a patient-centred evaluation tool. Data were gathered from four cohorts of patients using an iterative four-stage mixed-methods research design. Exploratory and confirmatory factor analyses were performed to establish the psychometric properties of the tool, focusing on validity, reliability, usability and parsimony. Some 534 patients were recruited to the study. A total of 24 patient-centred non-technical skill items were developed in stage 1, and reduced to nine items in stage 2 using exploratory factor analysis. In stage 3, confirmatory factor analysis demonstrated that these nine items each loaded on to one of three factors, with excellent internal consistency: decision-making, leadership, and communication and teamwork. In stage 4, validity testing established that the new tool was independent of physician empathy and predictive of surgical quality. Surgical leadership emerged as the most dominant skill that patients could recognize and evaluate. A novel nine-item assessment tool has been developed. The Patients' Evaluation of Non-Technical Skills (PENTS) tool allows valid and reliable measurement of surgeons' non-technical skills from the patient perspective. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

  3. Integrating decision support tools and environmental information systems: a case study on the Province of Milan

    International Nuclear Information System (INIS)

    Bagli, S.; Pistocchi, A.; Mazzoli, P.; Valentini, P.

    2006-01-01

    The paper demonstrates an application of advanced decision support tools within the framework of the environmental information system of the Province of Milan. These tools include environmental simulation models, multi criteria analysis, risk analysis and environmental accounting for marketable emission permits. After describing the general structure of the system, three demonstrational case studies are introduced concerning: groundwater pollution management; atmospheric pollution management; urban environmental quality perception and management. In the conclusion, potential use of tools like the ones implemented by the province of Milan within the framework of Local Agenda 21 processes is recalled [it

  4. Updated Decision Support Tool for the Management of Waste and Debris from Radiological Incidents

    International Nuclear Information System (INIS)

    Lemieux, P.; Thorneloe, S.; Hayes, C.; Rodgers, M.; Christman, R.

    2009-01-01

    Unique challenges exist for the handling, transport, and disposal of debris resulting from homeland security incidents, disasters or other national emergencies. Access to guidance for facilitating decision making in the safe and timely disposal of debris is critical to helping restore a community or region and prevent further contamination or spread of disease. For a radiological dispersal device (RDD) or other radiological incident, proper characterization of the quantity, properties, and level of contamination of debris and decontamination residue can have a significant impact on cleanup costs and timelines. A suite of decision support tools (DSTs) is being developed by the U.S. EPA's Office of Research and Development to assist individuals responsible for making decisions associated with handling, transport, treatment, and disposal of such debris. The DSTs are location-specific to help identify specific facilities and contacts for making final disposal decisions. The DSTs provide quick reference to technical information, regulations, and other information to provide decision makers with assistance in guiding disposal decisions that are important for the protection of public health, first responders, and the environment. This tool is being developed in partnership with other U.S. government agencies, EPA program offices, industry, and state and local emergency response programs. (authors)

  5. Clarity versus complexity: land-use modeling as a practical tool for decision-makers

    Science.gov (United States)

    Sohl, Terry L.; Claggett, Peter

    2013-01-01

    The last decade has seen a remarkable increase in the number of modeling tools available to examine future land-use and land-cover (LULC) change. Integrated modeling frameworks, agent-based models, cellular automata approaches, and other modeling techniques have substantially improved the representation of complex LULC systems, with each method using a different strategy to address complexity. However, despite the development of new and better modeling tools, the use of these tools is limited for actual planning, decision-making, or policy-making purposes. LULC modelers have become very adept at creating tools for modeling LULC change, but complicated models and lack of transparency limit their utility for decision-makers. The complicated nature of many LULC models also makes it impractical or even impossible to perform a rigorous analysis of modeling uncertainty. This paper provides a review of land-cover modeling approaches and the issues causes by the complicated nature of models, and provides suggestions to facilitate the increased use of LULC models by decision-makers and other stakeholders. The utility of LULC models themselves can be improved by 1) providing model code and documentation, 2) through the use of scenario frameworks to frame overall uncertainties, 3) improving methods for generalizing key LULC processes most important to stakeholders, and 4) adopting more rigorous standards for validating models and quantifying uncertainty. Communication with decision-makers and other stakeholders can be improved by increasing stakeholder participation in all stages of the modeling process, increasing the transparency of model structure and uncertainties, and developing user-friendly decision-support systems to bridge the link between LULC science and policy. By considering these options, LULC science will be better positioned to support decision-makers and increase real-world application of LULC modeling results.

  6. Informed public choices for low-carbon electricity portfolios using a computer decision tool.

    Science.gov (United States)

    Mayer, Lauren A Fleishman; Bruine de Bruin, Wändi; Morgan, M Granger

    2014-04-01

    Reducing CO2 emissions from the electricity sector will likely require policies that encourage the widespread deployment of a diverse mix of low-carbon electricity generation technologies. Public discourse informs such policies. To make informed decisions and to productively engage in public discourse, citizens need to understand the trade-offs between electricity technologies proposed for widespread deployment. Building on previous paper-and-pencil studies, we developed a computer tool that aimed to help nonexperts make informed decisions about the challenges faced in achieving a low-carbon energy future. We report on an initial usability study of this interactive computer tool. After providing participants with comparative and balanced information about 10 electricity technologies, we asked them to design a low-carbon electricity portfolio. Participants used the interactive computer tool, which constrained portfolio designs to be realistic and yield low CO2 emissions. As they changed their portfolios, the tool updated information about projected CO2 emissions, electricity costs, and specific environmental impacts. As in the previous paper-and-pencil studies, most participants designed diverse portfolios that included energy efficiency, nuclear, coal with carbon capture and sequestration, natural gas, and wind. Our results suggest that participants understood the tool and used it consistently. The tool may be downloaded from http://cedmcenter.org/tools-for-cedm/informing-the-public-about-low-carbon-technologies/ .

  7. Patient portals - An online tool for your health

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000880.htm Patient portals - an online tool for your health To ... is private and secure. What is in a Patient Portal? With a patient portal, you can: Make ...

  8. Artificial intelligence tools decision support systems in condition monitoring and diagnosis

    CERN Document Server

    Galar Pascual, Diego

    2015-01-01

    Artificial Intelligence Tools: Decision Support Systems in Condition Monitoring and Diagnosis discusses various white- and black-box approaches to fault diagnosis in condition monitoring (CM). This indispensable resource: Addresses nearest-neighbor-based, clustering-based, statistical, and information theory-based techniques Considers the merits of each technique as well as the issues associated with real-life application Covers classification methods, from neural networks to Bayesian and support vector machines Proposes fuzzy logic to explain the uncertainties associated with diagnostic processes Provides data sets, sample signals, and MATLAB® code for algorithm testing Artificial Intelligence Tools: Decision Support Systems in Condition Monitoring and Diagnosis delivers a thorough evaluation of the latest AI tools for CM, describing the most common fault diagnosis techniques used and the data acquired when these techniques are applied.

  9. Treatment decision-making among breast cancer patients in Malaysia

    Directory of Open Access Journals (Sweden)

    Nies YH

    2017-10-01

    Full Text Available Yong Hui Nies,1 Farida Islahudin,1 Wei Wen Chong,1 Norlia Abdullah,2 Fuad Ismail,3 Ros Suzanna Ahmad Bustamam,4 Yoke Fui Wong,5 JJ Saladina,2 Noraida Mohamed Shah1 1Faculty of Pharmacy, 2Department of Surgery, 3Department of Radiotherapy and Oncology, Universiti Kebangsaan Malaysia Medical Centre, 4Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Kuala Lumpur, 5Department of Radiotherapy and Oncology, National Cancer Institute, Putrajaya, Malaysia Purpose: This study investigated breast cancer patients’ involvement level in the treatment decision-making process and the concordance between patients’ and physician’s perspectives in decision-making. Participants and methods: A cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients’ involvement in treatment decision-making, and patients’ preference for behavioral involvement and information related to their disease. Results: The majority of patients preferred to share decision-making with their physicians (47.5%, while the second largest group preferred being passive (42.6% and a small number preferred being active (9.8%. However, the physicians perceived that the majority of patients preferred active decision-making (56.9%, followed by those who desired shared decision-making (32.8%, and those who preferred passive decision-making (10.3%. The overall concordance was 26.5% (54 of 204 patient–physician dyads. The median of preference for information score and behavioral involvement score was 4 (interquartile range [IQR] =3–5 and 2 (IQR =2–3, respectively. In univariate analysis, the ethnicity and

  10. [Patient expectations about decision-making for various health problems].

    Science.gov (United States)

    Delgado, Ana; López-Fernández, Luis Andrés; de Dios Luna, Juan; Saletti Cuesta, Lorena; Gil Garrido, Natalia; Puga González, Almudena

    2010-01-01

    To identify patient expectations of clinical decision-making at consultations with their general practitioners for distinct health problems and to determine the patient and general practitioner characteristics related to these expectations, with special focus on gender. We performed a multicenter cross-sectional study in 360 patients who were interviewed at home. Data on patients' sociodemographic, clinical characteristics and satisfaction were gathered. General practitioners supplied information on their gender and postgraduate training in family medicine. A questionnaire was used to collect data on patients' expectations that their general practitioner account of their opinion and on expectations of clinical decision making> at consultations with their general practitioner for five problems or hypothetical clinical scenarios (strong chest pain/cold with fever/abnormal discharge/depression or sadness/severe family problem). Patients were asked to indicate their preference that decisions on diagnosis and treatment be taken by: a) the general practitioner alone; b) the general practitioner, taking account of the patient's opinion; c) the patient, taking account of the general practitioner's opinion and d) the patient alone. A logistic regression was performed for clinical decision-making. The response rate was 90%. The mean age was 47.3 + or - 16.5 years and 51% were female. Patients' expectations that their general practitioner listen, explain and take account of their opinions were higher than their expectations of participating in decision-making, depending on the problem in question: 32% wished to participate in chest pain and 49% in family problems. Women had lower expectations of participating in depression and family problems. Patients with female general practitioners had higher expectations of participating in family problems and colds. Most patients wished to be listened to, informed and taken into account by their general practitioners and, to a lesser

  11. Decision-Making in Multiple Sclerosis Patients: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Mireille Neuhaus

    2018-01-01

    Full Text Available Background. Multiple sclerosis (MS is frequently associated with cognitive and behavioural deficits. A growing number of studies suggest an impact of MS on decision-making abilities. The aim of this systematic review was to assess if (1 performance of MS patients in decision-making tasks was consistently different from controls and (2 whether this modification was associated with cognitive dysfunction and emotional alterations. Methods. The search was conducted on Pubmed/Medline database. 12 studies evaluating the difference between MS patients and healthy controls using validated decision-making tasks were included. Outcomes considered were quantitative (net scores and qualitative measurements (deliberation time and learning from feedback. Results. Quantitative and qualitative decision-making impairment in MS was present in 64.7% of measurements. Patients were equally impaired in tasks for decision-making under risk and ambiguity. A correlation to other cognitive functions was present in 50% of cases, with the highest associations in the domains of processing speed and attentional capacity. Conclusions. In MS patients, qualitative and quantitative modifications may be present in any kind of decision-making task and can appear independently of other cognitive measures. Since decision-making abilities have a significant impact on everyday life, this cognitive aspect has an influential importance in various MS-related treatment settings.

  12. Decision-Making in Multiple Sclerosis Patients: A Systematic Review.

    Science.gov (United States)

    Neuhaus, Mireille; Calabrese, Pasquale; Annoni, Jean-Marie

    2018-01-01

    Multiple sclerosis (MS) is frequently associated with cognitive and behavioural deficits. A growing number of studies suggest an impact of MS on decision-making abilities. The aim of this systematic review was to assess if (1) performance of MS patients in decision-making tasks was consistently different from controls and (2) whether this modification was associated with cognitive dysfunction and emotional alterations. The search was conducted on Pubmed/Medline database. 12 studies evaluating the difference between MS patients and healthy controls using validated decision-making tasks were included. Outcomes considered were quantitative (net scores) and qualitative measurements (deliberation time and learning from feedback). Quantitative and qualitative decision-making impairment in MS was present in 64.7% of measurements. Patients were equally impaired in tasks for decision-making under risk and ambiguity. A correlation to other cognitive functions was present in 50% of cases, with the highest associations in the domains of processing speed and attentional capacity. In MS patients, qualitative and quantitative modifications may be present in any kind of decision-making task and can appear independently of other cognitive measures. Since decision-making abilities have a significant impact on everyday life, this cognitive aspect has an influential importance in various MS-related treatment settings.

  13. Patients' participation in decision-making in the medical field

    DEFF Research Database (Denmark)

    Glasdam, Stinne; Oeye, Christine; Thrysøe, Lars

    2015-01-01

    is going to happen in his life. Both professionals and patients have an underlying, tacit preconception that every medical treatment is better than no treatment. Patients do not always want to be a ‘customer’ in the healthcare system; they want to be a patient, consulting an expert for help and advice......, which creates resistance to the some parts of the decision-making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal frame and medical logic. The decision-making competence in relation to the choice of treatment is placed away...

  14. Development and Usability Testing of a Computer-Tailored Decision Support Tool for Lung Cancer Screening: Study Protocol.

    Science.gov (United States)

    Carter-Harris, Lisa; Comer, Robert Skipworth; Goyal, Anurag; Vode, Emilee Christine; Hanna, Nasser; Ceppa, DuyKhanh; Rawl, Susan M

    2017-11-16

    Awareness of lung cancer screening remains low in the screening-eligible population, and when patients visit their clinician never having heard of lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Therefore, methods to effectively support both patients and clinicians to engage in these important discussions are essential. To facilitate shared decision making about lung cancer screening, effective methods to prepare patients to have these important discussions with their clinician are needed. Our objective is to develop a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards instrument version 4.0 that will support shared decision making in lung cancer screening decisions. Using a 3-phase process, we will develop and test a prototype of a computer-tailored decision support tool in a sample of lung cancer screening-eligible individuals. In phase I, we assembled a community advisory board comprising 10 screening-eligible individuals to develop the prototype. In phase II, we recruited a sample of 13 screening-eligible individuals to test the prototype for usability, acceptability, and satisfaction. In phase III, we are conducting a pilot randomized controlled trial (RCT) with 60 screening-eligible participants who have never been screened for lung cancer. Outcomes tested include lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), perception of being prepared to engage in a patient-clinician discussion about lung cancer screening, occurrence of a patient-clinician discussion about lung cancer screening, and stage of adoption for lung cancer screening. Phases I and II are complete. Phase III is underway. As of July 15, 2017, 60 participants have been enrolled into the study, and have completed the baseline survey, intervention, and first

  15. [COMETE: a tool to develop psychosocial competences in patient education].

    Science.gov (United States)

    Saugeron, Benoit; Sonnier, Pierre; Marchais, Stéphanie

    2016-01-01

    This article presents a detailed description of the development and use of the COMETE tool. The COMETE tool is designed to help medical teams identify, develop or evaluate psychosocial skills in patient education and counselling. This tool, designed in the form of a briefcase, proposes methodological activities and cards that assess psychosocial skills during a shared educational assessment, group meetings or during an individual evaluation. This tool is part of a support approach for medical teams caring for patients with chronic diseases.

  16. Cost effectiveness of pediatric pneumococcal conjugate vaccines: a comparative assessment of decision-making tools.

    Science.gov (United States)

    Chaiyakunapruk, Nathorn; Somkrua, Ratchadaporn; Hutubessy, Raymond; Henao, Ana Maria; Hombach, Joachim; Melegaro, Alessia; Edmunds, John W; Beutels, Philippe

    2011-05-12

    Several decision support tools have been developed to aid policymaking regarding the adoption of pneumococcal conjugate vaccine (PCV) into national pediatric immunization programs. The lack of critical appraisal of these tools makes it difficult for decision makers to understand and choose between them. With the aim to guide policymakers on their optimal use, we compared publicly available decision-making tools in relation to their methods, influential parameters and results. The World Health Organization (WHO) requested access to several publicly available cost-effectiveness (CE) tools for PCV from both public and private provenance. All tools were critically assessed according to the WHO's guide for economic evaluations of immunization programs. Key attributes and characteristics were compared and a series of sensitivity analyses was performed to determine the main drivers of the results. The results were compared based on a standardized set of input parameters and assumptions. Three cost-effectiveness modeling tools were provided, including two cohort-based (Pan-American Health Organization (PAHO) ProVac Initiative TriVac, and PneumoADIP) and one population-based model (GlaxoSmithKline's SUPREMES). They all compared the introduction of PCV into national pediatric immunization program with no PCV use. The models were different in terms of model attributes, structure, and data requirement, but captured a similar range of diseases. Herd effects were estimated using different approaches in each model. The main driving parameters were vaccine efficacy against pneumococcal pneumonia, vaccine price, vaccine coverage, serotype coverage and disease burden. With a standardized set of input parameters developed for cohort modeling, TriVac and PneumoADIP produced similar incremental costs and health outcomes, and incremental cost-effectiveness ratios. Vaccine cost (dose price and number of doses), vaccine efficacy and epidemiology of critical endpoint (for example

  17. Developing an Interactive Data Visualization Tool to Assess the Impact of Decision Support on Clinical Operations.

    Science.gov (United States)

    Huber, Timothy C; Krishnaraj, Arun; Monaghan, Dayna; Gaskin, Cree M

    2018-05-18

    Due to mandates from recent legislation, clinical decision support (CDS) software is being adopted by radiology practices across the country. This software provides imaging study decision support for referring providers at the point of order entry. CDS systems produce a large volume of data, providing opportunities for research and quality improvement. In order to better visualize and analyze trends in this data, an interactive data visualization dashboard was created using a commercially available data visualization platform. Following the integration of a commercially available clinical decision support product into the electronic health record, a dashboard was created using a commercially available data visualization platform (Tableau, Seattle, WA). Data generated by the CDS were exported from the data warehouse, where they were stored, into the platform. This allowed for real-time visualization of the data generated by the decision support software. The creation of the dashboard allowed the output from the CDS platform to be more easily analyzed and facilitated hypothesis generation. Integrating data visualization tools into clinical decision support tools allows for easier data analysis and can streamline research and quality improvement efforts.

  18. Faculty Decisions on Serials Subscriptions Differ Significantly from Decisions Predicted by a Bibliometric Tool.

    Directory of Open Access Journals (Sweden)

    Sue F. Phelps

    2016-03-01

    Full Text Available Objective – To compare faculty choices of serials subscription cancellations to the scores of a bibliometric tool. Design – Natural experiment. Data was collected about faculty valuations of serials. The California Digital Library Weighted Value Algorithm (CDL-WVA was used to measure the value of journals to a particular library. These two sets of scores were then compared. Setting – A public research university in the United States of America. Subjects – Teaching and research faculty, as well as serials data. Methods – Experimental methodology was used to compare faculty valuations of serials (based on their journal cancellation choices to bibliometric valuations of the same journal titles (determined by CDL-WVA scores to identify the match rate between the faculty choices and the bibliographic data. Faculty were asked to select titles to cancel that totaled approximately 30% of the budget for their disciplinary fund code. This “keep” or “cancel” choice was the binary variable for the study. Usage data was gathered for articles downloaded through the link resolver for titles in each disciplinary dataset, and the CDL-WVA scores were determined for each journal title based on utility, quality, and cost effectiveness. Titles within each dataset were ranked highest to lowest using the CDL-WVA scores within each fund code, and then by subscription cost for titles with the same CDL-WVA score. The journal titles selected for comparison were those that ranked above the approximate 30% of titles chosen for cancellation by faculty and CDL-WVA scores. Researchers estimated an odds ratio of faculty choosing to keep a title and a CDL-WVA score that indicated the title should be kept. The p-value for that result was less than 0.0001, indicating that there was a negligible probability that the results were by chance. They also applied logistic regression to quantify the association between the numeric score of CDL-WVA and the binary variable

  19. Clinical Usefulness of Tools to Support Decision-making for Palliative Treatment of Metastatic Colorectal Cancer: A Systematic Review

    NARCIS (Netherlands)

    Engelhardt, Ellen G.; Révész, Dóra; Tamminga, Hans J.; Punt, Cornelis J. A.; Koopman, Mirjam; Onwuteaka-Philipsen, Bregje D.; Steyerberg, Ewout W.; Jansma, Ilse P.; de Vet, Henrica C. W.; Coupé, Veerle M. H.

    2018-01-01

    Decision-making regarding palliative treatment for patients with metastatic colorectal cancer (mCRC) is complex and comprises numerous decisions. Decision-making should be guided by the premise of maintaining and/or improving patients' quality of life, by patient preference, and by the trade-off

  20. Decision support systems in nuclear emergencies: harmonizing domestic and reference tools

    International Nuclear Information System (INIS)

    Vamanu, D.; Mateescu, Gh.; Berinde, A.; Slavnicu, D.; Acasandrei, V.; Slavnicu, E.

    2001-01-01

    The paper addresses the issue of securing the compatibility and inter-operability of computer packages designed to perform as decision support tools in the management of radiological emergencies, over the transition times towards the implementation and uniform acceptance and uniform acceptance of internationally-shared reference tools such as the European Union's RODOS (Real Time On-Line Decision Support System for Off-Site Nuclear Emergencies in Europe). One submits that a harmonization between the currently operational, domestic, and the reference tool can be contemplated, based on extensive code comparison and benchmarking. A case in point is presented, paralleling selected RODOS applications on simulated abnormal nuclear events, and the concurrent application of a resident software package, NOTEPAD, developed to emulate RODOS-wise function at IFIH-HH Bucharest. The reproducible similarity may make domestic decision support system (DSS) facilities useful as both practical tools and factors promoting the emergency preparedness awareness, during the interim time laps till the full development and deployment of RODOS as a reference DSS in Europe. (authors)

  1. Integrated Decision Tools for Sustainable Watershed/Ground Water and Crop Health using Predictive Weather, Remote Sensing, and Irrigation Decision Tools

    Science.gov (United States)

    Jones, A. S.; Andales, A.; McGovern, C.; Smith, G. E. B.; David, O.; Fletcher, S. J.

    2017-12-01

    US agricultural and Govt. lands have a unique co-dependent relationship, particularly in the Western US. More than 30% of all irrigated US agricultural output comes from lands sustained by the Ogallala Aquifer in the western Great Plains. Six US Forest Service National Grasslands reside within the aquifer region, consisting of over 375,000 ha (3,759 km2) of USFS managed lands. Likewise, National Forest lands are the headwaters to many intensive agricultural regions. Our Ogallala Aquifer team is enhancing crop irrigation decision tools with predictive weather and remote sensing data to better manage water for irrigated crops within these regions. An integrated multi-model software framework is used to link irrigation decision tools, resulting in positive management benefits on natural water resources. Teams and teams-of-teams can build upon these multi-disciplinary multi-faceted modeling capabilities. For example, the CSU Catalyst for Innovative Partnerships program has formed a new multidisciplinary team that will address "Rural Wealth Creation" focusing on the many integrated links between economic, agricultural production and management, natural resource availabilities, and key social aspects of govt. policy recommendations. By enhancing tools like these with predictive weather and other related data (like in situ measurements, hydrologic models, remotely sensed data sets, and (in the near future) linking to agro-economic and life cycle assessment models) this work demonstrates an integrated data-driven future vision of inter-meshed dynamic systems that can address challenging multi-system problems. We will present the present state of the work and opportunities for future involvement.

  2. Decision support systems in nuclear emergencies: A scenario-based comparison of domestic and reference tools

    International Nuclear Information System (INIS)

    Vamanu, D.; Slavnicu, S. D.; Slavnicu, E.; Vamanu, B.

    2004-01-01

    The article reports selective results of a comparison between RODOS - an emerging decision support system for the management of nuclear emergencies in Europe developed by an international research consortium under EEC aegis, and a resident software package developed and maintained for similar purposes at IFIN-HH, Bucharest. Reproducible similarity patterns obtained in the output data distributions provide for simple normalising procedures that may ensure convergent radiological assessments. When properly consolidated on a sufficient scenario casuistry, such procedures could lend a certain resilience to domestic decision support tools over the interim lead time required by the full implementation of RODOS, or other major league, internationally accepted reference systems. (authors)

  3. Patients' preferences for involvement in treatment decision making in Japan

    Directory of Open Access Journals (Sweden)

    Shimbo Takuro

    2004-03-01

    Full Text Available Abstract Background A number of previous studies have suggested that the Japanese have few opportunities to participate in medical decision-making, as a result both of entrenched physician paternalism and national characteristics of dependency and passivity. The hypothesis that Japanese patients would wish to participate in treatment decision-making if adequate information were provided, and the decision to be made was clearly identified, was tested by interview survey. Methods The subjects were diabetic patients at a single outpatient clinic in Kyoto. One of three case study vignettes (pneumonia, gangrene or cancer was randomly assigned to each subject and, employing face-to-face interviews, the subjects were asked what their wishes would be as patients, for treatment information, participation in decision-making and family involvement. Results 134 patients participated in the study, representing a response rate of 90%. The overall proportions of respondents who preferred active, collaborative, and passive roles were 12%, 71%, and 17%, respectively. Respondents to the cancer vignette were less likely to prefer an active role and were more likely to prefer family involvement in decision-making compared to non-cancer vignette respondents. If a physician's recommendation conflicted with their own wishes, 60% of the respondents for each vignette answered that they would choose to respect the physician's opinion, while few respondents would give the family's preference primary importance. Conclusions Our study suggested that a majority of Japanese patients have positive attitudes towards participation in medical decision making if they are fully informed. Physicians will give greater patient satisfaction if they respond to the desire of patients for participation in decision-making.

  4. Clinical decision-making: predictors of patient participation in nursing care.

    Science.gov (United States)

    Florin, Jan; Ehrenberg, Anna; Ehnfors, Margareta

    2008-11-01

    To investigate predictors of patients' preferences for participation in clinical decision-making in inpatient nursing care. Patient participation in decision-making in nursing care is regarded as a prerequisite for good clinical practice regarding the person's autonomy and integrity. A cross-sectional survey of 428 persons, newly discharged from inpatient care. The survey was conducted using the Control Preference Scale. Multiple logistic regression analysis was used for testing the association of patient characteristics with preferences for participation. Patients, in general, preferred adopting a passive role. However, predictors for adopting an active participatory role were the patient's gender (odds ratio = 1.8), education (odds ratio = 2.2), living condition (odds ratio = 1.8) and occupational status (odds ratio = 2.0). A probability of 53% was estimated, which female senior citizens with at least a high school degree and who lived alone would prefer an active role in clinical decision-making. At the same time, a working cohabiting male with less than a high school degree had a probability of 8% for active participation in clinical decision making in nursing care. Patient preferences for participation differed considerably and are best elicited by assessment of the individual patient. Relevance to clinical practice. The nurses have a professional responsibility to act in such a way that patients can participate and make decisions according to their own values from an informed position. Access to knowledge of patients'basic assumptions and preferences for participation is of great value for nurses in the care process. There is a need for nurses to use structured methods and tools for eliciting individual patient preferences regarding participation in clinical decision-making.

  5. Dying cancer patients talk about physician and patient roles in DNR decision making.

    Science.gov (United States)

    Eliott, Jaklin A; Olver, Ian

    2011-06-01

    Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do-not-resuscitate or do-not-resuscitate (DNR) decision], but there is little analysis of patient perspectives. Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision. Discursive analysis of qualitative data gathered during semi-structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital. Participants' descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision-making process. Participants' endorsement of physicians as decision makers rested upon physicians' enactment of the rational, knowledgeable and compassionate expert, which legitimized entrusting them to make the DNR decision. Where this was called into question, physicians were positioned as inappropriate decision makers. When patients' and physicians' understandings of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making. © 2010 Blackwell Publishing Ltd.

  6. Preliminary Turkish study of psychiatric in-patients' competence to make treatment decisions.

    Science.gov (United States)

    Aydin Er, Rahime; Sehiralti, Mine; Aker, Ahmet Tamer

    2013-03-01

    Competence is a prerequisite for informed consent. Patients who are found to be competent are entitled to accept or refuse the proposed treatment. In recent years, there has been an increased interest in studies examining competence for treatment in psychiatric patients. In this study, we aimed to investigate the decision-making competencies of inpatients with a range of psychiatric diseases. This study was carried out at the psychiatry clinic of Kocaeli University Hospital in Turkey from June 2007 to February 2008. Decision-making competence was assessed in 83 patients using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). The study groups consisted of patients with mood (39.8%), psychotic (27.7%) and anxiety disorders (18.1%), and alcohol/substance addiction (14.5%). There was a significant relation between decision-making competence and demographic and clinical characteristics. Appreciation of the given information was more impaired in psychotic disorder patients than in other patients, but understanding and reasoning of the given information was similar in all groups. These results reveal the importance of evaluating decision-making competencies of psychiatric patients before any treatment or intervention is carried out to ascertain their ability to give informed consent to treatment. Institutional and national policies need to be determined and put into practice relating to the assessment and management of competence in patients with psychiatric disorders. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

  7. Addressing Barriers to Shared Decision Making Among Latino LGBTQ Patients and Healthcare Providers in Clinical Settings.

    Science.gov (United States)

    Baig, Arshiya A; Lopez, Fanny Y; DeMeester, Rachel H; Jia, Justin L; Peek, Monica E; Vela, Monica B

    2016-10-01

    Effective shared decision making (SDM) between patients and healthcare providers has been positively associated with health outcomes. However, little is known about the SDM process between Latino patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and their healthcare providers. Our review of the literature identified unique aspects of Latino LGBTQ persons' culture, health beliefs, and experiences that may affect their ability to engage in SDM with their healthcare providers. Further research needs to examine Latino LGBTQ patient-provider experiences with SDM and develop tools that can better facilitate SDM in this patient population.

  8. Decision-theoretic planning of clinical patient management

    NARCIS (Netherlands)

    Peek, Niels Bastiaan

    2000-01-01

    When a doctor is treating a patient, he is constantly facing decisions. From the externally visible signs and symptoms he must establish a hypothesis of what might be wrong with the patient; then he must decide whether additional diagnostic procedures are required to verify this hypothesis,

  9. Users' experiences of an emergency department patient admission predictive tool: A qualitative evaluation.

    Science.gov (United States)

    Jessup, Melanie; Crilly, Julia; Boyle, Justin; Wallis, Marianne; Lind, James; Green, David; Fitzgerald, Gerard

    2016-09-01

    Emergency department overcrowding is an increasing issue impacting patients, staff and quality of care, resulting in poor patient and system outcomes. In order to facilitate better management of emergency department resources, a patient admission predictive tool was developed and implemented. Evaluation of the tool's accuracy and efficacy was complemented with a qualitative component that explicated the experiences of users and its impact upon their management strategies, and is the focus of this article. Semi-structured interviews were conducted with 15 pertinent users, including bed managers, after-hours managers, specialty department heads, nurse unit managers and hospital executives. Analysis realised dynamics of accuracy, facilitating communication and enabling group decision-making Users generally welcomed the enhanced potential to predict and plan following the incorporation of the patient admission predictive tool into their daily and weekly decision-making processes. They offered astute feedback with regard to their responses when faced with issues of capacity and communication. Participants reported an growing confidence in making informed decisions in a cultural context that is continually moving from reactive to proactive. This information will inform further patient admission predictive tool development specifically and implementation processes generally. © The Author(s) 2015.

  10. Web-Based Tools for Data Visualization and Decision Support for South Asia

    Science.gov (United States)

    Jones, N.; Nelson, J.; Pulla, S. T.; Ames, D. P.; Souffront, M.; David, C. H.; Zaitchik, B. F.; Gatlin, P. N.; Matin, M. A.

    2017-12-01

    The objective of the NASA SERVIR project is to assist developing countries in using information provided by Earth observing satellites to assess and manage climate risks, land use, and water resources. We present a collection of web apps that integrate earth observations and in situ data to facilitate deployment of data and water resources models as decision-making tools in support of this effort. The interactive nature of web apps makes this an excellent medium for creating decision support tools that harness cutting edge modeling techniques. Thin client apps hosted in a cloud portal eliminates the need for the decision makers to procure and maintain the high performance hardware required by the models, deal with issues related to software installation and platform incompatibilities, or monitor and install software updates, a problem that is exacerbated for many of the regional SERVIR hubs where both financial and technical capacity may be limited. All that is needed to use the system is an Internet connection and a web browser. We take advantage of these technologies to develop tools which can be centrally maintained but openly accessible. Advanced mapping and visualization make results intuitive and information derived actionable. We also take advantage of the emerging standards for sharing water information across the web using the OGC and WMO approved WaterML standards. This makes our tools interoperable and extensible via application programming interfaces (APIs) so that tools and data from other projects can both consume and share the tools developed in our project. Our approach enables the integration of multiple types of data and models, thus facilitating collaboration between science teams in SERVIR. The apps developed thus far by our team process time-varying netCDF files from Earth observations and large-scale computer simulations and allow visualization and exploration via raster animation and extraction of time series at selected points and/or regions.

  11. Design and Implementation of a Cloud Computing Adoption Decision Tool: Generating a Cloud Road

    Science.gov (United States)

    Bildosola, Iñaki; Río-Belver, Rosa; Cilleruelo, Ernesto; Garechana, Gaizka

    2015-01-01

    Migrating to cloud computing is one of the current enterprise challenges. This technology provides a new paradigm based on “on-demand payment” for information and communication technologies. In this sense, the small and medium enterprise is supposed to be the most interested, since initial investments are avoided and the technology allows gradual implementation. However, even if the characteristics and capacities have been widely discussed, entry into the cloud is still lacking in terms of practical, real frameworks. This paper aims at filling this gap, presenting a real tool already implemented and tested, which can be used as a cloud computing adoption decision tool. This tool uses diagnosis based on specific questions to gather the required information and subsequently provide the user with valuable information to deploy the business within the cloud, specifically in the form of Software as a Service (SaaS) solutions. This information allows the decision makers to generate their particular Cloud Road. A pilot study has been carried out with enterprises at a local level with a two-fold objective: to ascertain the degree of knowledge on cloud computing and to identify the most interesting business areas and their related tools for this technology. As expected, the results show high interest and low knowledge on this subject and the tool presented aims to readdress this mismatch, insofar as possible. PMID:26230400

  12. Design and Implementation of a Cloud Computing Adoption Decision Tool: Generating a Cloud Road.

    Directory of Open Access Journals (Sweden)

    Iñaki Bildosola

    Full Text Available Migrating to cloud computing is one of the current enterprise challenges. This technology provides a new paradigm based on "on-demand payment" for information and communication technologies. In this sense, the small and medium enterprise is supposed to be the most interested, since initial investments are avoided and the technology allows gradual implementation. However, even if the characteristics and capacities have been widely discussed, entry into the cloud is still lacking in terms of practical, real frameworks. This paper aims at filling this gap, presenting a real tool already implemented and tested, which can be used as a cloud computing adoption decision tool. This tool uses diagnosis based on specific questions to gather the required information and subsequently provide the user with valuable information to deploy the business within the cloud, specifically in the form of Software as a Service (SaaS solutions. This information allows the decision makers to generate their particular Cloud Road. A pilot study has been carried out with enterprises at a local level with a two-fold objective: to ascertain the degree of knowledge on cloud computing and to identify the most interesting business areas and their related tools for this technology. As expected, the results show high interest and low knowledge on this subject and the tool presented aims to readdress this mismatch, insofar as possible.

  13. Design and Implementation of a Cloud Computing Adoption Decision Tool: Generating a Cloud Road.

    Science.gov (United States)

    Bildosola, Iñaki; Río-Belver, Rosa; Cilleruelo, Ernesto; Garechana, Gaizka

    2015-01-01

    Migrating to cloud computing is one of the current enterprise challenges. This technology provides a new paradigm based on "on-demand payment" for information and communication technologies. In this sense, the small and medium enterprise is supposed to be the most interested, since initial investments are avoided and the technology allows gradual implementation. However, even if the characteristics and capacities have been widely discussed, entry into the cloud is still lacking in terms of practical, real frameworks. This paper aims at filling this gap, presenting a real tool already implemented and tested, which can be used as a cloud computing adoption decision tool. This tool uses diagnosis based on specific questions to gather the required information and subsequently provide the user with valuable information to deploy the business within the cloud, specifically in the form of Software as a Service (SaaS) solutions. This information allows the decision makers to generate their particular Cloud Road. A pilot study has been carried out with enterprises at a local level with a two-fold objective: to ascertain the degree of knowledge on cloud computing and to identify the most interesting business areas and their related tools for this technology. As expected, the results show high interest and low knowledge on this subject and the tool presented aims to readdress this mismatch, insofar as possible.

  14. LCA-IWM: A decision support tool for sustainability assessment of waste management systems

    International Nuclear Information System (INIS)

    Boer, J. den; Boer, E. den; Jager, J.

    2007-01-01

    The paper outlines the most significant result of the project 'The use of life cycle assessment tools for the development of integrated waste management strategies for cities and regions with rapid growing economies', which was the development of two decision-support tools: a municipal waste prognostic tool and a waste management system assessment tool. The article focuses on the assessment tool, which supports the adequate decision making in the planning of urban waste management systems by allowing the creation and comparison of different scenarios, considering three basic subsystems: (i) temporary storage; (ii) collection and transport and (iii) treatment, disposal and recycling. The design and analysis options, as well as the assumptions made for each subsystem, are shortly introduced, providing an overview of the applied methodologies and technologies. The sustainability assessment methodology used in the project to support the selection of the most adequate scenario is presented with a brief explanation of the procedures, criteria and indicators applied on the evaluation of each of the three sustainability pillars

  15. Important medical decisions: Using brief motivational interviewing to enhance patients' autonomous decision-making.

    Science.gov (United States)

    Pantalon, Michael V; Sledge, William H; Bauer, Stephen F; Brodsky, Beth; Giannandrea, Stephanie; Kay, Jerald; Lazar, Susan G; Mellman, Lisa A; Offenkrantz, William C; Oldham, John; Plakun, Eric M; Rockland, Lawrence H

    2013-03-01

    The use of motivational interviewing (MI) when the goals of patient and physician are not aligned is examined. A clinical example is presented of a patient who, partly due to anxiety and fear, wants to opt out of further evaluation of his hematuria while the physician believes that the patient must follow up on the finding of hematuria. As patients struggle in making decisions about their medical care, physician interactions can become strained and medical care may become compromised. Physicians sometimes rely on their authority within the doctor-patient relationship to assist patients in making decisions. These methods may be ineffective when there is a conflict in motivations or goals, such as with patient ambivalence and resistance. Furthermore, the values of patient autonomy may conflict with the values of beneficence. A patient simulation exercise is used to demonstrate the value of MI in addressing the motivations of a medical patient when autonomy is difficult to realize because of a high level of resistance to change due to fear. The salience of MI in supporting the value of patient autonomy without giving up the value of beneficence is discussed by providing a method of evaluating the patient's best interests by psychotherapeutically addressing his anxious, fear-based ambivalence.

  16. The Climate-Agriculture-Modeling and Decision Tool (CAMDT) for Climate Risk Management in Agriculture

    Science.gov (United States)

    Ines, A. V. M.; Han, E.; Baethgen, W.

    2017-12-01

    Advances in seasonal climate forecasts (SCFs) during the past decades have brought great potential to improve agricultural climate risk managements associated with inter-annual climate variability. In spite of popular uses of crop simulation models in addressing climate risk problems, the models cannot readily take seasonal climate predictions issued in the format of tercile probabilities of most likely rainfall categories (i.e, below-, near- and above-normal). When a skillful SCF is linked with the crop simulation models, the informative climate information can be further translated into actionable agronomic terms and thus better support strategic and tactical decisions. In other words, crop modeling connected with a given SCF allows to simulate "what-if" scenarios with different crop choices or management practices and better inform the decision makers. In this paper, we present a decision support tool, called CAMDT (Climate Agriculture Modeling and Decision Tool), which seamlessly integrates probabilistic SCFs to DSSAT-CSM-Rice model to guide decision-makers in adopting appropriate crop and agricultural water management practices for given climatic conditions. The CAMDT has a functionality to disaggregate a probabilistic SCF into daily weather realizations (either a parametric or non-parametric disaggregation method) and to run DSSAT-CSM-Rice with the disaggregated weather realizations. The convenient graphical user-interface allows easy implementation of several "what-if" scenarios for non-technical users and visualize the results of the scenario runs. In addition, the CAMDT also translates crop model outputs to economic terms once the user provides expected crop price and cost. The CAMDT is a practical tool for real-world applications, specifically for agricultural climate risk management in the Bicol region, Philippines, having a great flexibility for being adapted to other crops or regions in the world. CAMDT GitHub: https://github.com/Agro-Climate/CAMDT

  17. Decision support tool for used oil regeneration technologies assessment and selection.

    Science.gov (United States)

    Khelifi, Olfa; Dalla Giovanna, Fabio; Vranes, Sanja; Lodolo, Andrea; Miertus, Stanislav

    2006-09-01

    Regeneration is the most efficient way of managing used oil. It saves money by preventing costly cleanups and liabilities that are associated with mismanagement of used oil, it helps to protect the environment and it produces a technically renewable resource by enabling an indefinite recycling potential. There are a variety of processes and licensors currently offering ways to deal with used oils. Selecting a regeneration technology for used oil involves "cross-matching" key criteria. Therefore, the first prototype of spent oil regeneration (SPORE), a decision support tool, has been developed to help decision-makers to assess the available technologies and select the preferred used oil regeneration options. The analysis is based on technical, economical and environmental criteria. These criteria are ranked to determine their relative importance for a particular used oil regeneration project. The multi-criteria decision analysis (MCDA) is the core of the SPORE using the PROMETHEE II algorithm.

  18. Neuropsychological correlates of decision making in patients with bulimia nervosa.

    Science.gov (United States)

    Brand, Matthias; Franke-Sievert, Christiane; Jacoby, Georg E; Markowitsch, Hans J; Tuschen-Caffier, Brunna

    2007-11-01

    In addition to the core psychopathology of bulimia nervosa (BN), patients with BN often show impulsive behavior that has been related to decision making deficits in other patient groups, such as individuals with anorexia nervosa and pathological gamblers. However, it remains unclear whether BN patients also show difficulties in decision making. In this study, 14 patients with BN and 14 healthy comparison subjects, matched for age, gender, education, body mass index, and intelligence, were examined with the Game of Dice Task (M. Brand, E. Fujiwara, et al., 2005), a gambling task that has fixed winning probabilities and explicit rules for gains and losses, as well as with a neuropsychological test battery and personality questionnaires. On the task, the patients with BN chose the disadvantageous alternatives more frequently than did the comparison subjects. Performance on the Game of Dice Task was related to executive functioning but not to other neuropsychological functions, personality, or disease-specific variables in the BN group. Thus, in patients with BN, decision making abnormalities and executive reductions can be demonstrated and might be neuropsychological correlates of the patients' dysfunctional everyday-life decision making behavior. Neurocognitive functions should be considered in the treatment of BN. PsycINFO Database Record (c) 2007 APA, all rights reserved.

  19. Online, Interactive Option Grid Patient Decision Aids and their Effect on User Preferences.

    Science.gov (United States)

    Scalia, Peter; Durand, Marie-Anne; Kremer, Jan; Faber, Marjan; Elwyn, Glyn

    2018-01-01

    Randomized trials have shown that patient decision aids can modify users' preferred healthcare options, but research has yet to identify the attributes embedded in these tools that cause preferences to shift. The aim of this study was to investigate people's preferences as they used decision aids for 5 health decisions and, for each of the following: 1) determine if using the interactive Option Grid led to a pre-post shift in preferences; 2) determine which frequently asked questions (FAQs) led to preference shifts; 3) determine the FAQs that were rated as the most important as users compared options. Interactive Option Grid decision aids enable users to view attributes of available treatment or screening options, rate their importance, and specify their preferred options before and after decision aid use. The McNemar-Bowker paired test was used to compare stated pre-post preferences. Multinomial logistic regressions were conducted to investigate possible associations between covariates and preference shifts. Overall, 626 users completed the 5 most-used tools: 1) Amniocentesis test: yes or no? ( n = 73); 2) Angina: treatment options ( n = 88); 3) Breast cancer: surgical options ( n = 265); 4) Prostate Specific Antigen (PSA) test: yes or no? ( n = 82); 5) Statins for heart disease risk: yes or no? ( n = 118). The breast cancer, PSA, and statins Option Grid decision aids generated significant preference shifts. Generally, users shifted their preference when presented with the description of the available treatment options, and the risk associated with each option. The use of decision aids for some, but not all health decisions, was accompanied by a shift in user preferences. Users typically valued information associated with risks, and chose more risk averse options after completing the interactive tool.

  20. The Wind Atlas for South Africa (WASA): A tool to aid developers and decision makers

    CSIR Research Space (South Africa)

    Mabille, E

    2015-10-01

    Full Text Available ): A tool to aid developers and decision makers Eugene Mabille The WASA Project Team SANEDI South African National Energy Development Institute • executing agency – contracting the implementing partners • coordination and dissemination UCT... to produce wind atlas for generalised surface conditions (uniform terrain and roughness). Files compatible with WAsP software.  Used for the first WASA published in 2012.  KAMM/WAsP method, numerically very cheap, gives good results  underestimation...

  1. Information and shared decision-making are top patients' priorities

    Directory of Open Access Journals (Sweden)

    Bronstein Alexander

    2006-02-01

    Full Text Available Abstract Background The profound changes in medical care and the recent stress on a patient-centered approach mandate evaluation of current patient priorities. Methods Hospitalized and ambulatory patients at an academic medical center in central Israel were investigated. Consecutive patients (n = 274 indicated their first and second priority for a change or improvement in their medical care out of a mixed shortlist of 6 issues, 3 related to patient-physician relationship (being better informed and taking part in decisions; being seen by the same doctor each time; a longer consultation time and 3 issues related to the organizational aspect of care (easier access to specialists/hospital; shorter queue for tests; less charges for drugs. Results Getting more information from the physician and taking part in decisions was the most desirable patient choice, selected by 27.4% as their first priority. The next choices – access and queue – also relate to more patient autonomy and control over that of managed care regulations. Patients studied were least interested in continuity of care, consultation time or cost of drugs. Demographic or clinical variables were not significantly related to patients' choices. Conclusion Beyond its many benefits, being informed by their doctor and shared decision making is a top patient priority.

  2. The relationship between patient data and pooled clinical management decisions.

    Science.gov (United States)

    Ludbrook, G I; O'Loughlin, E J; Corcoran, T B; Grant, C

    2013-01-01

    A strong relationship between patient data and preoperative clinical decisions could potentially be used to support clinical decisions in preoperative management. The aim of this exploratory study was to determine the relationship between key patient data and pooled clinical opinions on management. In a previous study, panels of anaesthetists compared the quality of computer-assisted patient health assessments with outpatient consultations and made decisions on the need for preoperative tests, no preoperative outpatient assessment, possible postoperative intensive care unit/high dependency unit requirements and aspiration prophylaxis. In the current study, the relationship between patient data and these decisions was examined using binomial logistic regression analysis. Backward stepwise regression was used to identify independent predictors of each decision (at P >0.15), which were then incorporated into a predictive model. The number of factors related to each decision varied: blood picture (four factors), biochemistry (six factors), coagulation studies (three factors), electrocardiography (eight factors), chest X-ray (seven factors), preoperative outpatient assessment (17 factors), intensive care unit requirement (eight factors) and aspiration prophylaxis (one factor). The factor types also varied, but included surgical complexity, age, gender, number of medications or comorbidities, body mass index, hypertension, central nervous system condition, heart disease, sleep apnoea, smoking, persistent pain and stroke. Models based on these relationships usually demonstrated good sensitivity and specificity, with receiver operating characteristics in the following areas under curve: blood picture (0.75), biochemistry (0.86), coagulation studies (0.71), electrocardiography (0.90), chest X-ray (0.85), outpatient assessment (0.85), postoperative intensive care unit requirement (0.88) and aspiration prophylaxis (0.85). These initial results suggest modelling of patient

  3. Systems Analysis – a new paradigm and decision support tools for the water framework directive

    Directory of Open Access Journals (Sweden)

    M. Bruen

    2008-05-01

    Full Text Available In the early days of Systems Analysis the focus was on providing tools for optimisation, modelling and simulation for use by experts. Now there is a recognition of the need to develop and disseminate tools to assist in making decisions, negotiating compromises and communicating preferences that can easily be used by stakeholders without the need for specialist training. The Water Framework Directive (WFD requires public participation and thus provides a strong incentive for progress in this direction. This paper places the new paradigm in the context of the classical one and discusses some of the new approaches which can be used in the implementation of the WFD. These include multi-criteria decision support methods suitable for environmental problems, adaptive management, cognitive mapping, social learning and cooperative design and group decision-making. Concordance methods (such as ELECTRE and the Analytical Hierarchy Process (AHP are identified as multi-criteria methods that can be readily integrated into Decision Support Systems (DSS that deal with complex environmental issues with very many criteria, some of which are qualitative. The expanding use of the new paradigm provides an opportunity to observe and learn from the interaction of stakeholders with the new technology and to assess its effectiveness.

  4. Decision support tool for soil sampling of heterogeneous pesticide (chlordecone) pollution.

    Science.gov (United States)

    Clostre, Florence; Lesueur-Jannoyer, Magalie; Achard, Raphaël; Letourmy, Philippe; Cabidoche, Yves-Marie; Cattan, Philippe

    2014-02-01

    When field pollution is heterogeneous due to localized pesticide application, as is the case of chlordecone (CLD), the mean level of pollution is difficult to assess. Our objective was to design a decision support tool to optimize soil sampling. We analyzed the CLD heterogeneity of soil content at 0-30- and 30-60-cm depth. This was done within and between nine plots (0.4 to 1.8 ha) on andosol and ferralsol. We determined that 20 pooled subsamples per plot were a satisfactory compromise with respect to both cost and accuracy. Globally, CLD content was greater for andosols and the upper soil horizon (0-30 cm). Soil organic carbon cannot account for CLD intra-field variability. Cropping systems and tillage practices influence the CLD content and distribution; that is CLD pollution was higher under intensive banana cropping systems and, while upper soil horizon was more polluted than the lower one with shallow tillage (pollution in the soil profile. The decision tool we proposed compiles and organizes these results to better assess CLD soil pollution in terms of sampling depth, distance, and unit at field scale. It accounts for sampling objectives, farming practices (cropping system, tillage), type of soil, and topographical characteristics (slope) to design a relevant sampling plan. This decision support tool is also adaptable to other types of heterogeneous agricultural pollution at field level.

  5. Moving towards tangible decision-making tools for policy makers: Measuring and monitoring energy access provision

    International Nuclear Information System (INIS)

    Bhanot, Jaya; Jha, Vivek

    2012-01-01

    Access to energy services has been recognised as central to achieving economic growth and sustainable development. However, almost 1.3 billion people in the world still lack access to electricity and 2.7 billion lack access to clean cooking facilities. In this backdrop, the issue of energy access is receiving more interest than ever before and this has brought to the fore, the need for a robust decision support tool for policy makers to measure the progress of energy access provision and also to provide direction for future policy making. The paper studies existing definitions of energy access and identifies the key requirements for an appropriate decision-making tool to measure and monitor energy access provision. In this context the paper assesses the strengths and weaknesses of the metrics currently being used to measure energy access in policy, as well as of contemporary monitoring and evaluation frameworks being used in other sectors. Based on these insights, a dashboard of indicators is proposed as an alternate decision support tool for policy makers to measure energy access. The paper concludes with a discussion on what is needed to operationalise this proposed framework. - Highlights: ► No one indicator or metric can successfully capture progress on energy access. ► A service oriented approach is necessary to measure energy access. ► Socio-economic and political contexts influence success of energy access policies.

  6. Applying decision trial and evaluation laboratory as a decision tool for effective safety management system in aviation transport

    Directory of Open Access Journals (Sweden)

    Ifeanyichukwu Ebubechukwu Onyegiri

    2016-10-01

    Full Text Available In recent years, in the aviation industry, the weak engineering controls and lapses associated with safety management systems (SMSs are responsible for the seemingly unprecedented disasters. A previous study has confirmed the difficulties experienced by safety managers with SMSs and the need to direct research to this area of investigation for more insights and progress in the evaluation and maintenance of SMSs in the aviation industry. The purpose of this work is to examine the application of Decision Trial and Evaluation Laboratory (DEMATEL to the aviation industry in developing countries with illustration using the Nigerian aviation survey data for the validation of the method. The advantage of the procedure over other decision making methods is in its ability to apply feedback in its decision making. It also affords us the opportunity of breaking down the complex aviation SMS components and elements which are multi-variate in nature through the analysis of the contributions of the diverse system criteria from the perspective of cause and effects, which in turn yields easier and yet more effective aviation transportation accident pre-corrective actions. In this work, six revised components of an SMS were identified and DEMATEL was applied to obtain their direct and indirect impacts and influences on the overall SMS performance. Data collection was by the survey questionnaire, which served as the initial direct-relation matrix, coded in Matlab software for establishing the impact relation map (IRM. The IRM was then plotted in MS Excel spread-sheet software. From our results, safety structure and regulation has the highest impact level on an SMS with a corresponding positive relation level value. In conclusion, the results agree with those of previous researchers that used grey relational analysis. Thus, DEMATEL serves as a great tool and resource for the safety manager.

  7. Patients' and parents' concerns and decisions about orthodontic treatment

    OpenAIRE

    Kazanc?, Fatih; Aydo?an, Cihan; Alkan, ?zer

    2016-01-01

    Objective Patients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level. Methods One hundred and eigh...

  8. [The Intentions Affecting the Medical Decision-Making Behavior of Surrogate Decision Makers of Critically Ill Patients and Related Factors].

    Science.gov (United States)

    Su, Szu-Huei; Wu, Li-Min

    2018-04-01

    The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. A cross-sectional, correlation study design was used. A total of 193 surrogate decision makers from six ICUs in a medical center in southern Taiwan were enrolled as participants. Three structured questionnaires were used, including a demographic datasheet, the Family Relationship Scale, and the Behavioral Intention of Medical Decisions Scale. Significantly positive correlations were found between the behavioral intentions underlying medical decisions and the following variables: the relationship of the participant to the patient (Eta = .343, p = .020), the age of the patient (r = .295, p medical decisions of the surrogate decision makers, explaining 13.9% of the total variance. In assessing the behavioral intentions underlying the medical decisions of surrogate decision makers, health providers should consider the relationship between critical patients and their surrogate decision makers, patient age, the length of ICU stay, and whether the patient has a pre-signed advance healthcare directive in order to maximize the effectiveness of medical care provided to critically ill patients.

  9. The development of an online decision support tool for organizational readiness for change.

    Science.gov (United States)

    Khan, Sobia; Timmings, Caitlyn; Moore, Julia E; Marquez, Christine; Pyka, Kasha; Gheihman, Galina; Straus, Sharon E

    2014-05-10

    Much importance has been placed on assessing readiness for change as one of the earliest steps of implementation, but measuring it can be a complex and daunting task. Organizations and individuals struggle with how to reliably and accurately measure readiness for change. Several measures have been developed to help organizations assess readiness, but these are often underused due to the difficulty of selecting the right measure. In response to this challenge, we will develop and test a prototype of a decision support tool that is designed to guide individuals interested in implementation in the selection of an appropriate readiness assessment measure for their setting. A multi-phase approach will be used to develop the decision support tool. First, we will identify key measures for assessing organizational readiness for change from a recently completed systematic review. Included measures will be those developed for healthcare settings (e.g., acute care, public health, mental health) and that have been deemed valid and reliable. Second, study investigators and field experts will engage in a mapping exercise to categorize individual items of included measures according to key readiness constructs from an existing framework. Third, a stakeholder panel will be recruited and consulted to determine the feasibility and relevance of the selected measures using a modified Delphi process. Fourth, findings from the mapping exercise and stakeholder consultation will inform the development of a decision support tool that will guide users in appropriately selecting change readiness measures. Fifth, the tool will undergo usability testing. Our proposed decision support tool will address current challenges in the field of organizational change readiness by aiding individuals in selecting a valid and reliable assessment measure that is relevant to user needs and practice settings. We anticipate that implementers and researchers who use our tool will be more likely to conduct

  10. Inclusion of social indicators in decision support tools for the selection of sustainable site remediation options.

    Science.gov (United States)

    Cappuyns, Valérie

    2016-12-15

    Sustainable remediation requires a balanced decision-making process in which environmental, economic and social aspects of different remediation options are all considered together and the optimum remediation solution is selected. More attention has been paid to the evaluation of environmental and economic aspects, in particular to reduce the human and environmental risks and the remediation costs, to the exclusion of social aspects of remediation. This paper investigates how social aspects are currently considered in sustainability assessments of remediation projects. A selection of decision support tools (DSTs), used for the sustainability assessment of a remediation project, is analyzed to define how social aspects are considered in those tools. The social indicator categories of the Sustainable Remediation Forum - United Kingdom (SuRF-UK), are used as a basis for this evaluation. The consideration of social aspects in the investigated decision support tools is limited, but a clear increase is noticed in more recently developed tools. Among the five social indicator categories defined by SuRF-UK to facilitate a holistic consideration of social aspects of a remediation project only "Human health and safety" is systematically taken into account. "Neighbourhood and locality" is also often addressed, mostly emphasizing the potential disturbance caused by the remediation activities. However, the evaluation of 'Ethics and Equality', Communities and community involvement', and 'Uncertainty and evidence' is often neglected. Nevertheless, concrete examples can be found in some of the investigated tools. Specific legislation, standard procedures, and guidelines that have to be followed in a region or country are mainly been set up in the context of protecting human and ecosystem health, safety and prevention of nuisance. However, they sometimes already include some of the aspects addressed by the social indicators. In this perspective the use of DST to evaluate the

  11. Formal analysis of the surgical pathway and development of a new software tool to assist surgeons in the decision making in primary breast surgery.

    Science.gov (United States)

    Catanuto, Giuseppe; Pappalardo, Francesco; Rocco, Nicola; Leotta, Marco; Ursino, Venera; Chiodini, Paolo; Buggi, Federico; Folli, Secondo; Catalano, Francesca; Nava, Maurizio B

    2016-10-01

    The increased complexity of the decisional process in breast cancer surgery is well documented. With this study we aimed to create a software tool able to assist patients and surgeons in taking proper decisions. We hypothesized that the endpoints of breast cancer surgery could be addressed combining a set of decisional drivers. We created a decision support system software tool (DSS) and an interactive decision tree. A formal analysis estimated the information gain derived from each feature in the process. We tested the DSS on 52 patients and we analyzed the concordance of decisions obtained by different users and between the DSS suggestions and the actual surgery. We also tested the ability of the system to prevent post breast conservation deformities. The information gain revealed that patients preferences are the root of our decision tree. An observed concordance respectively of 0.98 and 0.88 was reported when the DSS was used twice by an expert operator or by a newly trained operator vs. an expert one. The observed concordance between the DSS suggestion and the actual decision was 0.69. A significantly higher incidence of post breast conservation defects was reported among patients who did not follow the DSS decision (Type III of Fitoussi, N = 4; 33.3%, p = 0.004). The DSS decisions can be reproduced by operators with different experience. The concordance between suggestions and actual decision is quite low, however the DSS is able to prevent post- breast conservation deformities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Patient decision making competence: outlines of a conceptual analysis.

    Science.gov (United States)

    Welie, J V; Welie, S P

    2001-01-01

    In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence.

  13. Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center

    Directory of Open Access Journals (Sweden)

    Karpa Kelly

    2011-10-01

    Full Text Available Abstract Background Consumer use of herbal and natural products (H/NP is increasing, yet physicians are often unprepared to provide guidance due to lack of educational training. This knowledge deficit may place consumers at risk of clinical complications. We wished to evaluate the impact that a natural medicine clinical decision tool has on faculty attitudes, practice experiences, and needs with respect to H/NP. Methods All physicians and clinical staff (nurse practitioners, physicians assistants (n = 532 in departments of Pediatrics, Family and Community Medicine, and Internal Medicine at our medical center were invited to complete 2 electronic surveys. The first survey was completed immediately before access to a H/NP clinical-decision tool was obtained; the second survey was completed the following year. Results Responses were obtained from 89 of 532 practitioners (16.7% on the first survey and 87 of 535 (16.3% clinicians on the second survey. Attitudes towards H/NP varied with gender, age, time in practice, and training. At baseline, before having an evidence-based resource available, nearly half the respondents indicated that they rarely or never ask about H/NP when taking a patient medication history. The majority of these respondents (81% indicated that they would like to learn more about H/NP, but 72% admitted difficulty finding evidence-based information. After implementing the H/NP tool, 63% of database-user respondents indicated that they now ask patients about H/NP when taking a drug history. Compared to results from the baseline survey, respondents who used the database indicated that the tool significantly increased their ability to find reliable H/NP information (P Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and time-consuming formal H/NP curricula. Yet, it will be challenging to make providers aware of such resources.

  14. Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

    DEFF Research Database (Denmark)

    Machowska, Anna; Alscher, Mark Dominik; Vanga, Satyanarayana Reddy

    2016-01-01

    for patients receiving education, making a decision, and receiving their preferred modality choice in UPS patients following a UPS educational program (UPS-EP). Methods: The Offering Patients Therapy Options in Unplanned Start (OPTiONS) study examined the impact of the implementation of a specific UPS......-EP, including decision support tools and pathway improvement on dialysis modality choice. Linear regression models were used to examine the factors predicting three key steps: referral and receipt of UPS-EP, modality decision making, and actual delivery of preferred modality choice. A simple economic assessment...... was performed to examine the potential benefit of implementing UPS-EP in terms of dialysis costs. Results: The majority of UPS patients could receive UPS-EP (214/270 patients) and were able to make a decision (177/214), although not all patients received their preferred choice (159/177). Regression analysis...

  15. The design of patient decision support interventions: addressing the theory-practice gap.

    Science.gov (United States)

    Elwyn, Glyn; Stiel, Mareike; Durand, Marie-Anne; Boivin, Jacky

    2011-08-01

    Although an increasing number of decision support interventions for patients (including decision aids) are produced, few make explicit use of theory. We argue the importance of using theory to guide design. The aim of this work was to address this theory-practice gap and to examine how a range of selected decision-making theories could inform the design and evaluation of decision support interventions. We reviewed the decision-making literature and selected relevant theories. We assessed their key principles, theoretical pathways and predictions in order to determine how they could inform the design of two core components of decision support interventions, namely, information and deliberation components and to specify theory-based outcome measures. Eight theories were selected: (1) the expected utility theory; (2) the conflict model of decision making; (3) prospect theory; (4) fuzzy-trace theory; (5) the differentiation and consolidation theory; (6) the ecological rationality theory; (7) the rational-emotional model of decision avoidance; and finally, (8) the Attend, React, Explain, Adapt model of affective forecasting. Some theories have strong relevance to the information design (e.g. prospect theory); some are more relevant to deliberation processes (conflict theory, differentiation theory and ecological validity). None of the theories in isolation was sufficient to inform the design of all the necessary components of decision support interventions. It was also clear that most work in theory-building has focused on explaining or describing how humans think rather than on how tools could be designed to help humans make good decisions. It is not surprising therefore that a large theory-practice gap exists as we consider decision support for patients. There was no relevant theory that integrated all the necessary contributions to the task of making good decisions in collaborative interactions. Initiatives such as the International Patient Decision Aids Standards

  16. Acceptance of shared decision making with reference to an electronic library of decision aids (arriba-lib) and its association to decision making in patients: an evaluation study.

    Science.gov (United States)

    Hirsch, Oliver; Keller, Heidemarie; Krones, Tanja; Donner-Banzhoff, Norbert

    2011-07-07

    Decision aids based on the philosophy of shared decision making are designed to help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes. A patient decision aid can be regarded as a complex intervention because it consists of several presumably relevant components. Decision aids have rarely been field tested to assess patients' and physicians' attitudes towards them. It is also unclear what effect decision aids have on the adherence to chosen options. The electronic library of decision aids (arriba-lib) to be used within the clinical encounter has a modular structure and contains evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. We conducted an evaluation study in which 29 primary care physicians included 192 patients. After the consultation, patients filled in questionnaires and were interviewed via telephone two months later. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Patients were highly satisfied with arriba-lib and the process of shared decision making. Two-thirds of patients reached in the telephone interview wanted to be counselled again with arriba-lib. There was a high congruence between preferred and perceived decision making. Of those patients reached in the telephone interview, 80.7% said that they implemented the decision, independent of gender and education. Elderly patients were more likely to say that they implemented the decision. Shared decision making with our multi-modular electronic library of decision aids (arriba-lib) was accepted by a high number of patients. It has positive associations to general aspects of decision making in patients. It can be used for patient groups with a wide range of individual

  17. Five-axis Control Processing Using NC Machine Tools : A Tool Posture Decision Using the Tangent Slope at a Cut Point on a Work

    OpenAIRE

    小島, 龍広; 西田, 知照; 扇谷, 保彦

    2003-01-01

    This report deals with the way to decide tool posture and the way to analytically calculate tool path for the work shape requiring 5-axis control machining. In the tool path calculation, basic equations are derived using the principle that the tangent slope at a cut point on a work and the one at a cutting point on a tool edge are identical. A tool posture decision procedure using the tangent slope at each cut point on a work is proposed for any shape of tool edge. The valid- ity of the way t...

  18. A decision support tool to prioritize risk management options for contaminated sites.

    Science.gov (United States)

    Sorvari, Jaana; Seppälä, Jyri

    2010-03-15

    The decisions on risk management (RM) of contaminated sites in Finland have typically been driven by practical factors such as time and money. However, RM is a multifaceted task that generally involves several additional determinants, e.g. performance and environmental effects of remediation methods, psychological and social factors. Therefore, we adopted a multi-criteria decision analysis approach and developed a decision support tool (DST) that is viable in decision-making in such a complex situation. The basic components of the DST are based on the Dutch REC system. However, our DST is more case-specific and allows the consideration of the type, magnitude and scale of contamination, land use, environmental conditions and socio-cultural aspects (e.g. loss of cultural heritage, image aspects). The construction of the DST was started by structuring the decision problem using a value tree. Based on this work we adopted the Multi-Attribute Value Theory (MAVT) for data aggregation. The final DST was demonstrated by two model sites for which the RM alternatives and site-specific data were created on the basis of factual remediation projects and by interviewing experts. The demonstration of the DST was carried out in a workshop where representatives of different stakeholders were requested to rank and weight the decision criteria involved. To get information on the consistency of the ranking of the RM alternatives, we used different weighting techniques (ratio estimation and pair-wise weighting) and alternative ways to treat individual respondents' weights in calculating the preference scores for each RM alternative. These dissimilar approaches resulted in some differences in the preference order of the RM alternatives. The demonstration showed that attention has to be paid to the proper description of the site, the principles of the procedure and the decision criteria. Nevertheless, the procedure proved to enable efficient communication between different stakeholders

  19. The impact of DECISION+2 on patient intention to engage in shared decision making: secondary analysis of a multicentre clustered randomized trial.

    Science.gov (United States)

    Couët, Nicolas; Labrecque, Michel; Robitaille, Hubert; Turcotte, Stéphane; Légaré, France

    2015-12-01

    Training health professionals in shared decision making (SDM) may influence their patients' intention to engage in SDM. To assess the impact of DECISION+2, a SDM training programme for family physicians about the use of antibiotics to treat acute respiratory infections (ARIs), on their patients' intention to engage in SDM in future consultations. Secondary analysis of a multicentre clustered randomized trial. Three hundred and fifty-nine patients consulting family physicians about an ARI in nine family practice teaching units (FPTUs). DECISION+2 (two-hour online tutorial, two-hour workshop, and decision support tools) was offered in the experimental group (five FPTUs, 162 physicians, 181 patients). Usual care was provided in the control group (four FPTUs, 108 physicians, 178 patients). Change in patients' intention scores (range -3 to +3) between pre- and post-consultation. The mean ± SD [median] scores of intention to engage in SDM were high in both study groups before consultation (DECISION+2 group: 1.4 ± 1.0 [1.7]; control group: 1.5 ± 1.1 [1.7]) and increased in both groups after consultation (DECISION+2 group: 2.1 ± 1.1 [2.7]; control group: 1.9 ± 1.2 [2.3]). Change of intention, classified as either increased, stable or decreased, was not statistically associated with the exposure to the DECISION+2 programme after adjusting for the cluster design (proportional odds ratio = 1.5; 95% confidence interval = 0.8-3.0). DECISION+2 had no significant impact on patients' intention to engage in SDM for choosing to use antibiotics or not to treat an ARI in future consultations. Patient-targeted interventions may be necessary to achieve this purpose. © 2014 John Wiley & Sons Ltd.

  20. AngelStow: A Commercial Optimization-Based Decision Support Tool for Stowage Planning

    DEFF Research Database (Denmark)

    Delgado-Ortegon, Alberto; Jensen, Rune Møller; Guilbert, Nicolas

    save port fees, optimize use of vessel capacity, and reduce bunker consumption. Stowage Coordinators (SCs) produce these plans manually with the help of graphical tools, but high-quality SPs are hard to generate with the limited support they provide. In this abstract, we introduce AngelStow which...... is a commercial optimization-based decision support tool for stowing container vessels developed in collaboration between Ange Optimization and The IT University of Copenhagen. The tool assists SCs in the process of generating SPs interactively, focusing on satisfying and optimizing constraints and objectives...... that are tedious to deal with for humans, while letting the SCs use their expertise to deal with hard combinatorial objectives and corner cases....

  1. Patient decision making in the face of conflicting medication information

    Directory of Open Access Journals (Sweden)

    Emily Elstad

    2012-08-01

    Full Text Available When patients consult more than one source of information about their medications, they may encounter conflicting information. Although conflicting information has been associated with negative outcomes, including worse medication adherence, little is known about how patients make health decisions when they receive conflicting information. The objective of this study was to explore the decision making strategies that individuals with arthritis use when they receive conflicting medication information. Qualitative telephone interviews were conducted with 20 men and women with arthritis. Interview vignettes posed scenarios involving conflicting information from different sources (e.g., doctor, pharmacist, and relative, and respondents were asked how they would respond to the situation. Data analysis involved inductive coding to identify emergent themes and deductive contextualization to make meaning from the emergent themes. In response to conflicting medication information, patients used rules of thumb, trial and error, weighed benefits and risks, and sought more information, especially from a doctor. Patients relied heavily on trial and error when there was no conflicting information involved in the vignette. In contrast, patients used rules of thumb as a unique response to conflicting information. These findings increase our understanding of what patients do when they receive conflicting medication information. Given that patient exposure to conflicting information is likely to increase alongside the proliferation of medication information on the Internet, patients may benefit from assistance in identifying the most appropriate decision strategies for dealing with conflicting information, including information about best information sources.

  2. Critical review of decision support tools for sustainability assessment of site remediation options.

    Science.gov (United States)

    Huysegoms, Lies; Cappuyns, Valérie

    2017-07-01

    In Europe alone, there are more than 2,5 million potentially contaminated sites of which 14% are expected to require remediation. Contaminated soil and groundwater can cause damage to human health as well as to valuable ecosystems. Globally more attention has been paid to this problem of soil contamination in the past decades. For example, more than 58 000 sites have been remediated in Europe between 2006 and 2011. Together with this increase in remediation projects there has been a surge in the development of new remediation technologies and decision support tools to be able to match every site and its specific characteristics to the best possible remediation alternative. In the past years the development of decision support tools (DST) has evolved in a more sustainable direction. Several DSTs added the claim not only to denote effective or technologically and economically feasible remediation alternatives but also to point out the more or most sustainable remediation alternatives. These trends in the evaluation of site remediation options left users with a confusing clew of possibly applicable tools to assist them in decision making for contaminated site remediation. This review provides a structured overview on the extent decision support tools for contaminated site remediation, that claim to assist in choosing the most sustainable remediation alternative, actually include the different elements of sustainability proposed in our assessment framework. The review contains an in-depth analysis of thirteen tools specifically developed to assess the sustainability of site remediation alternatives. This analysis is based on six criteria derived from the definition of sustainable development of the Brundtland report. The six criteria were concretized by using the three pillars of sustainability, applied to site remediation according to the SuRF-UK framework, two criteria derived from Life Cycle Assessment and Cost-Benefit Analysis, and an 'User friendly' criterion

  3. Modeling a Decision Support Tool for Buildable and Sustainable Building Envelope Designs

    Directory of Open Access Journals (Sweden)

    Natee Singhaputtangkul

    2015-05-01

    Full Text Available Sustainability and buildability requirements in building envelope design have significantly gained more importance nowadays, yet there is a lack of an appropriate decision support system (DSS that can help a building design team to incorporate these requirements and manage their tradeoffs at once. The main objective of this study is to build such a tool to facilitate a building design team to take into account sustainability and buildability criteria for assessment of building envelopes of high-rise residential buildings in Singapore. Literature reviews were conducted to investigate a comprehensive set of the sustainability and buildability criteria. This also included development of the tool using a Quality Functional Deployment (QFD approach combined with fuzzy set theory. A building design team was engaged to test the tool with the aim to evaluate usefulness of the tool in managing the tradeoffs among the sustainability and buildability criteria. The results from a qualitative data analysis suggested that the tool allowed the design team to effectively find a balance between the tradeoffs among the criteria when assessing multiple building envelope design alternatives. Main contributions of using this tool are achievement of a more efficient assessment of the building envelopes and more sustainable and buildable building envelope design.

  4. Assessing the Decision-Making Capacity of Terminally Ill Patients with Cancer.

    Science.gov (United States)

    Kolva, Elissa; Rosenfeld, Barry; Saracino, Rebecca

    2018-05-01

    Despite the clinical, ethical, and legal magnitude of end-of-life decision-making, the capacity of terminally ill patients to make the medical decisions they often face is largely unknown. In practice, clinicians are responsible for determining when their patients are no longer competent to make treatment decisions, yet the accuracy of these assessments is unclear. The purpose of this study was to explore decision-making capacity and its assessment in terminally ill cancer patients. Fifty-five patients with advanced cancer receiving inpatient palliative care and 50 healthy adults were administered the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to evaluate decision-making capacity with regard to the four most commonly used legal standards: Choice, Understanding, Appreciation, and Reasoning. Participants made a hypothetical treatment decision about whether to accept artificial nutrition and hydration for treatment of cachexia. Participants' physicians independently rated their decision-making capacity. Terminally ill participants were significantly more impaired than healthy adults on all MacCAT-T subscales. Most terminally ill participants were able to express a treatment choice (85.7%), but impairment was common on the Understanding (44.2%), Appreciation (49.0%), and Reasoning (85.4%) subscales. Agreement between physician-rated capacity and performance on the MacCAT-T subscales was poor. The use of the MacCAT-T revealed high rates of decisional impairment in terminally ill participants. Participants' physicians infrequently detected impairment identified by the MacCAT-T. The findings from the present study reinforce the need for engagement in advance care planning for patients with advanced cancer. Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  5. Effective dialogue: Enhanced public engagement as a legitimising tool for municipal waste management decision-making

    International Nuclear Information System (INIS)

    Garnett, Kenisha; Cooper, Tim

    2014-01-01

    Highlights: • A review of public engagement in waste management decision-making is undertaken. • Enhanced public engagement is explored as a means to legitimise waste decisions. • Analytical–deliberative processes are explored as a tool for effective dialogue. • Considerations for integrating public values with technical analysis are outlined. • Insights into the design of appropriate public engagement processes are provided. - Abstract: The complexity of municipal waste management decision-making has increased in recent years, accompanied by growing scrutiny from stakeholders, including local communities. This complexity reflects a socio-technical framing of the risks and social impacts associated with selecting technologies and sites for waste treatment and disposal facilities. Consequently there is growing pressure on local authorities for stakeholders (including communities) to be given an early opportunity to shape local waste policy in order to encourage swift planning, development and acceptance of the technologies needed to meet statutory targets to divert waste from landfill. This paper presents findings from a research project that explored the use of analytical–deliberative processes as a legitimising tool for waste management decision-making. Adopting a mixed methods approach, the study revealed that communicating the practical benefits of more inclusive forms of engagement is proving difficult even though planning and policy delays are hindering development and implementation of waste management infrastructure. Adopting analytical–deliberative processes at a more strategic level will require local authorities and practitioners to demonstrate how expert-citizen deliberations may foster progress in resolving controversial issues, through change in individuals, communities and institutions. The findings suggest that a significant shift in culture will be necessary for local authorities to realise the potential of more inclusive decision

  6. Practical Application of Modern Forecasting and Decision Tools at an Operational River Management Agency

    Science.gov (United States)

    Jawdy, C. M.; Carney, S.; Barber, N. M.; Balk, B. C.; Miller, G. A.

    2017-12-01

    The Tennessee Valley Authority (TVA) recently completed a complete overhaul of our River Forecast System (RFS). This modernization effort encompassed: uplift or addition of 89 data feeds calibration of a 140 subbasin rainfall-runoff model calibration of over 650 miles of hydraulic routings implementation of a decision optimization routine for 29 reservoirs implementation of hydrothermal forecast models for five river-cooled thermal plants creation of decision-friendly displays creation of a user-friendly wiki creation of a robust reporting system This talk will walk attendees through how a 24x7 river and grid management agency made decisions around how to operationalize the latest technologies in hydrology, hydraulics, decision science and information technology. The tradeoffs inherent in such an endeavor will be discussed so that research-oriented attendees can understand how best to align their research if they desire adoption within industry. More industry-oriented attendees can learn about the mechanics of how to succeed at such a large and complex project. Following the description of the modernization project, I can discuss TVA's plans for future growth of the system. We plan to add the following capabilities in the coming years: forecast verification tools to communicate floodplain risk tools to choose the best possible model forcings ensemble inflow modelling a river policy that allows for more reasonable tradeoff of benefits river decisions based on ensembles The iterative staging of such improvements is highly fraught with technical, political and operational risks. I will discuss how TVA's is using what we learned in the RFS modernization effort to grow further into delivering on the promise of these additional technologies.

  7. Effective dialogue: Enhanced public engagement as a legitimising tool for municipal waste management decision-making

    Energy Technology Data Exchange (ETDEWEB)

    Garnett, Kenisha, E-mail: k.garnett@cranfield.ac.uk [Institute for Environment, Health, Risks and Futures, School of Environment, Energy and Agri-food, Cranfield University, Cranfield MK43 0AL (United Kingdom); Cooper, Tim, E-mail: t.h.cooper@ntu.ac.uk [School of Architecture Design and the Built Environment, Nottingham Trent University, Burton Street, Nottingham NG1 4BU (United Kingdom)

    2014-12-15

    Highlights: • A review of public engagement in waste management decision-making is undertaken. • Enhanced public engagement is explored as a means to legitimise waste decisions. • Analytical–deliberative processes are explored as a tool for effective dialogue. • Considerations for integrating public values with technical analysis are outlined. • Insights into the design of appropriate public engagement processes are provided. - Abstract: The complexity of municipal waste management decision-making has increased in recent years, accompanied by growing scrutiny from stakeholders, including local communities. This complexity reflects a socio-technical framing of the risks and social impacts associated with selecting technologies and sites for waste treatment and disposal facilities. Consequently there is growing pressure on local authorities for stakeholders (including communities) to be given an early opportunity to shape local waste policy in order to encourage swift planning, development and acceptance of the technologies needed to meet statutory targets to divert waste from landfill. This paper presents findings from a research project that explored the use of analytical–deliberative processes as a legitimising tool for waste management decision-making. Adopting a mixed methods approach, the study revealed that communicating the practical benefits of more inclusive forms of engagement is proving difficult even though planning and policy delays are hindering development and implementation of waste management infrastructure. Adopting analytical–deliberative processes at a more strategic level will require local authorities and practitioners to demonstrate how expert-citizen deliberations may foster progress in resolving controversial issues, through change in individuals, communities and institutions. The findings suggest that a significant shift in culture will be necessary for local authorities to realise the potential of more inclusive decision

  8. Evaluating the content and development of decision aid tools for the management of menopause: A scoping review.

    Science.gov (United States)

    Siyam, Tasneem; Sultani, Humirah; Ross, Sue; Chatterley, Trish; Yuksel, Nese

    2017-12-01

    Decision-making during menopause (especially surgical menopause) can be complex given the variability in risk-benefit perceptions of menopausal treatments. Decision aid tools (DATs) help women participate in decision-making about options. Our objective is to identify and evaluate the content and development of DATs for managing menopause, with a special focus on surgical menopause. We systematically searched electronic databases, including MEDLINE and EMBASE, from inception to March 2017 for relevant records. The principal inclusion criterion was that papers reported studies on DATs for managing menopause. Search terms were derived from two concepts: menopause and DATs. Data extracted were presented in written evidence tables and narrative summaries. Our search yielded 18,801 records. Of these, 26 records met our inclusion criteria, which gave rise to 12 DATs from peer-reviewed literature and 6 from grey literature. Seventeen DATs were focused on natural menopause and two targeted surgical menopause, both identified from grey literature. More than half were published before the Women's Health Initiative (WHI) publication and 70% before the release of the International Patient Decision Aid Standards (IPDAS). Very few studies reported the full development of the DAT involved, and less than half of DATs were informed by a needs assessment to identify the decisional needs of their target population. Most DATs focused on hormone therapy as a treatment option and did not provide a comprehensive overview of other options. None of the DATs reported the steps involved in finding, appraising and summarizing scientific content of the tool. This review highlights several limitations in the content and development of DATs for managing menopause. No peer-reviewed DATs were identified for surgical menopause. A need for a complete, evidence-based DAT in the context of surgical menopause is identified. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Designing a data-driven decision support tool for nurse scheduling in the emergency department: a case study of a southern New Jersey emergency department.

    Science.gov (United States)

    Otegbeye, Mojisola; Scriber, Roslyn; Ducoin, Donna; Glasofer, Amy

    2015-01-01

    A health system serving Burlington and Camden Counties, New Jersey, sought to improve labor productivity for its emergency departments, with emphasis on optimizing nursing staff schedules. Using historical emergency department visit data and operating constraints, a decision support tool was designed to recommend the number of emergency nurses needed in each hour for each day of the week. The pilot emergency department nurse managers used the decision support tool's recommendations to redeploy nurse hours from weekends into a float pool to support periods of demand spikes on weekdays. Productivity improved significantly, with no unfavorable impact on patient throughput, and patient and staff satisfaction. Today's emergency department manager can leverage the increasing ease of access to the emergency department information system's data repository to successfully design a simple but effective tool to support the alignment of its nursing schedule with demand patterns. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  10. Decision-support tools for Extreme Weather and Climate Events in the Northeast United States

    Science.gov (United States)

    Kumar, S.; Lowery, M.; Whelchel, A.

    2013-12-01

    Decision-support tools were assessed for the 2013 National Climate Assessment technical input document, "Climate Change in the Northeast, A Sourcebook". The assessment included tools designed to generate and deliver actionable information to assist states and highly populated urban and other communities in assessment of climate change vulnerability and risk, quantification of effects, and identification of adaptive strategies in the context of adaptation planning across inter-annual, seasonal and multi-decadal time scales. State-level adaptation planning in the Northeast has generally relied on qualitative vulnerability assessments by expert panels and stakeholders, although some states have undertaken initiatives to develop statewide databases to support vulnerability assessments by urban and local governments, and state agencies. The devastation caused by Superstorm Sandy in October 2012 has raised awareness of the potential for extreme weather events to unprecedented levels and created urgency for action, especially in coastal urban and suburban communities that experienced pronounced impacts - especially in New Jersey, New York and Connecticut. Planning approaches vary, but any adaptation and resiliency planning process must include the following: - Knowledge of the probable change in a climate variable (e.g., precipitation, temperature, sea-level rise) over time or that the climate variable will attain a certain threshold deemed to be significant; - Knowledge of intensity and frequency of climate hazards (past, current or future events or conditions with potential to cause harm) and their relationship with climate variables; - Assessment of climate vulnerabilities (sensitive resources, infrastructure or populations exposed to climate-related hazards); - Assessment of relative risks to vulnerable resources; - Identification and prioritization of adaptive strategies to address risks. Many organizations are developing decision-support tools to assist in the urban

  11. A Diagnostics Tool to detect ensemble forecast system anomaly and guide operational decisions

    Science.gov (United States)

    Park, G. H.; Srivastava, A.; Shrestha, E.; Thiemann, M.; Day, G. N.; Draijer, S.

    2017-12-01

    The hydrologic community is moving toward using ensemble forecasts to take uncertainty into account during the decision-making process. The New York City Department of Environmental Protection (DEP) implements several types of ensemble forecasts in their decision-making process: ensemble products for a statistical model (Hirsch and enhanced Hirsch); the National Weather Service (NWS) Advanced Hydrologic Prediction Service (AHPS) forecasts based on the classical Ensemble Streamflow Prediction (ESP) technique; and the new NWS Hydrologic Ensemble Forecasting Service (HEFS) forecasts. To remove structural error and apply the forecasts to additional forecast points, the DEP post processes both the AHPS and the HEFS forecasts. These ensemble forecasts provide mass quantities of complex data, and drawing conclusions from these forecasts is time-consuming and difficult. The complexity of these forecasts also makes it difficult to identify system failures resulting from poor data, missing forecasts, and server breakdowns. To address these issues, we developed a diagnostic tool that summarizes ensemble forecasts and provides additional information such as historical forecast statistics, forecast skill, and model forcing statistics. This additional information highlights the key information that enables operators to evaluate the forecast in real-time, dynamically interact with the data, and review additional statistics, if needed, to make better decisions. We used Bokeh, a Python interactive visualization library, and a multi-database management system to create this interactive tool. This tool compiles and stores data into HTML pages that allows operators to readily analyze the data with built-in user interaction features. This paper will present a brief description of the ensemble forecasts, forecast verification results, and the intended applications for the diagnostic tool.

  12. Helping Patients to Make Informed Decisions : The PARE Guide to Disseminate EULAR Recommendations Among Patients

    NARCIS (Netherlands)

    de Wit, M.; Bakker, M.; van Bodegom-Vos, L.; Buch, M.; Caeyers, N.; Carluccio, A.; Geenen, R.; Greiff, R.; Glüsing, B.; Gossec, L.; Kent, A.; Poldema, I.; Vliet Vlieland, T.P.M.; Wiek, D.; Schipper, K.

    2015-01-01

    BACKGROUND Accurate patient information is necessary to make informed health decisions. However, the traditional, scientific wording of professional recommendations is often difficult to understand for lay people. OBJECTIVES To develop a practical guide for patient organizations and health

  13. Developing eHealth technology for people with dementia : towards a supportive decision tool facilitating shared decision making in dementia

    NARCIS (Netherlands)

    Span, M.; Smits, C.; Groen-van der Ven, L.; Jukema, J.; Cremers, A.H.M.; Vernooij-Dassen, M.; Eefsting, J.; Hettinga, M.

    2013-01-01

    People with dementia are confronted with many decisions. However, they are often not involved in the process of the decision-making. Shared Decision-Making (SDM) enables involvement of persons with dementia in the decision-making process. In our study, we develop a supportive IT application aiming

  14. Tools of the Future: How Decision Tree Analysis Will Impact Mission Planning

    Science.gov (United States)

    Otterstatter, Matthew R.

    2005-01-01

    The universe is infinitely complex; however, the human mind has a finite capacity. The multitude of possible variables, metrics, and procedures in mission planning are far too many to address exhaustively. This is unfortunate because, in general, considering more possibilities leads to more accurate and more powerful results. To compensate, we can get more insightful results by employing our greatest tool, the computer. The power of the computer will be utilized through a technology that considers every possibility, decision tree analysis. Although decision trees have been used in many other fields, this is innovative for space mission planning. Because this is a new strategy, no existing software is able to completely accommodate all of the requirements. This was determined through extensive research and testing of current technologies. It was necessary to create original software, for which a short-term model was finished this summer. The model was built into Microsoft Excel to take advantage of the familiar graphical interface for user input, computation, and viewing output. Macros were written to automate the process of tree construction, optimization, and presentation. The results are useful and promising. If this tool is successfully implemented in mission planning, our reliance on old-fashioned heuristics, an error-prone shortcut for handling complexity, will be reduced. The computer algorithms involved in decision trees will revolutionize mission planning. The planning will be faster and smarter, leading to optimized missions with the potential for more valuable data.

  15. A risk-based decision-aiding tool for waste disposal

    International Nuclear Information System (INIS)

    Weiner, R.F.; Reiser, A.S.; Elcock, C.G.; Nevins, S.

    1997-01-01

    N-CART (the National Spent Nuclear Fuel Program Cost Analysis and Risk Tool) is being developed to aid in low-risk, cost-effective, timely management of radioactive waste and spent nuclear fuel, and can therefore be used in management of mixed waste. N-CART provides evaluation of multiple alternatives and presents the consequences of proposed waste management activities in a clear and concise format. N-CART's decision-aiding analyses include comparisons and sensitivity analyses of multiple alternatives and allows the user to perform quick turn-around open-quotes what ifclose quotes studies to investigate various scenarios. Uncertainties in data (such as cost and schedule of various activities) are represented as distributions. N-CART centralizes documentation of the bases of program alternatives and program decisions, thereby supporting responses to stakeholders concerns. The initial N-CART design considers regulatory requirements, costs, and schedules for alternative courses of action. The final design will include risks (public health, occupational, economic, scheduling), economic benefits, and the impacts of secondary waste generation. An optimization tool is being incorporated that allows the user to specify the relative importance of cost, time risks, and other bases for decisions. The N-CART prototype can be used to compare the costs and schedules of disposal alternatives for mixed low-level radioactive waste (MLLW) and greater-than-Class-C (GTCC) waste, as well as spent nuclear fuel (SNF) and related scrap material

  16. A patient self-assessment tool for cardiac rehabilitation.

    Science.gov (United States)

    Phelan, C; Finnell, M D; Mottla, K A

    1989-01-01

    A patient self-assessment tool was designed, tested, and implemented to promote cardiac-specific data collection, based on Gordon's Functional Health Patterns, to maximize patient/family involvement in determining a plan of care, and to streamline primary nurses' documentation requirements. Retrospective and concurrent chart reviews provided data for quality assurance monitoring. The results of the monitoring demonstrated that the self-assessment tool markedly improved the patient-specific data base.

  17. Preradiation dental decisions in patients with head and neck cancer

    NARCIS (Netherlands)

    Bruins, H.H. (Hubert Herman)

    2001-01-01

    This thesis presents a series of studies that investigated preradiation dental decision making in patients with head and neck cancer. In Chapter 1, it is ascertained that in view of the risk for oral sequelae resulting from high-dose radiotherapy, special attention to preradiation dental planning

  18. Mismatch between health-care professionals' and patients' views on a diabetes patient decision aid: a qualitative study.

    Science.gov (United States)

    Lee, Ping Yein; Khoo, Ee Ming; Low, Wah Yun; Lee, Yew Kong; Abdullah, Khatijah Lim; Azmi, Syahidatul Akmal; Ng, Chirk Jenn

    2016-04-01

    Malaysia is an Asian country with population of diverse culture and health perceptions. Patient decision aid (PDA) is a new tool in Malaysia. Patients' and health-care professionals' (HCPs) expectation of a PDA is unknown. We aimed to explore patients' and health-care professionals'(HCPs) views on the information needed in a patient decision aid (PDA) on insulin initiation developed for patients with type 2 diabetes mellitus (T2DM). We used a qualitative design and thematic approach. Three main primary health-care settings in Malaysia: public university-based primary care clinics, public health-care clinics and private general practices. We conducted focus groups and one-to-one interviews with a purposive sample of health professionals and patients with type 2 diabetes. We interviewed 18 patients and 13 HCPs. Patients viewed the content of the PDA as simple and clear. However, HCPs felt the PDA might be difficult for patients with low literacy to understand. HCPs thought the PDA was too lengthy. Nevertheless, patients would prefer more information. HCPs tended to focus on benefits of insulin, while patients wanted to know the impact of insulin on their quality of life and practical issues regarding insulin and its side-effects. Patients preferred numbers to weigh the risks and benefits of treatment options. HCPs' views that presenting numbers in a PDA would be too complex for patients to understand. It is important to consider including issues related to psycho-social impact of treatment to patients when developing a patient decision aid. © 2015 John Wiley & Sons Ltd.

  19. A Web-Based Tool to Support Shared Decision Making for People With a Psychotic Disorder: Randomized Controlled Trial and Process Evaluation

    Science.gov (United States)

    Emerencia, Ando C; Boonstra, Nynke; Wunderink, Lex; de Jonge, Peter; Sytema, Sjoerd

    2013-01-01

    Background Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes. Objective This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders. Methods The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation. Results In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions

  20. Assessing Patient Participation in Health Policy Decision-Making in Cyprus.

    Science.gov (United States)

    Souliotis, Kyriakos; Agapidaki, Eirini; Peppou, Lily Evangelia; Tzavara, Chara; Samoutis, George; Theodorou, Mamas

    2016-06-20

    Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients' involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus. © 2016 by Kerman University of Medical Sciences.

  1. An ArcGIS decision support tool for artificial reefs site selection (ArcGIS ARSS)

    Science.gov (United States)

    Stylianou, Stavros; Zodiatis, George

    2017-04-01

    Although the use and benefits of artificial reefs, both socio-economic and environmental, have been recognized with research and national development programmes worldwide their development is rarely subjected to a rigorous site selection process and the majority of the projects use the traditional (non-GIS) approach, based on trial and error mode. Recent studies have shown that the use of Geographic Information Systems, unlike to traditional methods, for the identification of suitable areas for artificial reefs siting seems to offer a number of distinct advantages minimizing possible errors, time and cost. A decision support tool (DSS) has been developed based on the existing knowledge, the multi-criteria decision analysis techniques and the GIS approach used in previous studies in order to help the stakeholders to identify the optimal locations for artificial reefs deployment on the basis of the physical, biological, oceanographic and socio-economic features of the sites. The tool provides to the users the ability to produce a final report with the results and suitability maps. The ArcGIS ARSS support tool runs within the existing ArcMap 10.2.x environment and for the development the VB .NET high level programming language has been used along with ArcObjects 10.2.x. Two local-scale case studies were conducted in order to test the application of the tool focusing on artificial reef siting. The results obtained from the case studies have shown that the tool can be successfully integrated within the site selection process in order to select objectively the optimal site for artificial reefs deployment.

  2. Information Technology for Agriculture: Using it tools to aid decision-making process in small properties

    Directory of Open Access Journals (Sweden)

    Caroline de Oliveira Ferraz

    2017-07-01

    Full Text Available With the current scenario of agricultural competitiveness, the use of Information and Communication Technology (ICT tools has become increasingly common in the rural community, making life easier for farmers. The information obtained through Agroinformatics (Information Technology applied to agribusiness, serves as a basis for both decision-making, planning, and application of the best techniques and production processes. In Brazil, companies such as EMPRAPA (The Brazilian Agricultural Research Corporation work in the research and development of new technological tools, which seek to boost the agricultural production of small rural producers, reducing their costs and improving their results. But for this, it is necessary that the producers understand the concept of the importance in carrying out information collection in a correct way, because the information will be processed according to what is inserted in the systems. In this sense, this article aims to demonstrate through an explanatory research of qualitative nature and bibliographical character the importance of the use of ICT to support decision-making in the Brazilian rural sector. Also highlighting the benefits originated by the use of ICT in all stages of agricultural production and its accounting management, through examples of tools.

  3. Developing GIS based decision-support tools for agricultural counter-measurements after radiation accident

    International Nuclear Information System (INIS)

    Kepka, Pavel; Prochazka, Jan; Brom, Jakub; Pecharova, Emilie

    2009-01-01

    There is a whole variety of possibilities proposed by EURANOS data sheets for agriculture, for mid-term and long-term counter-measures after contamination of crops by radiation. We have developed a set of supportive tools for decision-makers within the project 'Methods of evaluation of contaminated territory after radiation accident - the importance of structure and functioning of a land cover'. Our TM tools are based on ArcGIS platform and Python programming language. We have developed a simple model for estimating the current biomass of the polluted crops. Inputs for this model are: a shape file of land cover data, database table with customisable plant growth characteristics and shape file of polluted areas. The model provides a shape file data set of estimated amounts of biomass of selected crops per hectare for a given day. The results are helpful for better performing of the countermeasure 'Early removal of crops'. The total amount of polluted waste, logistic costs (transport of people and material; required time; other costs) could be estimated only with basic GIS tools. The number of days expected for the harvest can be also calculated and compared with the dose and half-lives of the contaminating radionuclides. This analysis could also lead to a 'Do nothing' decision, especially in case of radionuclides with short times of half-life. (author)

  4. Stakeholder views of management and decision support tools to integrate climate change into Great Lakes Lake Whitefish management

    Science.gov (United States)

    Lynch, Abigail J.; Taylor, William W.; McCright, Aaron M.

    2016-01-01

    Decision support tools can aid decision making by systematically incorporating information, accounting for uncertainties, and facilitating evaluation between alternatives. Without user buy-in, however, decision support tools can fail to influence decision-making processes. We surveyed fishery researchers, managers, and fishers affiliated with the Lake Whitefish Coregonus clupeaformis fishery in the 1836 Treaty Waters of Lakes Huron, Michigan, and Superior to assess opinions of current and future management needs to identify barriers to, and opportunities for, developing a decision support tool based on Lake Whitefish recruitment projections with climate change. Approximately 64% of 39 respondents were satisfied with current management, and nearly 85% agreed that science was well integrated into management programs. Though decision support tools can facilitate science integration into management, respondents suggest that they face significant implementation barriers, including lack of political will to change management and perceived uncertainty in decision support outputs. Recommendations from this survey can inform development of decision support tools for fishery management in the Great Lakes and other regions.

  5. Developing a Tool for Measuring the Decision-Making Competence of Older Adults

    Science.gov (United States)

    Finucane, Melissa L.; Gullion, Christina M.

    2010-01-01

    The authors evaluated the reliability and validity of a tool for measuring older adults’ decision-making competence (DMC). Two-hundred-five younger adults (25-45 years), 208 young-older adults (65-74 years), and 198 old-older adults (75-97 years) made judgments and decisions related to health, finance, and nutrition. Reliable indices of comprehension, dimension weighting, and cognitive reflection were developed. Unlike previous research, the authors were able to compare old-older with young-older adults’ performance. As hypothesized, old-older adults performed more poorly than young-older adults; both groups of older adults performed more poorly than younger adults. Hierarchical regression analyses showed that a large amount of variance in decision performance across age groups (including mean trends) could be accounted for by social variables, health measures, basic cognitive skills, attitudinal measures, and numeracy. Structural equation modeling revealed significant pathways from three exogenous latent factors (crystallized intelligence, other cognitive abilities, and age) to the endogenous DMC latent factor. Further research is needed to validate the meaning of performance on these tasks for real-life decision making. PMID:20545413

  6. Decision-support tool for assessing future nuclear reactor generation portfolios

    International Nuclear Information System (INIS)

    Jain, Shashi; Roelofs, Ferry; Oosterlee, Cornelis W.

    2014-01-01

    Capital costs, fuel, operation and maintenance (O and M) costs, and electricity prices play a key role in the economics of nuclear power plants. Often standardized reactor designs are required to be locally adapted, which often impacts the project plans and the supply chain. It then becomes difficult to ascertain how these changes will eventually reflect in costs, which makes the capital costs component of nuclear power plants uncertain. Different nuclear reactor types compete economically by having either lower and less uncertain construction costs, increased efficiencies, lower and less uncertain fuel cycles and O and M costs etc. The decision making process related to nuclear power plants requires a holistic approach that takes into account the key economic factors and their uncertainties. We here present a decision-support tool that satisfactorily takes into account the major uncertainties in the cost elements of a nuclear power plant, to provide an optimal portfolio of nuclear reactors. The portfolio so obtained, under our model assumptions and the constraints considered, maximizes the combined returns for a given level of risk or uncertainty. These decisions are made using a combination of real option theory and mean–variance portfolio optimization. - Highlights: • Decisions to continue or abandon the construction of NPPs • Mean–variance portfolio of nuclear reactors • Sensitivity study of mean–variance portfolio of nuclear reactors

  7. Solution spaces for decision-making-a sustainability assessment tool for city-regions

    International Nuclear Information System (INIS)

    Wiek, Arnim; Binder, Claudia

    2005-01-01

    The sound development of city-regions presents a major planning challenge, as these regions are and will be the living spaces for the majority of the population. Therefore, a key question is how city-regions can be managed so that they develop in a sustainable way. Although Environmental Impact Assessment, Integrated Assessment, and other currently used approaches provide significant inputs for managing transition-processes towards sustainability, they must be extended to respond to three major deficiencies, which are (i) using lists of isolated indicators (ii) not performing a consistency analysis of the targets to be achieved, and (iii) not utilizing the potential of transdisciplinary approaches. The authors present an approach to constructing Sustainability Solution Spaces for Decision-Making (SSP). This approach fulfils the systemic, normative, and procedural requirements of an appropriate sustainability assessment as elaborated in the technical literature. It provides a consistent set of targets considering the systemic relations among the indicators representing the city-region. This gives the decision-makers a concise guideline for sustainable decisions and makes them aware of the synergistic and contradictory effects of their decisions. The modular tool is first depicted as a general procedure and later differentiated into two transdisciplinary approaches, a participatory and an expert approach

  8. Systematic maintenance analysis with decision support method and tool for optimizing maintenance programme

    International Nuclear Information System (INIS)

    Laakso, K.; Simola, K.; Dorrepaal, J.; Skogberg, P.

    1999-01-01

    This report describes an approach to evaluate the effectiveness of test and maintenance programs of technical systems used during several years. The method combines an analysis of the historical data on faults and repairs with an analysis of the history of periodic testing and preventive maintenance action programs. The application of the maintenance analysis from the methodological point of view in the reliability centered maintenance (RCM) project for Barsebaeck nuclear power plant is described. In order to limit the analysis resources, a method for ranking of objects for maintenance analysis is needed. Preliminary suggestions for changes in maintenance action programs are based on signals from simple maintenance indicators and qualitative analysis of underlying data on failures and maintenance. To facilitate generation of maintenance indicators, and make the maintenance analysis more efficient, a powerful and suitable data treatment tool is needed for analysis of the work order history. In the final maintenance decisions, additional decision criteria must be taken into account, and thus a more formal decision analysis is often needed for decision support. (au)

  9. Decision-Making in Patients with Hyperthyroidism: A Neuropsychological Study.

    Science.gov (United States)

    Yuan, Lili; Tian, Yanghua; Zhang, Fangfang; Ma, Huijuan; Chen, Xingui; Dai, Fang; Wang, Kai

    2015-01-01

    Cognitive and behavioral impairments are common in patients with abnormal thyroid function; these impairments cause a reduction in their quality of life. The current study investigates the decision making performance in patients with hyperthyroidism to explore the possible mechanism of their cognitive and behavioral impairments. Thirty-eight patients with hyperthyroidism and forty healthy control subjects were recruited to perform the Iowa Gambling Task (IGT), which assessed decision making under ambiguous conditions. Patients with hyperthyroidism had a higher score on the Zung Self-Rating Anxiety Scale (Z-SAS), and exhibited poorer executive function and IGT performance than did healthy control subjects. The patients preferred to choose decks with a high immediate reward, despite a higher future punishment, and were not capable of effectively using feedback information from previous choices. No clinical characteristics were associated with the total net score of the IGT in the current study. Patients with hyperthyroidism had decision-making impairment under ambiguous conditions. The deficits may result from frontal cortex and limbic system metabolic disorders and dopamine dysfunction.

  10. Decision-Making in Patients with Hyperthyroidism: A Neuropsychological Study

    Science.gov (United States)

    Zhang, Fangfang; Ma, Huijuan; Chen, Xingui; Dai, Fang; Wang, Kai

    2015-01-01

    Introduction Cognitive and behavioral impairments are common in patients with abnormal thyroid function; these impairments cause a reduction in their quality of life. The current study investigates the decision making performance in patients with hyperthyroidism to explore the possible mechanism of their cognitive and behavioral impairments. Methods Thirty-eight patients with hyperthyroidism and forty healthy control subjects were recruited to perform the Iowa Gambling Task (IGT), which assessed decision making under ambiguous conditions. Results Patients with hyperthyroidism had a higher score on the Zung Self-Rating Anxiety Scale (Z-SAS), and exhibited poorer executive function and IGT performance than did healthy control subjects. The patients preferred to choose decks with a high immediate reward, despite a higher future punishment, and were not capable of effectively using feedback information from previous choices. No clinical characteristics were associated with the total net score of the IGT in the current study. Conclusions Patients with hyperthyroidism had decision-making impairment under ambiguous conditions. The deficits may result from frontal cortex and limbic system metabolic disorders and dopamine dysfunction. PMID:26090955

  11. Measuring patient participation in surgical treatment decision-making from healthcare professionals' perspective.

    Science.gov (United States)

    Heggland, Liv-Helen; Mikkelsen, Aslaug; Øgaard, Torvald; Hausken, Kjell

    2014-02-01

    To develop, empirical test, and validate an instrument measuring patient participation in surgical treatment decision-making from healthcare professionals' perspective. Since the advent of New Public Management in many Western countries, patient participation in healthcare decision-making has been considered to be a best practice. A common notion is that well-educated and well-informed public want to choose their own treatments and providers and want to ask questions about the quality of their health services. Survey. A self-report-measuring instrument was designed and administered to 620 healthcare professionals. Items were developed, validated and tested by 451 nurses and physicians working in six surgical wards in a University Hospital in Norway. A 16-item scale with the following four dimensions was developed: information dissemination, formulation of options, integration of information and control. Factor analysis procedures and reliability testing were performed. A one-way, between-groups analysis of variance was conducted to compare doctors' and nurses' opinions on four dimensions of patient participation in surgical treatment decision-making. This article shows that patient participation in surgical treatment decision-making can be measured by a 16-item scale and four distinct dimensions. The analysis demonstrated a reasonable level of construct validity and reliability. Nurses and physicians have a positive attitude towards patient participation overall, but the two groups differ in the extent to which they accept the idea of patient participation in treatment decision-making. The instrument can be a tool for managers and healthcare professionals in the implementation of patient participation in clinical practice. Data from the instrument can be useful to identify health services being provided and what areas that could strengthen patient participation. © 2013 Blackwell Publishing Ltd.

  12. Understanding the stakeholders' intention to use economic decision-support tools: A cross-sectional study with the tobacco return on investment tool.

    Science.gov (United States)

    Cheung, Kei Long; Evers, Silvia M A A; Hiligsmann, Mickaël; Vokó, Zoltán; Pokhrel, Subhash; Jones, Teresa; Muñoz, Celia; Wolfenstetter, Silke B; Józwiak-Hagymásy, Judit; de Vries, Hein

    2016-01-01

    Despite an increased number of economic evaluations of tobacco control interventions, the uptake by stakeholders continues to be limited. Understanding the underlying mechanism in adopting such economic decision-support tools by stakeholders is therefore important. By applying the I-Change Model, this study aims to identify which factors determine potential uptake of an economic decision-support tool, i.e., the Return on Investment tool. Stakeholders (decision-makers, purchasers of services/pharma products, professionals/service providers, evidence generators and advocates of health promotion) were interviewed in five countries, using an I-Change based questionnaire. MANOVA's were conducted to assess differences between intenders and non-intenders regarding beliefs. A multiple regression analysis was conducted to identify the main explanatory variables of intention to use an economic decision-support tool. Ninety-three stakeholders participated. Significant differences in beliefs were found between non-intenders and intenders: risk perception, attitude, social support, and self-efficacy towards using the tool. Regression showed that demographics, pre-motivational, and motivational factors explained 69% of the variation in intention. This study is the first to provide a theoretical framework to understand differences in beliefs between stakeholders who do or do not intend to use economic decision-support tools, and empirically corroborating the framework. This contributes to our understanding of the facilitators and barriers to the uptake of these studies. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  13. Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study.

    Science.gov (United States)

    Giguere, Anik M C; Labrecque, Michel; Haynes, R Brian; Grad, Roland; Pluye, Pierre; Légaré, France; Cauchon, Michel; Greenway, Matthew; Carmichael, Pierre-Hugues

    2014-10-05

    Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice. We used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information. One hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89% expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6±1.2, scale 1-7, with 7 being "high"), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (Pdecision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked

  14. Patients' and parents' concerns and decisions about orthodontic treatment.

    Science.gov (United States)

    Kazancı, Fatih; Aydoğan, Cihan; Alkan, Özer

    2016-01-01

    Patients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level. One hundred and eighty-nine children and their parents were interviewed about concerns related to orthodontic treatment. Patients and parents were asked about orthodontic treatment decisions. Answers were recorded as "yes," "no," or "don't know." Chi-squared and Fisher's exact tests were used to compare concerns between age groups, sexes, and treatment demand levels. Kappa statistics were used to assess agreement between patients and their parents. Concerns about orthodontic treatment were gathered under 10 items as follows: "feeling pain," "the appearance of braces," "being teased," "avoiding smiling," "speech problems," "dietary changes," "problems with transportation," "economic problems," "long treatment duration," and "missing school." There was no statistically significant difference in concerns between the sexes or age groups. Some concern items and treatment demand were inversely related in patients. The results of this study demonstrate patients' and parents' concerns about orthodontic treatment. Differences between the concerns of patients with different treatment demands imply that children might reject orthodontic treatment because of their concerns. Appropriate consultation of patients addressing their concerns may help reduce anxiety and improve the acceptance of treatment.

  15. [Shared decision-making in medical practice--patient-centred communication skills].

    Science.gov (United States)

    van Staveren, Remke

    2011-01-01

    Most patients (70%) want to participate actively in important healthcare decisions, the rest (30%) prefer the doctor to make the decision for them. Shared decision-making provides more patient satisfaction, a better quality of life and contributes to a better doctor-patient relationship. Patients making their own decision generally make a well considered and medically sensible choice. In shared decision-making the doctor asks many open questions, gives and requests much information, asks if the patient wishes to participate in the decision-making and explicitly takes into account patient circumstances and preferences. Shared decision-making should remain an individual choice and should not become a new dogma.

  16. Medical decision-making capacity in patients with malignant glioma.

    Science.gov (United States)

    Triebel, Kristen L; Martin, Roy C; Nabors, Louis B; Marson, Daniel C

    2009-12-15

    Patients with malignant glioma (MG) must make ongoing medical treatment decisions concerning a progressive disease that erodes cognition. We prospectively assessed medical decision-making capacity (MDC) in patients with MG using a standardized psychometric instrument. Participants were 22 healthy controls and 26 patients with histologically verified MG. Group performance was compared on the Capacity to Consent to Treatment Instrument (CCTI), a psychometric measure of MDC incorporating 4 standards (choice, understanding, reasoning, and appreciation), and on neuropsychological and demographic variables. Capacity outcomes (capable, marginally capable, or incapable) on the CCTI standards were identified for the MG group. Within the MG group, scores on demographic, clinical, and neuropsychological variables were correlated with scores on each CCTI standard, and significant bivariate correlates were subsequently entered into exploratory stepwise regression analyses to identify multivariate cognitive predictors of the CCTI standards. Patients with MG performed significantly below controls on consent standards of understanding and reasoning, and showed a trend on appreciation. Relative to controls, more than 50% of the patients with MG demonstrated capacity compromise (marginally capable or incapable outcomes) in MDC. In the MG group, cognitive measures of verbal acquisition/recall and, to a lesser extent, semantic fluency predicted performance on the appreciation, reasoning, and understanding standards. Karnofsky score was also associated with CCTI performance. Soon after diagnosis, patients with malignant glioma (MG) have impaired capacity to make treatment decisions relative to controls. Medical decision-making capacity (MDC) impairment in MG seems to be primarily related to the effects of short-term verbal memory deficits. Ongoing assessment of MDC in patients with MG is strongly recommended.

  17. Benefits and limitations of using decision analytic tools to assess uncertainty and prioritize Landscape Conservation Cooperative information needs

    Science.gov (United States)

    Post van der Burg, Max; Cullinane Thomas, Catherine; Holcombe, Tracy R.; Nelson, Richard D.

    2016-01-01

    The Landscape Conservation Cooperatives (LCCs) are a network of partnerships throughout North America that are tasked with integrating science and management to support more effective delivery of conservation at a landscape scale. In order to achieve this integration, some LCCs have adopted the approach of providing their partners with better scientific information in an effort to facilitate more effective and coordinated conservation decisions. Taking this approach has led many LCCs to begin funding research to provide the information for improved decision making. To ensure that funding goes to research projects with the highest likelihood of leading to more integrated broad scale conservation, some LCCs have also developed approaches for prioritizing which information needs will be of most benefit to their partnerships. We describe two case studies in which decision analytic tools were used to quantitatively assess the relative importance of information for decisions made by partners in the Plains and Prairie Potholes LCC. The results of the case studies point toward a few valuable lessons in terms of using these tools with LCCs. Decision analytic tools tend to help shift focus away from research oriented discussions and toward discussions about how information is used in making better decisions. However, many technical experts do not have enough knowledge about decision making contexts to fully inform the latter type of discussion. When assessed in the right decision context, however, decision analyses can point out where uncertainties actually affect optimal decisions and where they do not. This helps technical experts understand that not all research is valuable in improving decision making. But perhaps most importantly, our results suggest that decision analytic tools may be more useful for LCCs as way of developing integrated objectives for coordinating partner decisions across the landscape, rather than simply ranking research priorities.

  18. Balance Sheets Versus Decision Dashboards to Support Patient Treatment Choices: A Comparative Analysis.

    Science.gov (United States)

    Dolan, James G; Veazie, Peter J

    2015-12-01

    Growing recognition of the importance of involving patients in preference-driven healthcare decisions has highlighted the need to develop practical strategies to implement patient-centered shared decision-making. The use of tabular balance sheets to support clinical decision-making is well established. More recent evidence suggests that graphic, interactive decision dashboards can help people derive deeper a understanding of information within a specific decision context. We therefore conducted a non-randomized trial comparing the effects of adding an interactive dashboard to a static tabular balance sheet on patient decision-making. The study population consisted of members of the ResearchMatch registry who volunteered to participate in a study of medical decision-making. Two separate surveys were conducted: one in the control group and one in the intervention group. All participants were instructed to imagine they were newly diagnosed with a chronic illness and were asked to choose between three hypothetical drug treatments, which varied with regard to effectiveness, side effects, and out-of-pocket cost. Both groups made an initial treatment choice after reviewing a balance sheet. After a brief "washout" period, members of the control group made a second treatment choice after reviewing the balance sheet again, while intervention group members made a second treatment choice after reviewing an interactive decision dashboard containing the same information. After both choices, participants rated their degree of confidence in their choice on a 1 to 10 scale. Members of the dashboard intervention group were more likely to change their choice of preferred drug (10.2 versus 7.5%; p = 0.054) and had a larger increase in decision confidence than the control group (0.67 versus 0.075; p < 0.03). There were no statistically significant between-group differences in decisional conflict or decision aid acceptability. These findings suggest that clinical decision dashboards may

  19. Communication Tools for End-of-Life Decision-Making in Ambulatory Care Settings: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Oczkowski, Simon J; Chung, Han-Oh; Hanvey, Louise; Mbuagbaw, Lawrence; You, John J

    2016-01-01

    Patients with serious illness, and their families, state that better communication and decision-making with healthcare providers is a high priority to improve the quality of end-of-life care. Numerous communication tools to assist patients, family members, and clinicians in end-of-life decision-making have been published, but their effectiveness remains unclear. To determine, amongst adults in ambulatory care settings, the effect of structured communication tools for end-of-life decision-making on completion of advance care planning. We searched for relevant randomized controlled trials (RCTs) or non-randomized intervention studies in MEDLINE, EMBASE, CINAHL, ERIC, and the Cochrane Database of Randomized Controlled Trials from database inception until July 2014. Two reviewers independently screened articles for eligibility, extracted data, and assessed risk of bias. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the quality of evidence for each of the primary and secondary outcomes. Sixty-seven studies, including 46 RCTs, were found. The majority evaluated communication tools in older patients (age >50) with no specific medical condition, but many specifically evaluated populations with cancer, lung, heart, neurologic, or renal disease. Most studies compared the use of communication tools against usual care, but several compared the tools to less-intensive advance care planning tools. The use of structured communication tools increased: the frequency of advance care planning discussions/discussions about advance directives (RR 2.31, 95% CI 1.25-4.26, p = 0.007, low quality evidence) and the completion of advance directives (ADs) (RR 1.92, 95% CI 1.43-2.59, pcare desired and care received by patients (RR 1.17, 95% CI 1.05-1.30, p = 0.004, low quality evidence, 2 RCTs). The use of structured communication tools may increase the frequency of discussions about and completion of advance directives, and concordance between

  20. Decision support tool to evaluate alternative policies regulating wind integration into autonomous energy systems

    International Nuclear Information System (INIS)

    Zouros, N.; Contaxis, G.C.; Kabouris, J.

    2005-01-01

    Integration of wind power into autonomous electricity systems strongly depends on the specific technical characteristics of these systems; the regulations applied should take into account physical system constraints. Introduction of market rules makes the issue even more complicated since the interests of the market participants often conflict each other. In this paper, an integrated tool for the comparative assessment of alternative regulatory policies is presented along with a methodology for decision-making, based on alternative scenarios analysis. The social welfare concept is followed instead of the traditional Least Cost Planning

  1. TOOL SUPPORT OF DECISION-MAKING AT SELECTION AND PERFORMANCE APPRAISAL TAKING INTO ACCOUNT MOTIVATION

    Directory of Open Access Journals (Sweden)

    Vadim Alexandrovich Lomazov

    2013-10-01

    Full Text Available The purpose of work consists in development of methods of information and algorithmic support of decision-making at an assessment and personnel selection taking into account motivation. The methods of a multicriteria assessment of alternatives and expert technologies are used as researching tools. The main result of the presented work is creation of the mathematical model that allows estimating a motivational orientation in the actions of the staff and job applicants. The scope of results of the work is the sphere of theoretical and applied questions of human resource management of the organizations.DOI: http://dx.doi.org/10.12731/2218-7405-2013-8-31

  2. Assessing Patient Participation in Health Policy Decision-Making in Cyprus

    Directory of Open Access Journals (Sweden)

    Kyriakos Souliotis

    2016-08-01

    Full Text Available Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA. PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI, an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients’ involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus.

  3. A Set of Web-based Tools for Integrating Scientific Research and Decision-Making through Systems Thinking

    Science.gov (United States)

    Currently, many policy and management decisions are made without considering the goods and services humans derive from ecosystems and the costs associated with protecting them. This approach is unlikely to be sustainable. Conceptual frameworks provide a tool for capturing, visual...

  4. MEETING IN CHICAGO: SADA: A FREEWARE DECISION SUPPORT TOOL INTEGRATING GIS, SAMPLE DESIGN, SPATIAL MODELING, AND ENVIRONMENTAL RISK ASSESSMENT

    Science.gov (United States)

    Spatial Analysis and Decision Assistance (SADA) is a Windows freeware program that incorporates tools from environmental assessment into an effective problem-solving environment. SADA was developed by the Institute for Environmental Modeling at the University of Tennessee and inc...

  5. SADA: A FREEWARE DECISION SUPPORT TOOL INTEGRATING GIS, SAMPLE DESIGN, SPATIAL MODELING AND RISK ASSESSMENT (SLIDE PRESENTATION)

    Science.gov (United States)

    Spatial Analysis and Decision Assistance (SADA) is a Windows freeware program that incorporates tools from environmental assessment into an effective problem-solving environment. SADA was developed by the Institute for Environmental Modeling at the University of Tennessee and inc...

  6. MEETING IN CZECH REPUBLIC: SADA: A FREEWARE DECISION SUPPORT TOOL INTEGRATING GIS, SAMPLE DESIGN, SPATIAL MODELING, AND RISK ASSESSMENT

    Science.gov (United States)

    Spatial Analysis and Decision Assistance (SADA) is a Windows freeware program that incorporates tools from environmental assessment into an effective problem-solving environment. SADA was developed by the Institute for Environmental Modeling at the University of Tennessee and inc...

  7. Clinical use of patient decision-making aids for stone patients.

    Science.gov (United States)

    Lim, Amy H; Streeper, Necole M; Best, Sara L; Penniston, Kristina L; Nakada, Stephen Y

    2017-08-01

    Patient decision-making aids (PDMAs) help patients make informed healthcare decisions and improve patient satisfaction. The utility of PDMAs for patients considering treatments for urolithiasis has not yet been published. We report our experience using PDMAs developed at our institution in the outpatient clinical setting in patients considering a variety of treatment options for stones. Patients with radiographically confirmed urolithiasis were given PDMAs regarding treatment options for their stone(s) based on their clinical profile. We assessed patients' satisfaction, involvedness, and feeling of making a more informed decision with utilization of the PDMAs using a Likert Scale Questionnaire. Information was also collected regarding previous stone passage, history and type of surgical intervention for urolithiasis, and level of education. Patients (n = 43; 18 males, 23 females and two unknown) 53 +/- 14years old were included. Patients reported that they understood the advantages and disadvantages outlined in the PDMAs (97%), that the PDMAs helped them make a more informed decision (83%) and felt more involved in the decision making process (88%). Patients reported that the aids were presented in a balanced manner and used up-to-date scientific information (100%, 84% respectively). Finally, a majority of the patients prefer an expert's opinion when making a treatment decision (98%) with 73% of patients preferring to form their own opinion based on available information. Previous stone surgery was associated with patients feeling more involved with the decision making process (p = 0.0465). PDMAs have a promising role in shared decision-making in the setting of treatment options for nephrolithiasis.

  8. Computational tool for postoperative evaluation of cochlear implant patients

    International Nuclear Information System (INIS)

    Giacomini, Guilherme; Pavan, Ana Luiza M.; Pina, Diana R. de; Altemani, Joao M.C.; Castilho, Arthur M.

    2016-01-01

    The aim of this study was to develop a tool to calculate the insertion depth angle of cochlear implants, from computed tomography exams. The tool uses different image processing techniques, such as thresholding and active contour. Then, we compared the average insertion depth angle of three different implant manufacturers. The developed tool can be used, in the future, to compare the insertion depth angle of the cochlear implant with postoperative response of patient's hearing. (author)

  9. Considering patient values and treatment preferences enhances patient involvement in rectal cancer treatment decision making.

    Science.gov (United States)

    Kunneman, Marleen; Marijnen, Corrie A M; Baas-Thijssen, Monique C M; van der Linden, Yvette M; Rozema, Tom; Muller, Karin; Geijsen, Elisabeth D; Stiggelbout, Anne M; Pieterse, Arwen H

    2015-11-01

    The shared decision making (SDM) model states that patients' values and preferences should be clarified to choose a strategy that best fits the patient. This study aimed to assess whether values and preferences of rectal cancer patients are voiced and considered in deciding about preoperative radiotherapy (PRT), and whether this makes patients feel more involved in treatment decision making. Pre-treatment consultations of radiation oncologists and patients eligible for PRT were audiotaped (N=90). Tapes were transcribed and coded to identify patients' values and treatment preferences. Patients filled in a post-consultation questionnaire on their perceived involvement in decision making (N=60). Patients' values were voiced for 62/611 of benefits/harms addressed (10%), in 38/90 consultations (42%; maximum 4 values per consultation), and most often related to major long-term treatment outcomes. Patients' treatment preferences were discussed in 20/90 consultations (22%). In 16/90 consultations (18%), the oncologists explicitly indicated to consider patients' values or preferences. Patients perceived a significantly more active role in decision making if their values or preferences had been voiced or considered. Patients' values and treatment preferences are voiced or considered in a minority of consultations. If they are, this increases patients' perceived involvement in the decision making process. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium.

    Science.gov (United States)

    Holmes-Rovner, Margaret; Nelson, Wendy L; Pignone, Michael; Elwyn, Glyn; Rovner, David R; O'Connor, Annette M; Coulter, Angela; Correa-de-Araujo, Rosaly

    2007-01-01

    This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clinical decision making.'' The formal debate addressed the theoretical problem of the appropriate gold standard for an improved decision, efficacy of decision aids, and prospects for implementation. Audience comments and questions focused on both theory and practice: the often unacknowledged roots of decision aids in expected utility theory and the practical problems of limited patient decision aid implementation in health care. The participants' vote on the proposition was approximately half for and half against.

  11. The IDEA Assessment Tool: Assessing the Reporting, Diagnostic Reasoning, and Decision-Making Skills Demonstrated in Medical Students' Hospital Admission Notes.

    Science.gov (United States)

    Baker, Elizabeth A; Ledford, Cynthia H; Fogg, Louis; Way, David P; Park, Yoon Soo

    2015-01-01

    Construct: Clinical skills are used in the care of patients, including reporting, diagnostic reasoning, and decision-making skills. Written comprehensive new patient admission notes (H&Ps) are a ubiquitous part of student education but are underutilized in the assessment of clinical skills. The interpretive summary, differential diagnosis, explanation of reasoning, and alternatives (IDEA) assessment tool was developed to assess students' clinical skills using written comprehensive new patient admission notes. The validity evidence for assessment of clinical skills using clinical documentation following authentic patient encounters has not been well documented. Diagnostic justification tools and postencounter notes are described in the literature (1,2) but are based on standardized patient encounters. To our knowledge, the IDEA assessment tool is the first published tool that uses medical students' H&Ps to rate students' clinical skills. The IDEA assessment tool is a 15-item instrument that asks evaluators to rate students' reporting, diagnostic reasoning, and decision-making skills based on medical students' new patient admission notes. This study presents validity evidence in support of the IDEA assessment tool using Messick's unified framework, including content (theoretical framework), response process (interrater reliability), internal structure (factor analysis and internal-consistency reliability), and relationship to other variables. Validity evidence is based on results from four studies conducted between 2010 and 2013. First, the factor analysis (2010, n = 216) yielded a three-factor solution, measuring patient story, IDEA, and completeness, with reliabilities of .79, .88, and .79, respectively. Second, an initial interrater reliability study (2010) involving two raters demonstrated fair to moderate consensus (κ = .21-.56, ρ =.42-.79). Third, a second interrater reliability study (2011) with 22 trained raters also demonstrated fair to moderate agreement

  12. Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform.

    Science.gov (United States)

    Hoffman, Aubri S; Llewellyn-Thomas, Hilary A; Tosteson, Anna N A; O'Connor, Annette M; Volk, Robert J; Tomek, Ivan M; Andrews, Steven B; Bartels, Stephen J

    2014-12-12

    Over 100 trials show that patient decision aids effectively improve patients' information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions. An interdisciplinary stakeholder panel designed the web-based research platform with three components: a) an introduction to shared decision making, b) a web-based patient decision aid, and c) interactive data collection items. Iterative focus groups provided feedback on paper drafts and online prototypes. A field test assessed a) feasibility for using the research platform, in terms of recruitment, usage, and acceptability; and b) feasibility of using the web-based decision aid component, compared to performance of a videobooklet decision aid in clinical care. This interdisciplinary, theory-based, patient-centered design approach produced a prototype for field-testing in six months. Participants (n = 126) reported that: the decision aid component was easy to use (98%), information was clear (90%), the length was appropriate (100%), it was appropriately detailed (90%), and it held their interest (97%). They spent a mean of 36 minutes using the decision aid and 100% preferred using their home/library computer. Participants scored a mean of 75% correct on the Decision Quality, Knowledge Subscale, and 74 out of 100 on the Preparation for Decision Making Scale. Completing the web-based decision aid reduced mean Decisional Conflict scores from 31.1 to 19.5 (p development of a web-based patient decision support research platform that was feasible for use in research studies in terms of recruitment, acceptability, and usage. Within this platform, the web

  13. Comparing assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool.

    Science.gov (United States)

    Aydin Er, Rahime; Sehiralti, Mine

    2014-07-01

    To compare assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool. This study was carried out at the psychiatry clinic of Kocaeli University Hospital from June 2007 to February 2008. The decision-making competence of the 83 patients who participated in the study was assessed by physicians, nurses, relatives and MacCAT-T. Of the 83 patients, the relatives of 73.8% of them, including the parents of 47.7%, were interviewed during the study. A moderately good consistency between the competency assessments of the nurses versus those of the physicians, but a poor consistency between the assessments of the physicians and nurses versus those of the patients' relatives, was determined. The differences in the competency assessment obtained with the MacCAT-T versus the evaluations of the physicians, nurses and patients' relatives were statistically significant. Our findings demonstrate those physicians, nurses and the patients' relatives have difficulty in identifying patients lacking decision-making competence. Therefore, an objective competence assessment tool should be used along with the assessments of physicians and nurses, both of whom can provide clinical data, as well as those of relatives, who can offer insights into the patient's moral values and expectations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Toward patient-centered, personalized and personal decision support and knowledge management: a survey.

    Science.gov (United States)

    Leong, T-Y

    2012-01-01

    This paper summarizes the recent trends and highlights the challenges and opportunities in decision support and knowledge management for patient-centered, personalized, and personal health care. The discussions are based on a broad survey of related references, focusing on the most recent publications. Major advances are examined in the areas of i) shared decision making paradigms, ii) continuity of care infrastructures and architectures, iii) human factors and system design approaches, iv) knowledge management innovations, and v) practical deployment and change considerations. Many important initiatives, projects, and plans with promising results have been identified. The common themes focus on supporting the individual patients who are playing an increasing central role in their own care decision processes. New collaborative decision making paradigms and information infrastructures are required to ensure effective continuity of care. Human factors and usability are crucial for the successful development and deployment of the relevant systems, tools, and aids. Advances in personalized medicine can be achieved through integrating genomic, phenotypic and other biological, individual, and population level information, and gaining useful insights from building and analyzing biological and other models at multiple levels of abstraction. Therefore, new Information and Communication Technologies and evaluation approaches are needed to effectively manage the scale and complexity of biomedical and health information, and adapt to the changing nature of clinical decision support. Recent research in decision support and knowledge management combines heterogeneous information and personal data to provide cost-effective, calibrated, personalized support in shared decision making at the point of care. Current and emerging efforts concentrate on developing or extending conventional paradigms, techniques, systems, and architectures for the new predictive, preemptive, and

  15. TEL4Health – Mobile tools to improve patient safety

    NARCIS (Netherlands)

    Drachsler, Hendrik; Kalz, Marco; Specht, Marcus

    2013-01-01

    Drachsler, H., Kalz, M., & Specht, M. (2013, 10 October). TEL4Health – Mobile tools to improve patient safety. Presentation given at the blended learning platform of the Netherlands Organisation for Hospitals (Nederlandse Vereniging van Ziekenhuizen), Utrecht, The Netherlands.

  16. Applications of urban tree canopy assessment and prioritization tools: supporting collaborative decision making to achieve urban sustainability goals

    Science.gov (United States)

    Dexter H. Locke; J. Morgan Grove; Michael Galvin; Jarlath P.M. ONeil-Dunne; Charles. Murphy

    2013-01-01

    Urban Tree Canopy (UTC) Prioritizations can be both a set of geographic analysis tools and a planning process for collaborative decision-making. In this paper, we describe how UTC Prioritizations can be used as a planning process to provide decision support to multiple government agencies, civic groups and private businesses to aid in reaching a canopy target. Linkages...

  17. Developing and Validating a Tool to Assess Ethical Decision-Making Ability of Nursing Students, Using Rubrics

    Science.gov (United States)

    Indhraratana, Apinya; Kaemkate, Wannee

    2012-01-01

    The aim of this paper is to develop a reliable and valid tool to assess ethical decision-making ability of nursing students using rubrics. A proposed ethical decision making process, from reviewing related literature was used as a framework for developing the rubrics. Participants included purposive sample of 86 nursing students from the Royal…

  18. Development and application of a decision support tool for reduction of product losses in the food-processing industry

    NARCIS (Netherlands)

    Akkerman, Renzo; van Donk, Dirk Pieter

    2008-01-01

    In food-processing industries, reduction of product losses is important for improving profitability and sustainability. This paper presents a decision support tool for analyzing the effects of planning decisions on the amount of product losses in the food-processing industry. We created a research

  19. A decision support tool for identifying abuse of controlled substances by ForwardHealth Medicaid members.

    Science.gov (United States)

    Mailloux, Allan T; Cummings, Stephen W; Mugdh, Mrinal

    2010-01-01

    Our objective was to use Wisconsin's Medicaid Evaluation and Decision Support (MEDS) data warehouse to develop and validate a decision support tool (DST) that (1) identifies Wisconsin Medicaid fee-for-service recipients who are abusing controlled substances, (2) effectively replicates clinical pharmacist recommendations for interventions intended to curb abuse of physician and pharmacy services, and (3) automates data extraction, profile generation and tracking of recommendations and interventions. From pharmacist manual reviews of medication profiles, seven measures of overutilization of controlled substances were developed, including (1-2) 6-month and 2-month "shopping" scores, (3-4) 6-month and 2-month forgery scores, (5) duplicate/same day prescriptions, (6) count of controlled substance claims, and the (7) shopping 6-month score for the individual therapeutic class with the highest score. The pattern analysis logic for the measures was encoded into SQL and applied to the medication profiles of 190 recipients who had already undergone manual review. The scores for each measure and numbers of providers were analyzed by exhaustive chi-squared automatic interaction detection (CHAID) to determine significant thresholds and combinations of predictors of pharmacist recommendations, resulting in a decision tree to classify recipients by pharmacist recommendations. The overall correct classification rate of the decision tree was 95.3%, with a 2.4% false positive rate and 4.0% false negative rate for lock-in versus prescriber-alert letter recommendations. Measures used by the decision tree include the 2-month and 6-month shopping scores, and the number of pharmacies and prescribers. The number of pharmacies was the best predictor of abuse of controlled substances. When a Medicaid recipient receives prescriptions for controlled substances at 8 or more pharmacies, the likelihood of a lock-in recommendation is 90%. The availability of the Wisconsin MEDS data warehouse has

  20. An evaluation of patient's decisions regarding dental prosthetic treatment

    Directory of Open Access Journals (Sweden)

    Nupur D Shrirao

    2016-01-01

    Full Text Available Introduction: For fabricating dental prostheses that meet patients' demands and have good longevity and function, appropriate treatment planning and decision-making are required. Therefore, not only technical skills and clinical judgment of the dentist are needed, but also patients' attitude toward treatment plays a critical role in posttreatment satisfaction. Aim: The aim of this study is to investigate the factors affecting decision-making and the selection of dental prosthesis by the patients. Materials and Methods: A cross-sectional survey to determine patients' attitudes about replacement of teeth was conducted. This survey was performed with the help of a prevalidated questionnaire, which contained the demographic data of every patient, whether or not they accept the treatment plan proposed by the dentist, and a close-ended multiple choice question stating the reasons cited by them if they decline the proposed treatment plan. Results: The data were subjected to statistical analysis by Chi-square test at a significance level of P< 0.05. A relationship between the demographical information such as age, gender, educational status, marital status, and monthly income of each patient and the single best reason opted by them to not undergo the proposed treatment plan was established. Conclusions: In the sample of population studied, most of the patients declined the proposed treatment plan and accepted the alternate one. High expenditure is the most common reason for this rejection.

  1. ResilSIM—A Decision Support Tool for Estimating Resilience of Urban Systems

    Directory of Open Access Journals (Sweden)

    Sarah Irwin

    2016-09-01

    Full Text Available Damages to urban systems as a result of water-related natural disasters have escalated in recent years. The observed trend is expected to increase in the future as the impacts of population growth, rapid urbanization and climate change persist. To alleviate the damages associated with these impacts, it is recommended to integrate disaster management methods into planning, design and operational policies under all levels of government. This manuscript proposes the concept of ResilSIM: A decision support tool that rapidly estimates the resilience (a modern disaster management measure that is dynamic in time and space of an urban system to the consequences of natural disasters. The web-based tool (with mobile access operates in near real-time. It is designed to assist decision makers in selecting the best options for integrating adaptive capacity into their communities to protect against the negative impacts of a hazard. ResilSIM is developed for application in Toronto and London, Ontario, Canada; however, it is only demonstrated for use in the city of London, which is susceptible to riverine flooding. It is observed how the incorporation of different combinations of adaptation options maintain or strengthen London’s basic structures and functions in the event of a flood.

  2. Evaluation of Pushback Decision-Support Tool Concept for Charlotte Douglas International Airport Ramp Operations

    Science.gov (United States)

    Hayashi, Miwa; Hoang, Ty; Jung, Yoon C.; Malik, Waqar; Lee, Hanbong; Dulchinos, Victoria L.

    2015-01-01

    This paper proposes a new departure pushback decision-support tool (DST) for airport ramp-tower controllers. It is based on NASA's Spot and Runway Departure Advisor (SARDA) collaborative decision-making concept, except with the modification that the gate releases now are controlled by tactical pushback (or gate-hold) advisories instead of strategic pre-assignments of target pushback times to individual departure flights. The proposed ramp DST relies on data exchange with the airport traffic control tower (ATCT) to coordinate pushbacks with the ATCT's flow-management intentions under current operational constraints, such as Traffic Management Initiative constraints. Airlines would benefit in reduced taxi delay and fuel burn. The concept was evaluated in a human-in-the-loop simulation experiment with current ramp-tower controllers at the Charlotte Douglas International Airport as participants. The results showed that the tool helped reduce taxi time by one minute per flight and overall departure flight fuel consumption by 10-12% without reducing runway throughput. Expect Departure Clearance Time (EDCT) conformance also was improved when advisories were provided. These benefits were attained without increasing the ramp-tower controllers' workload. Additionally, the advisories reduced the ATCT controllers' workload.

  3. The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Human Space Flight Missions

    Science.gov (United States)

    Kerstman, Eric L.; Minard, Charles; FreiredeCarvalho, Mary H.; Walton, Marlei E.; Myers, Jerry G., Jr.; Saile, Lynn G.; Lopez, Vilma; Butler, Douglas J.; Johnson-Throop, Kathy A.

    2011-01-01

    This slide presentation reviews the Integrated Medical Model (IMM) and its use as a risk assessment and decision support tool for human space flight missions. The IMM is an integrated, quantified, evidence-based decision support tool useful to NASA crew health and mission planners. It is intended to assist in optimizing crew health, safety and mission success within the constraints of the space flight environment for in-flight operations. It uses ISS data to assist in planning for the Exploration Program and it is not intended to assist in post flight research. The IMM was used to update Probability Risk Assessment (PRA) for the purpose of updating forecasts for the conditions requiring evacuation (EVAC) or Loss of Crew Life (LOC) for the ISS. The IMM validation approach includes comparison with actual events and involves both qualitative and quantitaive approaches. The results of these comparisons are reviewed. Another use of the IMM is to optimize the medical kits taking into consideration the specific mission and the crew profile. An example of the use of the IMM to optimize the medical kits is reviewed.

  4. The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Space Flight Medical Systems

    Science.gov (United States)

    Kerstman, Eric; Minard, Charles; Saile, Lynn; deCarvalho, Mary Freire; Myers, Jerry; Walton, Marlei; Butler, Douglas; Iyengar, Sriram; Johnson-Throop, Kathy; Baumann, David

    2009-01-01

    The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

  5. Which species? A decision-support tool to guide plant selection in stormwater biofilters

    Science.gov (United States)

    Payne, Emily G. I.; Pham, Tracey; Deletic, Ana; Hatt, Belinda E.; Cook, Perran L. M.; Fletcher, Tim D.

    2018-03-01

    Plant species are diverse in form, function and environmental response. This provides enormous potential for designing nature-based stormwater treatment technologies, such as biofiltration systems. However, species can vary dramatically in their pollutant-removal performance, particularly for nitrogen removal. Currently, there is a lack of information on how to efficiently select from the vast palette of species. This study aimed to identify plant traits beneficial to performance and create a decision-support tool to screen species for further testing. A laboratory experiment using 220 biofilter columns paired plant morphological characteristics with nitrogen removal and water loss for 20 Australian native species and two lawn grasses. Testing was undertaken during wet and dry conditions, for two biofilter designs (saturated zone and free-draining). An extensive root system and high total biomass were critical to the effective removal of total nitrogen (TN) and nitrate (NO3-), driven by high nitrogen assimilation. The same characteristics were key to performance under dry conditions, and were associated with high water use for Australian native plants; linking assimilation and transpiration. The decision-support tool uses these scientific relationships and readily-available information to identify the morphology, natural distribution and stress tolerances likely to be good predictors of plant nitrogen and water uptake.

  6. The challenge of predicting problematic chemicals using a decision analysis tool: Triclosan as a case study.

    Science.gov (United States)

    Perez, Angela L; Gauthier, Alison M; Ferracini, Tyler; Cowan, Dallas M; Kingsbury, Tony; Panko, Julie

    2017-01-01

    Manufacturers lack a reliable means for determining whether a chemical will be targeted for deselection from their supply chain. In this analysis, 3 methods for determining whether a specific chemical (triclosan) would meet the criteria necessary for being targeted for deselection are presented. The methods included a list-based approach, use of a commercially available chemical assessment software tool run in 2 modes, and a public interest evaluation. Our results indicated that triclosan was included on only 6 of the lists reviewed, none of which were particularly influential in chemical selection decisions. The results from the chemical assessment tool evaluations indicated that human and ecological toxicity for triclosan is low and received scores indicating that the chemical would be considered of low concern. However, triclosan's peak public interest tracked several years in advance of increased regulatory scrutiny of this chemical suggesting that public pressure may have been influential in deselection decisions. Key data gaps and toxicity endpoints not yet regulated such as endocrine disruption potential or phototoxicity, but that are important to estimate the trajectory for deselection of a chemical, are discussed. Integr Environ Assess Manag 2017;13:198-207. © 2016 SETAC. © 2016 SETAC.

  7. Evidence-based decision making and asthma in the internet age: the tools of the trade.

    Science.gov (United States)

    Jadad, A R

    2002-01-01

    At the dawn of the Information Age, the practice of evidence-based decision making (EBDM) is still hindered by many important barriers related to the decision makers, to the evidence per se or to the health system. Some of these barriers, particularly those related to the distillation, dissemination and packaging of research evidence, could be overcome by recent and ongoing developments in portable/wearable computers, internet appliances, multimedia and wireless broadband internet traffic. This article describes specific EBDM-related tools, with emphasis on internet-enabled "how to" books; and tools to improve the quality of reporting research, to formulate questions; to search for evidence; to access journals, systematic reviews and guidelines; to interact with organizations promoting EBDM; and to tailor evidence to individual cases. However, thinking that all barriers to the practice of EBDM could be solved by fancy information technology is naïve. Barriers related to the generation, interpretation, integration and use of the evidence demand more complex and perhaps unfeasible solutions, as overcoming them will require substantial changes in the structure of the health system, in the politics of science and in the way in which humans think and behave.

  8. Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center

    Science.gov (United States)

    2011-01-01

    Background Consumer use of herbal and natural products (H/NP) is increasing, yet physicians are often unprepared to provide guidance due to lack of educational training. This knowledge deficit may place consumers at risk of clinical complications. We wished to evaluate the impact that a natural medicine clinical decision tool has on faculty attitudes, practice experiences, and needs with respect to H/NP. Methods All physicians and clinical staff (nurse practitioners, physicians assistants) (n = 532) in departments of Pediatrics, Family and Community Medicine, and Internal Medicine at our medical center were invited to complete 2 electronic surveys. The first survey was completed immediately before access to a H/NP clinical-decision tool was obtained; the second survey was completed the following year. Results Responses were obtained from 89 of 532 practitioners (16.7%) on the first survey and 87 of 535 (16.3%) clinicians on the second survey. Attitudes towards H/NP varied with gender, age, time in practice, and training. At baseline, before having an evidence-based resource available, nearly half the respondents indicated that they rarely or never ask about H/NP when taking a patient medication history. The majority of these respondents (81%) indicated that they would like to learn more about H/NP, but 72% admitted difficulty finding evidence-based information. After implementing the H/NP tool, 63% of database-user respondents indicated that they now ask patients about H/NP when taking a drug history. Compared to results from the baseline survey, respondents who used the database indicated that the tool significantly increased their ability to find reliable H/NP information (P < 0.0001), boosted their knowledge of H/NP (p < 0.0001), and increased their confidence in providing accurate H/NP answers to patients and colleagues (P < 0.0001). Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and

  9. Values based decision making: a tool for achieving the goals of healthcare.

    Science.gov (United States)

    Mills, Anne E; Spencer, Edward M

    2005-03-01

    The recognition that the success of the healthcare organization depends on its achievement of two interrelated goals is a relatively recent phenomenon. In its mid-history the healthcare organization was largely able to ignore cost issues. In its latter history, many would argue that it ignored its quality goals as it pursued its cost goals (15). Either approach, given declining revenues and a competitive landscape, is incompatible with continued responsible operation. If this is true, then tools that were appropriate when the healthcare organization was focused on the achievement of one or another of these goals are not adequate as the healthcare organization seeks to achieve both goals together. Thus, new perspectives and new tools must be found that help the organization address two intimately related but sometimes conflicting goals. Values based decision-making can be the perspective needed, and organization ethics is one tool that can be of use in supporting it within the institution. But there are caveats. In order for values based decision-making to be effective, leadership must take an active role in promoting its use. It must relinquish a degree of control and it must begin to trust its stakeholders to make decisions within the context of the organization's values and goals. This can be extremely difficult, as control by senior management is often seen as the only effective means of ensuring that correct decisions are made. There are additional difficulties in the healthcare organization. Control rests within two groups and the healthcare organization is operating in an environment in which variance elimination is emphasized as a means of controlling costs. This may be an appealing notion for revenue strapped healthcare organization leaders, but it implies greater control exerted by managers, not less. Relinquishing any degree of control is a frightening prospect, but it has been done successfully. An excellent example of leadership encouraging decisions

  10. Learning environment simulator: a tool for local decision makers and first responders

    Energy Technology Data Exchange (ETDEWEB)

    Leclaire, Rene J [Los Alamos National Laboratory; Hirsch, Gary B [CLE, INCORPORATED

    2009-01-01

    The National Infrastructure Simulation and Analysis Center (NISAC) has developed a prototype learning environment simulator (LES) based on the Critical Infrastructure Protection Decision Support System (CIPDSS) infrastructure and scenario models. The LES is designed to engage decision makers at the grass-roots level (local/city/state) to deepen their understanding of an evolving crisis, enhance their intuition and allow them to test their own strategies for events before they occur. An initial version is being developed, centered on a pandemic influenza outbreak and has been successfully tested with a group of hospital administrators and first responders. LES is not a predictive tool but rather a simulated environment allowing the user to experience the complexities of a crisis before it happens. Users can contrast various approaches to the crisis, competing with alternative strategies of their own or other participants. LES is designed to assist decision makers in making informed choices by functionally representing relevant scenarios before they occur, including impacts to critical infrastructures with their interdependencies, and estimating human health & safety and economic impacts. In this paper a brief overview of the underlying models are given followed by a description of the LES, its interface and usage and an overview of the experience testing LES with a group of hospital administrators and first responders. The paper concludes with a brief discussion of the work remaining to make LES operational.

  11. Nuclear and Radiological Emergency Management and Rehabilitation Strategies: Towards a EU approach for decision support tools

    International Nuclear Information System (INIS)

    Raskob, W.; Gering, F.; Lochard, J.; Nisbet, A.; Starostova, V.; Tomic, B.

    2011-01-01

    Highlights: → European emergency management and rehabilitation was strengthened. → Development of generic European handbooks for urban and agricultural areas. → Decision support systems became more operational. → Harmonisation of tools in Europe has been promoted. - Abstract: The 5-year multi-national project EURANOS (European Approach to Nuclear and Radiological Emergency Management and Rehabilitation Strategies), funded by the European Commission and 23 European Member States, started in April 2004. Integrating 17 national emergency management organisations with 33 research institutes, it brings together best practices, knowledge and technology to enhance the preparedness for Europe's response to any radiation emergency and long term contamination. Key objectives of the project are to collate information on the likely effectiveness and consequences of a wide range of countermeasures, to provide guidance to emergency management organisations and decision makers on the establishment of an appropriate response strategy and to further enhance advanced decision support systems (DSS), in particular, RODOS (Real-time On-line Decisions Support) decision support system), through feedback from their operational use. Further, the project aims to create regional initiatives leading to information exchange based on state-of-the-art information technologies, to develop guidance which assists Member States in developing a framework for the sustainable rehabilitation of living conditions in contaminated areas and to maintain and enhance knowledge and competence through emergency exercises, training and education, thus fostering best practice in emergency response. The project is divided into three major research activities and a set of demonstration projects which are split in two phases lasting over two and three years, respectively. The research activities address specific issues previously identified by the users or by previous research in the area. They are focused

  12. An Evolutionary Complex Systems Decision-Support Tool for the Management of Operations

    Science.gov (United States)

    Baldwin, J. S.; Allen, P. M.; Ridgway, K.

    2011-12-01

    This research aimed to add both to the development of complex systems thinking in the subject area of Operations and Production Management and to the limited number of applications of computational models and simulations from the science of complex systems. The latter potentially offer helpful decision-support tools for operations and production managers. A mechanical engineering firm was used as a case study where a combined qualitative and quantitative methodological approach was employed to extract the required data from four senior managers. Company performance measures as well as firm technologies, practices and policies, and their relation and interaction with one another, were elicited. The data were subjected to an evolutionary complex systems model resulting in a series of simulations. The findings included both reassuring and some unexpected results. The simulation based on the CEO's opinions led the most cohesive and synergistic collection of practices describing the firm, closely followed by the Marketing and R&D Managers. The Manufacturing Manager's responses led to the most extreme evolutionary trajectory where the integrity of the entire firm came into question particularly when considering how employees were utilised. By drawing directly from the opinions and views of managers rather than from logical 'if-then' rules and averaged mathematical representations of agents that characterise agent-based and other self-organisational models, this work builds on previous applications by capturing a micro-level description of diversity and a learning effect that has been problematical not only in terms of theory but also in application. This approach can be used as a decision-support tool for operations and other managers providing a forum with which to explore a) the strengths, weaknesses and consequences of different decision-making capacities within the firm; b) the introduction of new manufacturing technologies, practices and policies; and, c) the

  13. An Evolutionary Complex Systems Decision-Support Tool for the Management of Operations

    International Nuclear Information System (INIS)

    Baldwin, J S; Allen, P M; Ridgway, K

    2011-01-01

    This research aimed to add both to the development of complex systems thinking in the subject area of Operations and Production Management and to the limited number of applications of computational models and simulations from the science of complex systems. The latter potentially offer helpful decision-support tools for operations and production managers. A mechanical engineering firm was used as a case study where a combined qualitative and quantitative methodological approach was employed to extract the required data from four senior managers. Company performance measures as well as firm technologies, practices and policies, and their relation and interaction with one another, were elicited. The data were subjected to an evolutionary complex systems model resulting in a series of simulations. The findings included both reassuring and some unexpected results. The simulation based on the CEO's opinions led the most cohesive and synergistic collection of practices describing the firm, closely followed by the Marketing and R and D Managers. The Manufacturing Manager's responses led to the most extreme evolutionary trajectory where the integrity of the entire firm came into question particularly when considering how employees were utilised. By drawing directly from the opinions and views of managers rather than from logical 'if-then' rules and averaged mathematical representations of agents that characterise agent-based and other self-organisational models, this work builds on previous applications by capturing a micro-level description of diversity and a learning effect that has been problematical not only in terms of theory but also in application. This approach can be used as a decision-support tool for operations and other managers providing a forum with which to explore a) the strengths, weaknesses and consequences of different decision-making capacities within the firm; b) the introduction of new manufacturing technologies, practices and policies; and, c) the

  14. Development and utilization of complementary communication channels for treatment decision making and survivorship issues among cancer patients: The CIS Research Consortium Experience

    OpenAIRE

    Linda Fleisher; Kuang Yi Wen; Suzanne M. Miller; Michael Diefenbach; Annette L. Stanton; Mary Ropka; Marion Morra; Peter C. Raich

    2015-01-01

    Objective: Cancer patients and survivors are assuming active roles in decision-making and digital patient support tools are widely used to facilitate patient engagement. As part of Cancer Information Service Research Consortium's randomized controlled trials focused on the efficacy of eHealth interventions to promote informed treatment decision-making for newly diagnosed prostate and breast cancer patients, and post-treatment breast cancer, we conducted a rigorous process evaluation to examin...

  15. Patient-Centered Tools for Medication Information Search.

    Science.gov (United States)

    Wilcox, Lauren; Feiner, Steven; Elhadad, Noémie; Vawdrey, David; Tran, Tran H

    2014-05-20

    Recent research focused on online health information seeking highlights a heavy reliance on general-purpose search engines. However, current general-purpose search interfaces do not necessarily provide adequate support for non-experts in identifying suitable sources of health information. Popular search engines have recently introduced search tools in their user interfaces for a range of topics. In this work, we explore how such tools can support non-expert, patient-centered health information search. Scoping the current work to medication-related search, we report on findings from a formative study focused on the design of patient-centered, medication-information search tools. Our study included qualitative interviews with patients, family members, and domain experts, as well as observations of their use of Remedy, a technology probe embodying a set of search tools. Post-operative cardiothoracic surgery patients and their visiting family members used the tools to find information about their hospital medications and were interviewed before and after their use. Domain experts conducted similar search tasks and provided qualitative feedback on their preferences and recommendations for designing these tools. Findings from our study suggest the importance of four valuation principles underlying our tools: credibility, readability, consumer perspective, and topical relevance.

  16. International Patients' Travel Decision Making Process- A Conceptual Framework.

    Science.gov (United States)

    Khan, Mohammad Jamal; Chelliah, Shankar; Haron, Mahmod Sabri

    2016-02-01

    Role of information source, perceived benefits and risks, and destination image has significantly been examined in travel and tourism literature; however, in medical tourism it is yet to be examined thoroughly. The concept discussed in this article is drawn form well established models in tourism literature. The purpose of this research was to identify the source of information, travel benefits and perceived risks related to movement of international patients and develop a conceptual model based on well-established theory. Thorough database search (Science Direct, utmj.org, nih.gov, nchu.edu.tw, palgrave-journals, medretreat, Biomedcentral) was performed to fulfill the objectives of the study. International patients always concern about benefits and risks related to travel. These benefits and risks form images of destination in the minds of international patients. Different sources of information make international patients acquaint about the associated benefits and risks, which later leads to development of intention to visit. This conceptual paper helps in establishing model for decision-making process of international patients in developing visit intention. Ample amount of literature is available detailing different factors involved in travel decision making of international patients; however literature explaining relationship between these factors is scarce.

  17. Development of a Support Tool for Complex Decision-Making in the Provision of Rural Maternity Care

    Science.gov (United States)

    Hearns, Glen; Klein, Michael C.; Trousdale, William; Ulrich, Catherine; Butcher, David; Miewald, Christiana; Lindstrom, Ronald; Eftekhary, Sahba; Rosinski, Jessica; Gómez-Ramírez, Oralia; Procyk, Andrea

    2010-01-01

    Context: Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. Objective: To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. Design: Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. Setting: Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. Participants: Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). Results: We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. Conclusions: Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the

  18. Patient decision-making: medical ethics and mediation.

    OpenAIRE

    Craig, Y J

    1996-01-01

    A review of medical ethics literature relating to the importance of the participation of patients in decision-making introduces the role of rights-based mediation as a voluntary process now being developed innovatively in America. This is discussed in relation to the theory of communicative ethics and moral personhood. References are then made to the work of medical ethics committees and the role of mediation within these. Finally it is suggested that mediation is part of an eirenic ethic alr...

  19. Patient and professional accuracy of recalled treatment decisions in out-patient consultations

    DEFF Research Database (Denmark)

    Skinner, T. C.; Barnard, K.; Cradock, S.

    2007-01-01

    Aims: To test the assumption that professional recall of consultation decisions is valid and more accurate than patient recall of consultation decisions. Methods: One hundred and thirty-four consultations between diabetes specialist nurses and diabetes specialist dietitians in an adult out-patien...

  20. A modeling tool to support decision making in future hydropower development in Chile

    Science.gov (United States)

    Vicuna, S.; Hermansen, C.; Cerda, J. P.; Olivares, M. A.; Gomez, T. I.; Toha, E.; Poblete, D.; Mao, L.; Falvey, M. J.; Pliscoff, P.; Melo, O.; Lacy, S.; Peredo, M.; Marquet, P. A.; Maturana, J.; Gironas, J. A.

    2017-12-01

    development targets are tested and compared. The results illustrate the capabilities of the tool to identify promising hydropower development strategies and to aid public policy discussions aimed at establishing incentives and regulations, and therefore provide decision makers with supporting material allowing a more informed discussion.

  1. Development of a multi-criteria decision tool for remediation after a nuclear or radiological accident

    Energy Technology Data Exchange (ETDEWEB)

    Luca, Christiano de; Rochedo, Elaine R.R.; Ferreira, Nadya M.P.D., E-mail: christiano_luca@hotmail.com, E-mail: elainerochedo@gmail.com, E-mail: nadya@ime.eb.br [Instituto Militar de Engenharia (IME), Rio de Janeiro, RJ (Brazil)

    2013-07-01

    The review of accidents involving Nuclear Power Plants or facilities that use or process radioactive sources have raised issues related to the decision-making processes and to the procedures used to reestablish the normal living conditions in the affected areas. Due to the large complexity of the decision processes after accidents, a multi-criteria approach has been recommended to support the choice among the several procedures that may improve the environmental conditions. As part of the process of developing a multi-criteria decision support tool, a questionnaire was created to be fulfilled by experts to derive the relevance of the technical criteria to be considered in the model. At this stage, only the technical criteria related to radiation protection of the public will be focused; legal aspects, costs and public opinion, although relevant in the decision-making process, are beyond the scope of this work. The questionnaire contains 12 questions, each containing 5 degrees of importance. The answers are statically analyzed to generate a multiplicative factor to be included in the multicriteria model. To facilitate the process of distributing the questionnaire to the selected experts and then for a better processing and ordering of the information gathered, a program based on the Hypertext Preprocessor language (PHP) was created; this methodology has been chosen because of its compatibility and security in existing operating systems. The relevance rank showed the long-term dose reduction and the generation of wastes as the most relevant aspects to be considered in selecting remediation strategies for a contaminated area. (author)

  2. Development of a multi-criteria decision tool for remediation after a nuclear or radiological accident

    International Nuclear Information System (INIS)

    Luca, Christiano de; Rochedo, Elaine R.R.; Ferreira, Nadya M.P.D.

    2013-01-01

    The review of accidents involving Nuclear Power Plants or facilities that use or process radioactive sources have raised issues related to the decision-making processes and to the procedures used to reestablish the normal living conditions in the affected areas. Due to the large complexity of the decision processes after accidents, a multi-criteria approach has been recommended to support the choice among the several procedures that may improve the environmental conditions. As part of the process of developing a multi-criteria decision support tool, a questionnaire was created to be fulfilled by experts to derive the relevance of the technical criteria to be considered in the model. At this stage, only the technical criteria related to radiation protection of the public will be focused; legal aspects, costs and public opinion, although relevant in the decision-making process, are beyond the scope of this work. The questionnaire contains 12 questions, each containing 5 degrees of importance. The answers are statically analyzed to generate a multiplicative factor to be included in the multicriteria model. To facilitate the process of distributing the questionnaire to the selected experts and then for a better processing and ordering of the information gathered, a program based on the Hypertext Preprocessor language (PHP) was created; this methodology has been chosen because of its compatibility and security in existing operating systems. The relevance rank showed the long-term dose reduction and the generation of wastes as the most relevant aspects to be considered in selecting remediation strategies for a contaminated area. (author)

  3. [Evaluation of the capacity of elderly patients to make decisions about their health].

    Science.gov (United States)

    Atienza-Martín, F J; Garrido-Lozano, M; Losada-Ruiz, C; Rodríguez-Fernández, L M; Revuelta-Pérez, F; Marín-Andrés, G

    2013-09-01

    To assess the decision-making capacity and variables related to this, in elderly patients in a home care program. A cross-sectional study was conducted on 130 patients assigned to home care program or in social welfare residences of an urban health centre. Demographic variables, as well as comorbidities, social support, institutionalisation, number of drugs used, degree of dependence (Barthel Index), cognitive function (Pfeiffer) were collected. The primary endpoint was the capacity for decision-making about their health assessed using the Aid to Capacity Evaluation (ACE) tool. There was a prevalence of 58.5% capacity. There was an association between ability and independence for activities of daily living (odds ratio (OR): 12.214; Confidence interval 95% (95% CI): 3.90 to 32.29, P de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  4. A new spatial multi-criteria decision support tool for site selection for implementation of managed aquifer recharge.

    Science.gov (United States)

    Rahman, M Azizur; Rusteberg, Bernd; Gogu, R C; Lobo Ferreira, J P; Sauter, Martin

    2012-05-30

    This study reports the development of a new spatial multi-criteria decision analysis (SMCDA) software tool for selecting suitable sites for Managed Aquifer Recharge (MAR) systems. The new SMCDA software tool functions based on the combination of existing multi-criteria evaluation methods with modern decision analysis techniques. More specifically, non-compensatory screening, criteria standardization and weighting, and Analytical Hierarchy Process (AHP) have been combined with Weighted Linear Combination (WLC) and Ordered Weighted Averaging (OWA). This SMCDA tool may be implemented with a wide range of decision maker's preferences. The tool's user-friendly interface helps guide the decision maker through the sequential steps for site selection, those steps namely being constraint mapping, criteria hierarchy, criteria standardization and weighting, and criteria overlay. The tool offers some predetermined default criteria and standard methods to increase the trade-off between ease-of-use and efficiency. Integrated into ArcGIS, the tool has the advantage of using GIS tools for spatial analysis, and herein data may be processed and displayed. The tool is non-site specific, adaptive, and comprehensive, and may be applied to any type of site-selection problem. For demonstrating the robustness of the new tool, a case study was planned and executed at Algarve Region, Portugal. The efficiency of the SMCDA tool in the decision making process for selecting suitable sites for MAR was also demonstrated. Specific aspects of the tool such as built-in default criteria, explicit decision steps, and flexibility in choosing different options were key features, which benefited the study. The new SMCDA tool can be augmented by groundwater flow and transport modeling so as to achieve a more comprehensive approach to the selection process for the best locations of the MAR infiltration basins, as well as the locations of recovery wells and areas of groundwater protection. The new spatial

  5. Predicting the probability of mortality of gastric cancer patients using decision tree.

    Science.gov (United States)

    Mohammadzadeh, F; Noorkojuri, H; Pourhoseingholi, M A; Saadat, S; Baghestani, A R

    2015-06-01

    Gastric cancer is the fourth most common cancer worldwide. This reason motivated us to investigate and introduce gastric cancer risk factors utilizing statistical methods. The aim of this study was to identify the most important factors influencing the mortality of patients who suffer from gastric cancer disease and to introduce a classification approach according to decision tree model for predicting the probability of mortality from this disease. Data on 216 patients with gastric cancer, who were registered in Taleghani hospital in Tehran,Iran, were analyzed. At first, patients were divided into two groups: the dead and alive. Then, to fit decision tree model to our data, we randomly selected 20% of dataset to the test sample and remaining dataset considered as the training sample. Finally, the validity of the model examined with sensitivity, specificity, diagnosis accuracy and the area under the receiver operating characteristic curve. The CART version 6.0 and SPSS version 19.0 softwares were used for the analysis of the data. Diabetes, ethnicity, tobacco, tumor size, surgery, pathologic stage, age at diagnosis, exposure to chemical weapons and alcohol consumption were determined as effective factors on mortality of gastric cancer. The sensitivity, specificity and accuracy of decision tree were 0.72, 0.75 and 0.74 respectively. The indices of sensitivity, specificity and accuracy represented that the decision tree model has acceptable accuracy to prediction the probability of mortality in gastric cancer patients. So a simple decision tree consisted of factors affecting on mortality of gastric cancer may help clinicians as a reliable and practical tool to predict the probability of mortality in these patients.

  6. For Third Enrollment Period, Marketplaces Expand Decision Support Tools To Assist Consumers.

    Science.gov (United States)

    Wong, Charlene A; Polsky, Daniel E; Jones, Arthur T; Weiner, Janet; Town, Robert J; Baker, Tom

    2016-04-01

    The design of the Affordable Care Act's online health insurance Marketplaces can improve how consumers make complex health plan choices. We examined the choice environment on the state-based Marketplaces and HealthCare.gov in the third open enrollment period. Compared to previous enrollment periods, we found greater adoption of some decision support tools, such as total cost estimators and integrated provider lookups. Total cost estimators differed in how they generated estimates: In some Marketplaces, consumers categorized their own utilization, while in others, consumers answered detailed questions and were assigned a utilization profile. The tools available before creating an account (in the window-shopping period) and afterward (in the real-shopping period) differed in several Marketplaces. For example, five Marketplaces provided total cost estimators to window shoppers, but only two provided them to real shoppers. Further research is needed on the impact of different choice environments and on which tools are most effective in helping consumers pick optimal plans. Project HOPE—The People-to-People Health Foundation, Inc.

  7. Dopaminergic influences on emotional decision making in euthymic bipolar patients.

    Science.gov (United States)

    Burdick, Katherine E; Braga, Raphael J; Gopin, Chaya B; Malhotra, Anil K

    2014-01-01

    We recently reported that the D2/D3 agonist pramipexole may have pro-cognitive effects in euthymic patients with bipolar disorder (BPD); however, the emergence of impulse-control disorders has been documented in Parkinson's disease (PD) after pramipexole treatment. Performance on reward-based tasks is altered in healthy subjects after a single dose of pramipexole, but its potential to induce abnormalities in BPD patients is unknown. We assessed reward-dependent decision making in euthymic BPD patients pre- and post 8 weeks of treatment with pramipexole or placebo by using the Iowa Gambling Task (IGT). The IGT requires subjects to choose among four card decks (two risky and two conservative) and is designed to promote learning to make advantageous (conservative) choices over time. Thirty-four BPD patients completed both assessments (18 placebo and 16 pramipexole). Baseline performance did not differ by treatment group (F=0.63; p=0.64); however, at week 8, BPD patients on pramipexole demonstrated a significantly greater tendency to make increasingly high-risk, high-reward choices across the five blocks, whereas the placebo group's pattern was similar to that reported in healthy individuals (treatment × time × block interaction, pinfluences risk-associated decision-making performance in euthymic BPD. The clinical implications remain unknown.

  8. Prognostic risk estimates of patients with multiple sclerosis and their physicians: comparison to an online analytical risk counseling tool.

    Directory of Open Access Journals (Sweden)

    Christoph Heesen

    Full Text Available BACKGROUND: Prognostic counseling in multiple sclerosis (MS is difficult because of the high variability of disease progression. Simultaneously, patients and physicians are increasingly confronted with making treatment decisions at an early stage, which requires taking individual prognoses into account to strike a good balance between benefits and harms of treatments. It is therefore important to understand how patients and physicians estimate prognostic risk, and whether and how these estimates can be improved. An online analytical processing (OLAP tool based on pooled data from placebo cohorts of clinical trials offers short-term prognostic estimates that can be used for individual risk counseling. OBJECTIVE: The aim of this study was to clarify if personalized prognostic information as presented by the OLAP tool is considered useful and meaningful by patients. Furthermore, we used the OLAP tool to evaluate patients' and physicians' risk estimates. Within this evaluation process we assessed short-time prognostic risk estimates of patients with MS (final n = 110 and their physicians (n = 6 and compared them with the estimates of OLAP. RESULTS: Patients rated the OLAP tool as understandable and acceptable, but to be only of moderate interest. It turned out that patients, physicians, and the OLAP tool ranked patients similarly regarding their risk of disease progression. Both patients' and physicians' estimates correlated most strongly with those disease covariates that the OLAP tool's estimates also correlated with most strongly. Exposure to the OLAP tool did not change patients' risk estimates. CONCLUSION: While the OLAP tool was rated understandable and acceptable, it was only of modest interest and did not change patients' prognostic estimates. The results suggest, however, that patients had some idea regarding their prognosis and which factors were most important in this regard. Future work with OLAP should assess long-term prognostic

  9. Prognostic risk estimates of patients with multiple sclerosis and their physicians: comparison to an online analytical risk counseling tool.

    Science.gov (United States)

    Heesen, Christoph; Gaissmaier, Wolfgang; Nguyen, Franziska; Stellmann, Jan-Patrick; Kasper, Jürgen; Köpke, Sascha; Lederer, Christian; Neuhaus, Anneke; Daumer, Martin

    2013-01-01

    Prognostic counseling in multiple sclerosis (MS) is difficult because of the high variability of disease progression. Simultaneously, patients and physicians are increasingly confronted with making treatment decisions at an early stage, which requires taking individual prognoses into account to strike a good balance between benefits and harms of treatments. It is therefore important to understand how patients and physicians estimate prognostic risk, and whether and how these estimates can be improved. An online analytical processing (OLAP) tool based on pooled data from placebo cohorts of clinical trials offers short-term prognostic estimates that can be used for individual risk counseling. The aim of this study was to clarify if personalized prognostic information as presented by the OLAP tool is considered useful and meaningful by patients. Furthermore, we used the OLAP tool to evaluate patients' and physicians' risk estimates. Within this evaluation process we assessed short-time prognostic risk estimates of patients with MS (final n = 110) and their physicians (n = 6) and compared them with the estimates of OLAP. Patients rated the OLAP tool as understandable and acceptable, but to be only of moderate interest. It turned out that patients, physicians, and the OLAP tool ranked patients similarly regarding their risk of disease progression. Both patients' and physicians' estimates correlated most strongly with those disease covariates that the OLAP tool's estimates also correlated with most strongly. Exposure to the OLAP tool did not change patients' risk estimates. While the OLAP tool was rated understandable and acceptable, it was only of modest interest and did not change patients' prognostic estimates. The results suggest, however, that patients had some idea regarding their prognosis and which factors were most important in this regard. Future work with OLAP should assess long-term prognostic estimates and clarify its usefulness for patients and physicians

  10. Impaired social decision making in patients with major depressive disorder.

    Science.gov (United States)

    Zhang, Hui-Jun; Sun, Delin; Lee, Tatia M C

    2012-07-01

    Research on how depression influences social decision making has been scarce. This study investigated how people with depression make decisions in an interpersonal trust-reciprocity game. Fifty female patients diagnosed with major depressive disorders (MDDs) and 49 healthy women participated in this study. The experiment was conducted on a one-to-one basis. Participants were asked to play the role of a trustee responsible for investing money given to them by an anonymous female investor playing on another computer station. In each trial, the investor would send to a participant (the trustee) a request for a certain percentage of the appreciated investment (repayment proportion). Since only the participant knew the exact amount of the appreciated investment, she could decide to pay more (altruistic act), the same, or less (deceptive act) than the requested amount. The participant's money acquired in the trial would be confiscated if her deceptive act was caught. The frequency of deceptive or altruistic decisions and relative monetary gain in each decision choice were examined. People with depression made fewer deceptive and fewer altruistic responses than healthy controls in all conditions. Moreover, the specific behavioral pattern presented by people with depression was modulated by the task factors, including the risk of deception detection and others' intentions (benevolence vs. malevolence). Findings of this study contribute to furthering our understanding of the specific pattern of social behavioral changes associated with depression.

  11. A Clinical Decision Support System for Breast Cancer Patients

    Science.gov (United States)

    Fernandes, Ana S.; Alves, Pedro; Jarman, Ian H.; Etchells, Terence A.; Fonseca, José M.; Lisboa, Paulo J. G.

    This paper proposes a Web clinical decision support system for clinical oncologists and for breast cancer patients making prognostic assessments, using the particular characteristics of the individual patient. This system comprises three different prognostic modelling methodologies: the clinically widely used Nottingham prognostic index (NPI); the Cox regression modelling and a partial logistic artificial neural network with automatic relevance determination (PLANN-ARD). All three models yield a different prognostic index that can be analysed together in order to obtain a more accurate prognostic assessment of the patient. Missing data is incorporated in the mentioned models, a common issue in medical data that was overcome using multiple imputation techniques. Risk group assignments are also provided through a methodology based on regression trees, where Boolean rules can be obtained expressed with patient characteristics.

  12. Patient understanding of the revised USPSTF screening mammogram guidelines: need for development of patient decision aids

    Directory of Open Access Journals (Sweden)

    Allen Summer V

    2012-10-01

    Full Text Available Abstract Background The purpose of the study was to examine patients’ understanding of the revised screening mammogram guidelines released by the United States Preventive Services Task Force (USPSTF in 2009 addressing age at initiation and frequency of screening mammography. Methods Patients from the Departments of Family Medicine, Internal Medicine, and Obstetrics and Gynecology (n = 150 at a tertiary care medical center in the United States completed a survey regarding their understanding of the revised USPSTF guidelines following their release, within four to six months of their scheduled mammogram (March 2010 to May 2010. Results Of the patients surveyed, 97/147 (67% indicated increased confusion regarding the age and frequency of screening mammography, 61/148 (41% reported increased anxiety about mammograms, and 58/146 (40% reported anxiety about their own health status following the release of the revised screening guidelines. Most of the patients surveyed, 111/148 (75%, did not expect to change their timing or frequency of screening mammograms in the future. Conclusion Results from this survey suggested increased confusion and possibly an increase in patients’ anxiety related to screening mammography and their own health status following the release of the revised USPSTF screening mammogram guidelines to the public and subsequent media portrayal of the revised guidelines. Although the study did not specifically address causality for these findings, the results highlight the need for improvements in the communication of guidelines to patients and the public. Development of shared decision-making tools and outcomes should be considered to address the communication challenge.

  13. [Adaptation of the Medical Office Survey on Patient Safety Culture (MOSPSC) tool].

    Science.gov (United States)

    Silvestre-Busto, C; Torijano-Casalengua, M L; Olivera-Cañadas, G; Astier-Peña, M P; Maderuelo-Fernández, J A; Rubio-Aguado, E A

    2015-01-01

    To adapt the Medical Office Survey on Patient Safety Culture (MOSPSC) Excel(®) tool for its use by Primary Care Teams of the Spanish National Public Health System. The process of translation and adaptation of MOSPSC from the Agency for Healthcare and Research in Quality (AHRQ) was performed in five steps: Original version translation, Conceptual equivalence evaluation, Acceptability and viability assessment, Content validity and Questionnaire test and response analysis, and psychometric properties assessment. After confirming MOSPSC as a valid, reliable, consistent and useful tool for assessing patient safety culture in our setting, an Excel(®) worksheet was translated and adapted in the same way. It was decided to develop a tool to analyze the "Spanish survey" and to keep it linked to the "Original version" tool. The "Spanish survey" comparison data are those obtained in a 2011 nationwide Spanish survey, while the "Original version" comparison data are those provided by the AHRQ in 2012. The translated and adapted tool and the analysis of the results from a 2011 nationwide Spanish survey are available on the website of the Ministry of Health, Social Services and Equality. It allows the questions which are decisive in the different dimensions to be determined, and it provides a comparison of the results with graphical representation. Translation and adaptation of this tool enables a patient safety culture in Primary Care in Spain to be more effectively applied. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  14. Patients' perceptions of sharing in decisions: a systematic review of interventions to enhance shared decision making in routine clinical practice.

    Science.gov (United States)

    Légaré, France; Turcotte, Stéphane; Stacey, Dawn; Ratté, Stéphane; Kryworuchko, Jennifer; Graham, Ian D

    2012-01-01

    Shared decision making is the process in which a healthcare choice is made jointly by the health professional and the patient. Little is known about what patients view as effective or ineffective strategies to implement shared decision making in routine clinical practice. This systematic review evaluates the effectiveness of interventions to improve health professionals' adoption of shared decision making in routine clinical practice, as seen by patients. We searched electronic databases (PubMed, the Cochrane Library, EMBASE, CINAHL, and PsycINFO) from their inception to mid-March 2009. We found additional material by reviewing the reference lists of the studies found in the databases; systematic reviews of studies on shared decision making; the proceedings of various editions of the International Shared Decision Making Conference; and the transcripts of the Society for Medical Decision Making's meetings. In our study selection, we included randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series analyses in which patients evaluated interventions to improve health professionals' adoption of shared decision making. The interventions in question consisted of the distribution of printed educational material; educational meetings; audit and feedback; reminders; and patient-mediated initiatives (e.g. patient decision aids). Two reviewers independently screened the studies and extracted data. Statistical analyses considered categorical and continuous process measures. We computed the standardized effect size for each outcome at the 95% confidence interval. The primary outcome of interest was health professionals' adoption of shared decision making as reported by patients in a self-administered questionnaire. Of the 6764 search results, 21 studies reported 35 relevant comparisons. Overall, the quality of the studies ranged from 0% to 83%. Only three of the 21 studies reported a clinically significant effect

  15. Communication tools for end-of-life decision-making in the intensive care unit: a systematic review and meta-analysis.

    Science.gov (United States)

    Oczkowski, Simon J W; Chung, Han-Oh; Hanvey, Louise; Mbuagbaw, Lawrence; You, John J

    2016-04-09

    For many patients admitted to the intensive care unit (ICU), preferences for end-of-life care are unknown, and clinicians and substitute decision-makers are required to make decisions about the goals of care on their behalf. We conducted a systematic review to determine the effect of structured communication tools for end-of-life decision-making, compared to usual care, upon the number of documented goals of care discussions, documented code status, and decisions to withdraw life-sustaining treatments, in adult patients admitted to the ICU. We searched multiple databases including MEDLINE, Embase, CINAHL, ERIC, and Cochrane from database inception until July 2014. Two reviewers independently screened articles, assessed eligibility, verified data extraction, and assessed risk of bias using the tool described by the Cochrane Collaboration and the Newcastle Ottawa Scale. Pooled estimates of effect (relative risk, standardized mean difference, or mean difference), were calculated where sufficient data existed. GRADE was used to evaluate the overall quality of evidence for each outcome. We screened 5785 abstracts and reviewed the full text of 424 articles, finding 168 eligible articles, including 19 studies in the ICU setting. The use of communication tools increased documentation of goals-of-care discussions (RR 3.47, 95% CI 1.55, 7.75, p = 0.020, very low-quality evidence), but did not have an effect on code status documentation (RR 1.03, 95% CI 0.96, 1.10, p = 0.540, low-quality evidence) or decisions to withdraw or withhold life-sustaining treatments (RR 0.98, 95% CI 0.89, 1.08, p = 0.70, low-quality evidence). The use of such tools was associated with a decrease in multiple measures of health care resource utilization, including duration of mechanical ventilation (MD -1.9 days, 95% CI -3.26, -0.54, p = 0.006, very low-quality evidence), length of ICU stay (MD -1.11 days, 95% CI -2.18, -0.03, p = 0.04, very low-quality evidence), and health care costs (SMD -0.32, 95

  16. Vascular access choice in incident hemodialysis patients: a decision analysis.

    Science.gov (United States)

    Drew, David A; Lok, Charmaine E; Cohen, Joshua T; Wagner, Martin; Tangri, Navdeep; Weiner, Daniel E

    2015-01-01

    Hemodialysis vascular access recommendations promote arteriovenous (AV) fistulas first; however, it may not be the best approach for all hemodialysis patients, because likelihood of successful fistula placement, procedure-related and subsequent costs, and patient survival modify the optimal access choice. We performed a decision analysis evaluating AV fistula, AV graft, and central venous catheter (CVC) strategies for patients initiating hemodialysis with a CVC, a scenario occurring in over 70% of United States dialysis patients. A decision tree model was constructed to reflect progression from hemodialysis initiation. Patients were classified into one of three vascular access choices: maintain CVC, attempt fistula, or attempt graft. We explicitly modeled probabilities of primary and secondary patency for each access type, with success modified by age, sex, and diabetes. Access-specific mortality was incorporated using preexisting cohort data, including terms for age, sex, and diabetes. Costs were ascertained from the 2010 USRDS report and Medicare for procedure costs. An AV fistula attempt strategy was found to be superior to AV grafts and CVCs in regard to mortality and cost for the majority of patient characteristic combinations, especially younger men without diabetes. Women with diabetes and elderly men with diabetes had similar outcomes, regardless of access type. Overall, the advantages of an AV fistula attempt strategy lessened considerably among older patients, particularly women with diabetes, reflecting the effect of lower AV fistula success rates and lower life expectancy. These results suggest that vascular access-related outcomes may be optimized by considering individual patient characteristics. Copyright © 2015 by the American Society of Nephrology.

  17. Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II.

    Directory of Open Access Journals (Sweden)

    Annie LeBlanc

    Full Text Available Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient's estimated risk of fracture using the FRAX calculator is unknown.Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates.We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01, improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively, had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001. Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer. There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07; medication adherence at 6 months was no different across arms.Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results.clinical trials.gov NCT00949611.

  18. "Best Case/Worst Case": Qualitative Evaluation of a Novel Communication Tool for Difficult in-the-Moment Surgical Decisions.

    Science.gov (United States)

    Kruser, Jacqueline M; Nabozny, Michael J; Steffens, Nicole M; Brasel, Karen J; Campbell, Toby C; Gaines, Martha E; Schwarze, Margaret L

    2015-09-01

    To evaluate a communication tool called "Best Case/Worst Case" (BC/WC) based on an established conceptual model of shared decision-making. Focus group study. Older adults (four focus groups) and surgeons (two focus groups) using modified questions from the Decision Aid Acceptability Scale and the Decisional Conflict Scale to evaluate and revise the communication tool. Individuals aged 60 and older recruited from senior centers (n = 37) and surgeons from academic and private practices in Wisconsin (n = 17). Qualitative content analysis was used to explore themes and concepts that focus group respondents identified. Seniors and surgeons praised the tool for the unambiguous illustration of multiple treatment options and the clarity gained from presentation of an array of treatment outcomes. Participants noted that the tool provides an opportunity for in-the-moment, preference-based deliberation about options and a platform for further discussion with other clinicians and loved ones. Older adults worried that the format of the tool was not universally accessible for people with different educational backgrounds, and surgeons had concerns that the tool was vulnerable to physicians' subjective biases. The BC/WC tool is a novel decision support intervention that may help facilitate difficult decision-making for older adults and their physicians when considering invasive, acute medical treatments such as surgery. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  19. The effect of completing a surrogacy information and decision-making tool upon admission to an intensive care unit on length of stay and charges.

    Science.gov (United States)

    Hatler, Carol W; Grove, Charlene; Strickland, Stephanie; Barron, Starr; White, Bruce D

    2012-01-01

    Many critically ill patients in intensive care units (ICUs) are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients' preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by (1) assuring the early identification of a surrogate if indicated on admission and (2) clarifying the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process. PROJECT AND METHODS: The study was to determine if early use of a simple method of identifying a patient's surrogate and treatment preferences might impact length of stay (LOS) and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects (total N = 203) were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer.The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients' surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool. Significant differences were found between pre- and post-groups in terms of hospital LOS (F = 6.39, p = .01) and total hospital charges (F = 7.03, p = .009). Project findings indicate that the use of a simple admission assessment tool

  20. Pilot study on developing a decision support tool for guiding re-administration of chemotherapeutic agent after a serious adverse drug reaction

    Directory of Open Access Journals (Sweden)

    Chew Lita

    2011-07-01

    Full Text Available Abstract Background Currently, there are no standard guidelines for recommending re-administration of a chemotherapeutic drug to a patient after a serious adverse drug reaction (ADR incident. The decision on whether to rechallenge the patient is based on the experience of the clinician and is highly subjective. Thus the aim of this study is to develop a decision support tool to assist clinicians in this decision making process. Methods The inclusion criteria for patients in this study are: (1 had chemotherapy at National Cancer Centre Singapore between 2004 to 2009, (2 suffered from serious ADRs, and (3 were rechallenged. A total of 46 patients fulfilled the inclusion criteria. A genetic algorithm attribute selection method was used to identify clinical predictors for patients' rechallenge status. A Naïve Bayes model was then developed using 35 patients and externally validated using 11 patients. Results Eight patient attributes (age, chemotherapeutic drug, albumin level, red blood cell level, platelet level, abnormal white blood cell level, abnormal alkaline phosphatase level and abnormal alanine aminotransferase level were identified as clinical predictors for rechallenge status of patients. The Naïve Bayes model had an AUC of 0.767 and was found to be useful for assisting clinical decision making after clinicians had identified a group of patients for rechallenge. A platform independent version and an online version of the model is available to facilitate independent validation of the model. Conclusion Due to the limited size of the validation set, a more extensive validation of the model is necessary before it can be adopted for routine clinical use. Once validated, the model can be used to assist clinicians in deciding whether to rechallenge patients by determining if their initial assessment of rechallenge status of patients is accurate.

  1. Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs.

    Science.gov (United States)

    Ernecoff, Natalie C; Witteman, Holly O; Chon, Kristen; Chen, Yanquan Iris; Buddadhumaruk, Praewpannarai; Chiarchiaro, Jared; Shotsberger, Kaitlin J; Shields, Anne-Marie; Myers, Brad A; Hough, Catherine L; Carson, Shannon S; Lo, Bernard; Matthay, Michael A; Anderson, Wendy G; Peterson, Michael W; Steingrub, Jay S; Arnold, Robert M; White, Douglas B

    2016-06-01

    Although barriers to shared decision making in intensive care units are well documented, there are currently no easily scaled interventions to overcome these problems. We sought to assess stakeholders' perceptions of the acceptability, usefulness, and design suggestions for a tablet-based tool to support communication and shared decision making in ICUs. We conducted in-depth semi-structured interviews with 58 key stakeholders (30 surrogates and 28 ICU care providers). Interviews explored stakeholders' perceptions about the acceptability of a tablet-based tool to support communication and shared decision making, including the usefulness of modules focused on orienting families to the ICU, educating them about the surrogate's role, completing a question prompt list, eliciting patient values, educating about treatment options, eliciting perceptions about prognosis, and providing psychosocial support resources. The interviewer also elicited stakeholders' design suggestions for such a tool. We used constant comparative methods to identify key themes that arose during the interviews. Overall, 95% (55/58) of participants perceived the proposed tool to be acceptable, with 98% (57/58) of interviewees finding six or more of the seven content domains acceptable. Stakeholders identified several potential benefits of the tool including that it would help families prepare for the surrogate role and for family meetings as well as give surrogates time and a framework to think about the patient's values and treatment options. Key design suggestions included: conceptualize the tool as a supplement to rather than a substitute for surrogate-clinician communication; make the tool flexible with respect to how, where, and when surrogates can access the tool; incorporate interactive exercises; use video and narration to minimize the cognitive load of the intervention; and build an extremely simple user interface to maximize usefulness for individuals with low computer literacy. There is

  2. Simple decision tools to help optimize the control strategy 2 weeks into a Danish FMD epidemic

    DEFF Research Database (Denmark)

    Willeberg, Preben; Hisham Beshara Halasa, Tariq; Boklund, Anette

    2012-01-01

    The choice of whether or not to apply emergency vaccination is one of the most difficult decisions facing the authorities when foot-and-mouth disease (FMD) breaks out in a free country (Barnett et al. 2002). A simple quantitative tool has been proposed using the first 14-days incidence (FFI...... detected after day 14, the epidemic duration after day 14 and the size of the affected region at the end of the epidemic. Statistically significant positive correlations were found in all regression analyses of the data. There was, however, a high degree of variation (Fig. 1), which is to be expected...... to estimate predictive values by applying selected cut-off- values for both the dependent and the independent variables (Table 1). Emergency vaccination should be considered during an outbreak if the predicted cumulative size, duration or cost of the epidemic appears alarming (EU 2003, Kitching et al. 2005...

  3. Patient centered decision making in palliative cancer treatment: a world of paradoxes

    NARCIS (Netherlands)

    de Haes, Hanneke; Koedoot, Nelleke

    2003-01-01

    Patient centered palliative cancer care would imply, first, the introduction of psychosocial endpoints when evaluating treatment and making decisions. Second, patient control would have to be enhanced by information giving and increased decision involvement. We have indicated that paradoxes exist

  4. Clinical factors and the decision to transfuse chronic dialysis patients.

    Science.gov (United States)

    Whitman, Cynthia B; Shreay, Sanatan; Gitlin, Matthew; van Oijen, Martijn G H; Spiegel, Brennan M R

    2013-11-01

    Red blood cell transfusion was previously the principle therapy for anemia in CKD but became less prevalent after the introduction of erythropoiesis-stimulating agents. This study used adaptive choice-based conjoint analysis to identify preferences and predictors of transfusion decision-making in CKD. A computerized adaptive choice-based conjoint survey was administered between June and August of 2012 to nephrologists, internists, and hospitalists listed in the American Medical Association Masterfile. The survey quantified the relative importance of 10 patient attributes, including hemoglobin levels, age, occult blood in stool, severity of illness, eligibility for transplant, iron indices, erythropoiesis-stimulating agents, cardiovascular disease, and functional status. Triggers of transfusions in common dialysis scenarios were studied, and based on adaptive choice-based conjoint-derived preferences, relative importance by performing multivariable regression to identify predictors of transfusion preferences was assessed. A total of 350 providers completed the survey (n=305 nephrologists; mean age=46 years; 21% women). Of 10 attributes assessed, absolute hemoglobin level was the most important driver of transfusions, accounting for 29% of decision-making, followed by functional status (16%) and cardiovascular comorbidities (12%); 92% of providers transfused when hemoglobin was 7.5 g/dl, independent of other factors. In multivariable regression, Veterans Administration providers were more likely to transfuse at 8.0 g/dl (odds ratio, 5.9; 95% confidence interval, 1.9 to 18.4). Although transplant eligibility explained only 5% of decision-making, nephrologists were five times more likely to value it as important compared with non-nephrologists (odds ratio, 5.2; 95% confidence interval, 2.4 to 11.1). Adaptive choice-based conjoint analysis was useful in predicting influences on transfusion decisions. Hemoglobin level, functional status, and cardiovascular comorbidities

  5. [Patients' preferences for information in health care decision-making].

    Science.gov (United States)

    Borracci, Raúl A; Manente, Diego; Giorgi, Mariano A; Calderón, Gustavo; Ciancio, Alejandro; Doval, Hernán C

    2012-01-01

    A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctor's knowledge to obtain information (81.7%), in wanting to know the options of treatment and express one's point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (or: 0.64), giving less freedom to family involvement (or: 1.31). people with a lower social and economical level claim fewer options (or: 0.48) and gave less family participation (or = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (or: 0.60); and the ones with lower education level trusted less in the doctor's knowledge (or: 1.81), demanded fewer options (or: 0.45) and chose not to know the severity of the disease (or: 0.56). the analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patient's autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.

  6. Diagnostic Laparoscopy as Decision Tool for Re-recurrent Inguinal Hernia Treatment Following Open Anterior and Laparo-Endoscopic Posterior Repair

    Directory of Open Access Journals (Sweden)

    Ferdinand Köckerling

    2017-05-01

    Full Text Available IntroductionThe guidelines of the international hernia societies recommend posterior repair in laparo-endoscopic technique for recurrent inguinal hernia after open anterior mesh repair and, conversely, open anterior repair for recurrence after laparo-endoscopic primary repair. Even when these guidelines are followed, already 1 year after repair a re-recurrence rate of 1–2% must be expected, with that rate rising further in the subsequent years. Accordingly, increasingly more patients with re-recurrence after anterior and posterior mesh implantation must be treated, which constitutes a problem that to date has been investigated in only very few studies. Hence, there are no well-founded recommendations. This paper now presents a number of case reports aimed at identifying the role of explorative laparoscopy as decision tool for re-recurrent inguinal hernia treatment.Patients and methodsBased on three case reports the role of explorative laparoscopy as decision tool for re-recurrent inguinal hernia treatment is presented below.ResultsIn all the three cases described explorative laparoscopy played a key role as decision tool when deciding how best to treat re-recurrence after anterior and posterior inguinal hernia repair. In one case severe adhesions after robotic prostatectomy and in another case correct placement of the mesh in the posterior plane, adhesions from the cecum to the groin region and no definitive finding of a re-recurrence resulted in an open repair. In the third case, an insufficient laparoscopic posterior mesh placement made the re-recurrent TAPP procedure relatively easy.ConclusionExplorative laparoscopy is an important decision tool for re-recurrent inguinal hernia treatment to minimize the risks of the procedure for the patients.

  7. Twitter Chats as a Research Tool: A Study of Young Adult Financial Decisions

    Directory of Open Access Journals (Sweden)

    Barbara O’Neill

    2018-02-01

    Full Text Available Many researchers collect online survey data because it is cost-effective and less time-consuming than traditional research methods. This paper describes Twitter chats as a research tool vis-à-vis two other online research methods: providing links to electronic surveys to respondents and use of commercially available survey panels through vendors with readily available respondents. Similar to a face-to-face focus group, Twitter chats provide a synchronous environment for participants to answer a structured series of questions and to respond to both the chat facilitator and each other. This paper also reports representative responses from a Twitter chat that explored financial decisions of young adults. The chat was sponsored by a multi-state group of land-grant university researchers, in cooperation with WiseBread, a personal finance website targeted to millennials, to recruit respondents for a more extensive month-long online survey about the financial decisions of young adults. The Twitter chat responses suggest that student loans were the top concern of participants, and debt and housing rounded out the top three concerns. The internet, both websites and social media, was the most frequently cited source of financial information. The article concludes with a discussion of lessons learned from the Twitter chat experience and suggestions for professional practice.

  8. Depleted uranium hexafluoride (DUF6) management system--a decision tool

    International Nuclear Information System (INIS)

    Gasper, J.R.; Sutter, R.J.; Avci, H.I.

    1995-01-01

    The Depleted Uranium Hexafluoride (DUF 6 ) Management System (DMS) is being developed as a decision tool to provide cost and risk data for evaluation of short-and long-term management strategies for depleted uranium. It can be used to assist decision makers on a programmatic or site-specific level. Currently, the DMS allows evaluation of near-term cylinder management strategies such as storage yard improvements, cylinder restocking, and reconditioning. The DMS has been designed to provide the user with maximum flexibility for modifying data and impact factors (e.g., unit costs and risk factors). Sensitivity analysis can be performed on all key parameters such as cylinder corrosion rate, inspection frequency, and impact factors. Analysis may be conducted on a system-wide, site, or yard basis. The costs and risks from different scenarios may be compared in graphic or tabular format. Ongoing development of the DMS will allow similar evaluation of long-term management strategies such as conversion to other chemical forms. The DMS is a Microsoft Windows 3.1 based, stand-alone computer application. It can be operated on a 486 or faster computer with VGA, 4 MB of RAM, and 10 MB of disk space

  9. Tools to Help Society in Decision Making: Legal and Policy Trends. Proceedings of a Topical Session

    International Nuclear Information System (INIS)

    Vari, Anna; Caddy, Joanne; ); Kotra, Janet P.; Pancher, Bertrand; Tromans, Stephan

    2009-01-01

    As part of its programme of work the OECD/NEA Forum on Stakeholder Confidence continues to investigate the theme of 'Tools and Processes to Help Society in Decision Making'. Following a presentation in June 2007 of environmental law and its implications for stakeholder involvement in decision making, the FSC decided to take a look at a variety of legal and policy issues. In particular, interest was expressed in seeing how law and policy may define which stakeholders must be consulted or engaged, and to consider when and whether that is helpful. A topical session was held on June 5, 2008 during the FSC's ninth regular meeting. Case studies were presented from the US, the UK, and France. An international survey of means for open and inclusive policy making was presented by the OECD Government directorate. The results of a questionnaire filled by FSC members served as the basis of the introductory presentation. Two sub-groups retired to discuss the material and a Rapporteur from each delivered feedback in plenary. These proceedings include a summary of the findings and discussions (Anna Vari), and the slides (some with accompanying text) provided for each case study: 1 - Open and Inclusive Policy Making: Emerging Practice in OECD Countries (Joanne Caddy); 2 - Deciding Whether to Authorized Construction at Yucca Mountain Explaining NRC's Process (Janet P. Kotra); 3 - Rights and Obligations under International Conventions (Stephan Tromans); 4 - Setting Criteria for the Representativeness of NGO/CSOs: Report on Hearings at the Request of France's Prime Minister (Bertrand Pancher)

  10. A decision support tool for sustainable supplier selection in manufacturing firms

    Directory of Open Access Journals (Sweden)

    Ifeyinwa Orji

    2014-10-01

    Full Text Available Purpose: Most original equipment manufacturers (OEMs are strategically involved in supplier base rationalization and increased consciousness of sustainable development thus, reinforcing need for accurately considering sustainability in supplier selection to improve organizational performance. In real industrial case, imprecise data, ambiguity of human judgment, uncertainty among sustainability factors and the need to capture all subjective and objective criteria are unavoidable and pose huge challenge to accurately incorporate sustainability factors into supplier selection.Methodology: This study develops a model based on integrated multi- criteria decision making (MCDM methods to solve such problems. The developed model applies Fuzzy logic, DEMATEL and TOPSIS to effectively analyze the interdependencies between sustainability criteria and to select the best sustainable supplier in fuzzy environment while capturing all subjective and objective criteria. A case study is illustrated to test the proposed model in a gear manufacturing company, an OEM to provide insights and for practical applications.Findings: Results show that social factors of sustainability ranks as the most important in supplier selection. However, the most influential sustainability sub- criteria are work safety (WS and quality.Originality/Value: The model is capable of capturing all subjective and objective criteria in fuzzy environment to accurately incorporate sustainability factors in supplier selection. It is decision support tool relevant for providing insights to managers while implementing sustainable supplier selection.

  11. Pareto frontier analyses based decision making tool for transportation of hazardous waste

    International Nuclear Information System (INIS)

    Das, Arup; Mazumder, T.N.; Gupta, A.K.

    2012-01-01

    Highlights: ► Posteriori method using multi-objective approach to solve bi-objective routing problem. ► System optimization (with multiple source–destination pairs) in a capacity constrained network using non-dominated sorting. ► Tools like cost elasticity and angle based focus used to analyze Pareto frontier to aid stakeholders make informed decisions. ► A real life case study of Kolkata Metropolitan Area to explain the workability of the model. - Abstract: Transportation of hazardous wastes through a region poses immense threat on the development along its road network. The risk to the population, exposed to such activities, has been documented in the past. However, a comprehensive framework for routing hazardous wastes has often been overlooked. A regional Hazardous Waste Management scheme should incorporate a comprehensive framework for hazardous waste transportation. This framework would incorporate the various stakeholders involved in decision making. Hence, a multi-objective approach is required to safeguard the interest of all the concerned stakeholders. The objective of this study is to design a methodology for routing of hazardous wastes between the generating units and the disposal facilities through a capacity constrained network. The proposed methodology uses posteriori method with multi-objective approach to find non-dominated solutions for the system consisting of multiple origins and destinations. A case study of transportation of hazardous wastes in Kolkata Metropolitan Area has also been provided to elucidate the methodology.

  12. A Sustainable Historic Waterfront Revitalization Decision Support Tool for Attracting Tourists

    Directory of Open Access Journals (Sweden)

    Ali Keyvanfar

    2018-01-01

    Full Text Available Waterfront revitalization would be an effective strategy to preserve heritages, conserve the contaminated or abandoned site and inspire the identity and authenticity. However, there is no decision support tool to quantify and evaluate the sustainability accreditation of waterfronts in tourism attraction. This research aimed to identify the most potential waterfront typology in tourism attraction and develop the waterfront sustainable revitalization (SWR index assessment model. The SWR index can assist policy makers and urban developers to analyze the heritage waterfronts using Analytical Hierarchy Process (AHP method. The research found out the historic waterfront has the highest potential in tourism attraction among other typologies. And, pollution moderator is mostly important sub-criterion in tourism absorption (WC2.2 = 0.1294; followed by Identity (WC1.2 = 0.1272 and Safety and well-being (WC1.3 = 0.1043. The SWR index can be applied in any waterfronts in heritage cities around the world, while this research implemented it as a case study in Bandar Maharani, Muar, Malaysia. It resulted Bandar Maharani was ranked as grade C; means, usable waterfront to which extent environmental, social and physical revitalization are needed. The SWR index can be coupled with other decision-making methods in future, to reduce its inconsistencies and increasing accuracy.

  13. Usability testing of ANSWER: a web-based methotrexate decision aid for patients with rheumatoid arthritis.

    Science.gov (United States)

    Li, Linda C; Adam, Paul M; Townsend, Anne F; Lacaille, Diane; Yousefi, Charlene; Stacey, Dawn; Gromala, Diane; Shaw, Chris D; Tugwell, Peter; Backman, Catherine L

    2013-12-01

    Decision aids are evidence-based tools designed to inform people of the potential benefit and harm of treatment options, clarify their preferences and provide a shared decision-making structure for discussion at a clinic visit. For patients with rheumatoid arthritis (RA) who are considering methotrexate, we have developed a web-based patient decision aid called the ANSWER (Animated, Self-serve, Web-based Research Tool). This study aimed to: 1) assess the usability of the ANSWER prototype; 2) identify strengths and limitations of the ANSWER from the patient's perspective. The ANSWER prototype consisted of: 1) six animated patient stories and narrated information on the evidence of methotrexate for RA; 2) interactive questionnaires to clarify patients' treatment preferences. Eligible participants for the usability test were patients with RA who had been prescribed methotrexate. They were asked to verbalize their thoughts (i.e., think aloud) while using the ANSWER, and to complete the System Usability Scale (SUS) to assess overall usability (range = 0-100; higher = more user friendly). Participants were audiotaped and observed, and field notes were taken. The testing continued until no new modifiable issues were found. We used descriptive statistics to summarize participant characteristics and the SUS scores. Content analysis was used to identified usability issues and navigation problems. 15 patients participated in the usability testing. The majority were aged 50 or over and were university/college graduates (n = 8, 53.4%). On average they took 56 minutes (SD = 34.8) to complete the tool. The mean SUS score was 81.2 (SD = 13.5). Content analysis of audiotapes and field notes revealed four categories of modifiable usability issues: 1) information delivery (i.e., clarity of the information and presentation style); 2) navigation control (i.e., difficulties in recognizing and using the navigation control buttons); 3) layout (i.e., position of the

  14. Decision Simulation Technique (DST) as a scanning tool for exploring and explicating sustainability issues in transport decision making

    DEFF Research Database (Denmark)

    Jeppesen, Sara Lise

    2009-01-01

    This paper places focus on explicit consideration of sustainability issues in transport decision making by presenting and using a developed “Decision Simulation Technique” (DST). This technique can be used by an analyst to ‘scan’ a transport planning problem with regard to what in DST terms...... is called a sustainability strategy. This scanning can serve the purpose of informing a group of decision makers before they actually have to deal with, for example, the choice among a number of alternatives that have all been formulated as being relevant. The main focus of the paper is to illustrate how...

  15. Evaluation of the Effectiveness of Stormwater Decision Support Tools for Infrastructure Selection and the Barriers to Implementation

    Science.gov (United States)

    Spahr, K.; Hogue, T. S.

    2016-12-01

    Selecting the most appropriate green, gray, and / or hybrid system for stormwater treatment and conveyance can prove challenging to decision markers across all scales, from site managers to large municipalities. To help streamline the selection process, a multi-disciplinary team of academics and professionals is developing an industry standard for selecting and evaluating the most appropriate stormwater management technology for different regions. To make the tool more robust and comprehensive, life-cycle cost assessment and optimization modules will be included to evaluate non-monetized and ecosystem benefits of selected technologies. Initial work includes surveying advisory board members based in cities that use existing decision support tools in their infrastructure planning process. These surveys will qualify the decisions currently being made and identify challenges within the current planning process across a range of hydroclimatic regions and city size. Analysis of social and other non-technical barriers to adoption of the existing tools is also being performed, with identification of regional differences and institutional challenges. Surveys will also gage the regional appropriateness of certain stormwater technologies based off experiences in implementing stormwater treatment and conveyance plans. In additional to compiling qualitative data on existing decision support tools, a technical review of components of the decision support tool used will be performed. Gaps in each tool's analysis, like the lack of certain critical functionalities, will be identified and ease of use will be evaluated. Conclusions drawn from both the qualitative and quantitative analyses will be used to inform the development of the new decision support tool and its eventual dissemination.

  16. Accept or Decline? An Analytics-Based Decision Tool for Kidney Offer Evaluation.

    Science.gov (United States)

    Bertsimas, Dimitris; Kung, Jerry; Trichakis, Nikolaos; Wojciechowski, David; Vagefi, Parsia A

    2017-12-01

    When a deceased-donor kidney is offered to a waitlisted candidate, the decision to accept or decline the organ relies primarily upon a practitioner's experience and intuition. Such decisions must achieve a delicate balance between estimating the immediate benefit of transplantation and the potential for future higher-quality offers. However, the current experience-based paradigm lacks scientific rigor and is subject to the inaccuracies that plague anecdotal decision-making. A data-driven analytics-based model was developed to predict whether a patient will receive an offer for a deceased-donor kidney at Kidney Donor Profile Index thresholds of 0.2, 0.4, and 0.6, and at timeframes of 3, 6, and 12 months. The model accounted for Organ Procurement Organization, blood group, wait time, DR antigens, and prior offer history to provide accurate and personalized predictions. Performance was evaluated on data sets spanning various lengths of time to understand the adaptability of the method. Using United Network for Organ Sharing match-run data from March 2007 to June 2013, out-of-sample area under the receiver operating characteristic curve was approximately 0.87 for all Kidney Donor Profile Index thresholds and timeframes considered for the 10 most populous Organ Procurement Organizations. As more data becomes available, area under the receiver operating characteristic curve values increase and subsequently level off. The development of a data-driven analytics-based model may assist transplant practitioners and candidates during the complex decision of whether to accept or forgo a current kidney offer in anticipation of a future high-quality offer. The latter holds promise to facilitate timely transplantation and optimize the efficiency of allocation.

  17. REFLECTIONS ON THE NICE DECISION TO REJECT PATIENT PRODUCTION LOSSES.

    Science.gov (United States)

    Shearer, James; Byford, Sarah; Birch, Steve

    2017-01-01

    Patient production losses occur when individuals' capacities to work, whether paid or unpaid, are impaired by illness, treatment, disability, or death. There is controversy about whether and how to include patient production losses in economic evaluations in health care. Patient production losses have not previously been considered when evaluating medications for reimbursement under the U.K. National Health Service. Proposals for value-based assessment of health technologies in the United Kingdom created renewed interest in whether and how to include costs from a wider societal perspective, such as patient production losses, within economic evaluation of healthcare interventions. A narrative review was undertaken of theoretical, ethical, and policy issues that might inform decisions that involve the normative question of whether or not to include patient production losses in economic evaluation. It seems difficult to reconcile the implications of including patient production losses with the objectives of a healthcare system dedicated to providing universal healthcare coverage without regard to patients' ability to pay. Tax payer funded healthcare systems may legitimately adopt maximands other than health gain, but these will be at the opportunity cost of less than maximum health gains.

  18. Amplifying Each Patient's Voice: A Systematic Review of Multi-criteria Decision Analyses Involving Patients.

    Science.gov (United States)

    Marsh, Kevin; Caro, J Jaime; Hamed, Alaa; Zaiser, Erica

    2017-04-01

    Qualitative methods tend to be used to incorporate patient preferences into healthcare decision making. However, for patient preferences to be given adequate consideration by decision makers they need to be quantified. Multi-criteria decision analysis (MCDA) is one way to quantify and capture the patient voice. The objective of this review was to report on existing MCDAs involving patients to support the future use of MCDA to capture the patient voice. MEDLINE and EMBASE were searched in June 2014 for English-language papers with no date restriction. The following search terms were used: 'multi-criteria decision*', 'multiple criteria decision*', 'MCDA', 'benefit risk assessment*', 'risk benefit assessment*', 'multicriteri* decision*', 'MCDM', 'multi-criteri* decision*'. Abstracts were included if they reported the application of MCDA to assess healthcare interventions where patients were the source of weights. Abstracts were excluded if they did not apply MCDA, such as discussions of how MCDA could be used; or did not evaluate healthcare interventions, such as MCDAs to assess the level of health need in a locality. Data were extracted on weighting method, variation in patient and expert preferences, and discussion on different weighting techniques. The review identified ten English-language studies that reported an MCDA to assess healthcare interventions and involved patients as a source of weights. These studies reported 12 applications of MCDA. Different methods of preference elicitation were employed: direct weighting in workshops; discrete choice experiment surveys; and the analytical hierarchy process using both workshops and surveys. There was significant heterogeneity in patient responses and differences between patients, who put greater weight on disease characteristics and treatment convenience, and experts, who put more weight on efficacy. The studies highlighted cognitive challenges associated with some weighting methods, though patients' views on their

  19. Megasite Management Tool (mmt): a Decision Support System Built Using Mapwindow Activex Control

    Science.gov (United States)

    Pulsani, B. R.

    2017-11-01

    Megasite Management Tool (MMT) is planning and evaluation software for contaminated sites. Using different statistical modules, MMT produces maps which help decision makers in rehabilitating contaminated sites. The input data used by MMT is of geographic nature and exists as shapefile and raster format. As MMT is built using simple windows forms application, the objective of the study was to find a way to visualize geographic data and to allow the user to edit its attribute information. Therefore, the application requirement was to find GIS libraries which offer capabilities such as (1) map viewer with navigation tools (2) library to read/write geographic data and (3) software which allows free distribution of the developed components. A research on these requirements led to the discovery of MapWindow ActiveX components which not only offered these capabilities but also provided free and open source licensing options for redistribution. Although considerable amount of reports and publications exist on MMT, the major contribution provided by MapWindow libraries have been under played. The current study emphasises upon the contribution and advantages MapWindow ActiveX provides for incorporating GIS functionality to an already existing application. Similar components for other languages have also been reviewed.

  20. Cyberinfrastructure for the collaborative development of U2U decision support tools

    Directory of Open Access Journals (Sweden)

    Larry L. Biehl

    2017-01-01

    Full Text Available This paper describes the use of cyberinfrastructure to create interactive applications as part of the Useful to Usable (U2U project. These applications transform historical climate data, knowledge, and models into decision support tools for end users such as crop farmers, university Extension educators, and other agricultural advisors. In creating a cyberinfrastructure to support the U2U project, four major challenges have been addressed: designing and developing highly usable web applications with frequent feedback, establishing a software engineering environment to support iterative development, integrating and synthesizing historical and current datasets from a variety of sources (local vs. remote, different access methods, and formats, and supporting project collaboration needs of data and document sharing, project management, and public outreach. The overall goals of the cyberinfrastructure and its architecture design are described. Methods for data retrieval and synthesis, as well as the various software components utilized are discussed. The development and integration of tools into the collaborative HUBzero framework are highlighted, including the use of HUBzero’s core features to share ideas, algorithms, and results. A highly iterative development process that includes feedback from experts and end-users to feed requirement definition, design and application updates are also examined.

  1. AERO: A Decision Support Tool for Wind Erosion Assessment in Rangelands and Croplands

    Science.gov (United States)

    Galloza, M.; Webb, N.; Herrick, J.

    2015-12-01

    Wind erosion is a key driver of global land degradation, with on- and off-site impacts on agricultural production, air quality, ecosystem services and climate. Measuring rates of wind erosion and dust emission across land use and land cover types is important for quantifying the impacts and identifying and testing practical management options. This process can be assisted by the application of predictive models, which can be a powerful tool for land management agencies. The Aeolian EROsion (AERO) model, a wind erosion and dust emission model interface provides access by non-expert land managers to a sophisticated wind erosion decision-support tool. AERO incorporates land surface processes and sediment transport equations from existing wind erosion models and was designed for application with available national long-term monitoring datasets (e.g. USDI BLM Assessment, Inventory and Monitoring, USDA NRCS Natural Resources Inventory) and monitoring protocols. Ongoing AERO model calibration and validation are supported by geographically diverse data on wind erosion rates and land surface conditions collected by the new National Wind Erosion Research Network. Here we present the new AERO interface, describe parameterization of the underpinning wind erosion model, and provide a summary of the model applications across agricultural lands and rangelands in the United States.

  2. Prostate Cancer Patients' Understanding of the Gleason Scoring System: Implications for Shared Decision-Making.

    Science.gov (United States)

    Tagai, Erin K; Miller, Suzanne M; Kutikov, Alexander; Diefenbach, Michael A; Gor, Ronak A; Al-Saleem, Tahseen; Chen, David Y T; Fleszar, Sara; Roy, Gem

    2018-01-15

    The Gleason scoring system is a key component of a prostate cancer diagnosis, since it indicates disease aggressiveness. It also serves as a risk communication tool that facilitates shared treatment decision-making. However, the system is highly complex and therefore difficult to communicate: factors which have been shown to undermine well-informed and high-quality shared treatment decision-making. To systematically explore prostate cancer patients' understanding of the Gleason scoring system (GSS), we assessed knowledge and perceived importance among men who had completed treatment (N = 50). Patients were administered a survey that assessed patient knowledge and patients' perceived importance of the GSS, as well as demographics, medical factors (e.g., Gleason score at diagnosis), and health literacy. Bivariate analyses were conducted to identify associations with patient knowledge and perceived importance of the GSS. The sample was generally well-educated (48% with a bachelor's degree or higher) and health literate (M = 12.9, SD = 2.2, range = 3-15). Despite this, patient knowledge of the GSS was low (M = 1.8, SD = 1.4, range = 1-4). Patients' understanding of the importance of the GSS was moderate (M = 2.8, SD = 1.0, range = 0-4) and was positively associated with GSS knowledge (p decision-making. Future studies are needed to explore the potential utility of a simplified Gleason grading system and improved patient-provider communication.

  3. 'Practical' resources to support patient and family engagement in healthcare decisions: a scoping review.

    Science.gov (United States)

    Kovacs Burns, Katharina; Bellows, Mandy; Eigenseher, Carol; Gallivan, Jennifer

    2014-04-15

    Extensive literature exists on public involvement or engagement, but what actual tools or guides exist that are practical, tested and easy to use specifically for initiating and implementing patient and family engagement, is uncertain. No comprehensive review and synthesis of general international published or grey literature on this specific topic was found. A systematic scoping review of published and grey literature is, therefore, appropriate for searching through the vast general engagement literature to identify 'patient/family engagement' tools and guides applicable in health organization decision-making, such as within Alberta Health Services in Alberta, Canada. This latter organization requested this search and review to inform the contents of a patient engagement resource kit for patients, providers and leaders. Search terms related to 'patient engagement', tools, guides, education and infrastructure or resources, were applied to published literature databases and grey literature search engines. Grey literature also included United States, Australia and Europe where most known public engagement practices exist, and Canada as the location for this study. Inclusion and exclusion criteria were set, and include: English documents referencing 'patient engagement' with specific criteria, and published between 1995 and 2011. For document analysis and synthesis, document analysis worksheets were used by three reviewers for the selected 224 published and 193 grey literature documents. Inter-rater reliability was ensured for the final reviews and syntheses of 76 published and 193 grey documents. Seven key themes emerged from the literature synthesis analysis, and were identified for patient, provider and/or leader groups. Articles/items within each theme were clustered under main topic areas of 'tools', 'education' and 'infrastructure'. The synthesis and findings in the literature include 15 different terms and definitions for 'patient engagement', 17 different

  4. An advance care plan decision support video before major surgery: a patient- and family-centred approach.

    Science.gov (United States)

    Isenberg, Sarina R; Crossnohere, Norah L; Patel, Manali I; Conca-Cheng, Alison; Bridges, John F P; Swoboda, Sandy M; Smith, Thomas J; Pawlik, Timothy M; Weiss, Matthew; Volandes, Angelo E; Schuster, Anne; Miller, Judith A; Pastorini, Carolyn; Roter, Debra L; Aslakson, Rebecca A

    2018-06-01

    Video-based advanc care planning (ACP) tools have been studied in varied medical contexts; however, none have been developed for patients undergoing major surgery. Using a patient- and family-centredness approach, our objective was to implement human-centred design (HCD) to develop an ACP decision support video for patients and their family members when preparing for major surgery. The study investigators partnered with surgical patients and their family members, surgeons and other health professionals to design an ACP decision support video using key HCD principles. Adapting Maguire's HCD stages from computer science to the surgical context, while also incorporating Elwyn et al 's specifications for patient-oriented decision support tool development, we used a six-stage HCD process to develop the video: (1) plan HCD process; (2) specify where video will be used; (3) specify user and organisational requirements; (4) produce and test prototypes; (5) carry out user-based assessment; (6) field test with end users. Over 450 stakeholders were engaged in the development process contributing to setting objectives, applying for funding, providing feedback on the storyboard and iterations of the decision tool video. Throughout the HCD process, stakeholders' opinions were compiled and conflicting approaches negotiated resulting in a tool that addressed stakeholders' concerns. Our patient- and family-centred approach using HCD facilitated discussion and the ability to elicit and balance sometimes competing viewpoints. The early engagement of users and stakeholders throughout the development process may help to ensure tools address the stated needs of these individuals. NCT02489799. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Shared Decision Making and Effective Physician-Patient Communication: The Quintessence of Patient-Centered Care

    Directory of Open Access Journals (Sweden)

    Huy Ming Lim

    2015-03-01

    Full Text Available The Institute of Medicine’s (IOM 2001 landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, identified patient-centeredness as one of the fundamental attributes of quality health care, alongside safety, effectiveness, timeliness, efficiency, and equity. The IOM defined patient-centeredness as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” This concept of patient-centered care represents a paradigm shift from the traditional disease-oriented and physician-centered care, grounding health care in the subjective experience of illness and the needs and preferences of individual patients rather than the evaluation and treatment of diseases which emphasizes on leveraging clinical expertise and evidence derived from population-based studies. Regrettably, despite the ubiquitous talk about patient-centered care in modern health care, shared decision-making and effective physician-patient communication—the two cruxes of patient-centered care—are yet to become the norms. Strategies to promote and enhance shared decision-making and effective communication between clinicians and patients should be rigorously implemented to establish a health care system that truly values patients as individuals and turn the rhetoric of patient-centered care into reality.

  6. Mapping data through concept maps: an auxiliary tool for decision making regarding institutional projects

    International Nuclear Information System (INIS)

    D’Avila, Adriana L.

    2017-01-01

    This paper reports a data mapping construction aimed to subsidize the decision making process regarding institutional projects, at different levels of responsibility, at the Instituto de Engenharia Nuclear. The conception models a systemic and adaptive tool which is based on the concept mapping theory developed by Novak. The Instituto de Engenharia Nuclear (IEN) is a research center of the Comissão de Energia Nuclear (CNEN), an autarchy attached to Ministério da Ciência, Tecnologia, Inovações e Comunicações. The main focus of IEN is research and development of nuclear science and technology. The developed tool creates a more effective and accessible way of sharing information. However, beyond project data integration into a specific instrument, it also has the intent to compensate the consequences of the continued reduction of the number of workers at IEN over recent years. The recent CNEN management report, published in 2016, showed the problematic situation caused by the loss of workers, stressing the high number of pensions granted and to be granted in the near future. The loss of labor force, besides exposing the urgent need for optimizing knowledge management efforts, also sheds light into another problem: the need for grouping responsibilities among the remaining workers. In this respect, the tool developed helps to face this challenge, enhancing autonomy at different levels but preserving the institutional guidelines. To conclude the report, and in order to exemplify the method, the paper also describes the map construction relative an innovative project proposal in a joint development towards the nuclear area. (author)

  7. Mapping data through concept maps: an auxiliary tool for decision making regarding institutional projects

    Energy Technology Data Exchange (ETDEWEB)

    D’Avila, Adriana L., E-mail: adriana@ien.gov.br [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil). Divisão de Engenharia Nuclear

    2017-11-01

    This paper reports a data mapping construction aimed to subsidize the decision making process regarding institutional projects, at different levels of responsibility, at the Instituto de Engenharia Nuclear. The conception models a systemic and adaptive tool which is based on the concept mapping theory developed by Novak. The Instituto de Engenharia Nuclear (IEN) is a research center of the Comissão de Energia Nuclear (CNEN), an autarchy attached to Ministério da Ciência, Tecnologia, Inovações e Comunicações. The main focus of IEN is research and development of nuclear science and technology. The developed tool creates a more effective and accessible way of sharing information. However, beyond project data integration into a specific instrument, it also has the intent to compensate the consequences of the continued reduction of the number of workers at IEN over recent years. The recent CNEN management report, published in 2016, showed the problematic situation caused by the loss of workers, stressing the high number of pensions granted and to be granted in the near future. The loss of labor force, besides exposing the urgent need for optimizing knowledge management efforts, also sheds light into another problem: the need for grouping responsibilities among the remaining workers. In this respect, the tool developed helps to face this challenge, enhancing autonomy at different levels but preserving the institutional guidelines. To conclude the report, and in order to exemplify the method, the paper also describes the map construction relative an innovative project proposal in a joint development towards the nuclear area. (author)

  8. Novel combined patient instruction and discharge summary tool improves timeliness of documentation and outpatient provider satisfaction

    Directory of Open Access Journals (Sweden)

    Meredith Gilliam

    2017-03-01

    Full Text Available Background: Incomplete or delayed acces