Designing a Decision Support System (DSS) for Academic Library Managers Using Preprogrammed Application Software on a Microcomputer.

ERIC Educational Resources Information Center

McDonald, Joseph

1986-01-01

Focusing on management decisions in academic libraries, this article compares management information systems (MIS) with decision support systems (DSS) and discusses the decision-making process, information needs of library managers, sources of data, reasons for choosing microcomputer, preprogrammed application software, prototyping a system, and…

User Oriented Techniques to Support Interaction and Decision Making with Large Educational Databases

ERIC Educational Resources Information Center

Hartley, Roger; Almuhaidib, Saud M. Y.

2007-01-01

Information Technology is developing rapidly and providing policy/decision makers with large amounts of information that require processing and analysis. Decision support systems (DSS) aim to provide tools that not only help such analyses, but enable the decision maker to experiment and simulate the effects of different policies and selection…

System for selecting relevant information for decision support.

PubMed

Kalina, Jan; Seidl, Libor; Zvára, Karel; Grünfeldová, Hana; Slovák, Dalibor; Zvárová, Jana

2013-01-01

We implemented a prototype of a decision support system called SIR which has a form of a web-based classification service for diagnostic decision support. The system has the ability to select the most relevant variables and to learn a classification rule, which is guaranteed to be suitable also for high-dimensional measurements. The classification system can be useful for clinicians in primary care to support their decision-making tasks with relevant information extracted from any available clinical study. The implemented prototype was tested on a sample of patients in a cardiological study and performs an information extraction from a high-dimensional set containing both clinical and gene expression data.

Knowledge-Based Information Management in Decision Support for Ecosystem Management

Treesearch

Keith Reynolds; Micahel Saunders; Richard Olson; Daniel Schmoldt; Michael Foster; Donald Latham; Bruce Miller; John Steffenson; Lawrence Bednar; Patrick Cunningham

1995-01-01

The Pacific Northwest Research Station (USDA Forest Service) is developing a knowledge-based information management system to provide decision support for watershed analysis in the Pacific Northwest region of the U.S. The decision support system includes: (1) a GIS interface that allows users to graphically navigate to specific provinces and watersheds and display a...

Treatment decision-making in ductal carcinoma in situ: A mixed methods systematic review of women's experiences and information needs.

PubMed

Rutherford, Claudia; Mercieca-Bebber, Rebecca; Butow, Phyllis; Wu, Jenny Liang; King, Madeleine T

2017-09-01

Decision-making in ductal carcinoma in situ (DCIS) is complex due to the heterogeneity of the disease. This study aimed to understand women's experience of making treatment decisions for DCIS, their information and support needs, and factors that influenced decisions. We searched six electronic databases, conference proceedings, and key authors. Two reviewers independently applied inclusion and quality criteria, and extracted findings. Thematic analysis was used to combine and summarise findings. We identified six themes and 28 subthemes from 18 studies. Women with DCIS have knowledge deficits about DCIS, experience anxiety related to information given at diagnosis and the complexity of decision-making, and have misconceptions regarding risks and outcomes of treatment. Women's decisions are influenced by their understanding of risk, the clinical features of their DCIS, and the benefits and harms of treatment options. Women are dissatisfied with the decisional support available. Informed and shared decision-making in this complex decision setting requires clear communication of information specific to DCIS and individual's, as well as decision support for patients and clinicians. This approach would educate patients and clinicians, and assist clinicians in supporting patients to an evidence-based treatment plan that aligns with individual values and pReferences. Copyright © 2017 Elsevier B.V. All rights reserved.

Geospatial Data Fusion and Multigroup Decision Support for Surface Water Quality Management

NASA Astrophysics Data System (ADS)

Sun, A. Y.; Osidele, O.; Green, R. T.; Xie, H.

2010-12-01

Social networking and social media have gained significant popularity and brought fundamental changes to many facets of our everyday life. With the ever-increasing adoption of GPS-enabled gadgets and technology, location-based content is likely to play a central role in social networking sites. While location-based content is not new to the geoscience community, where geographic information systems (GIS) are extensively used, the delivery of useful geospatial data to targeted user groups for decision support is new. Decision makers and modelers ought to make more effective use of the new web-based tools to expand the scope of environmental awareness education, public outreach, and stakeholder interaction. Environmental decision processes are often rife with uncertainty and controversy, requiring integration of multiple sources of information and compromises between diverse interests. Fusing of multisource, multiscale environmental data for multigroup decision support is a challenging task. Toward this goal, a multigroup decision support platform should strive to achieve transparency, impartiality, and timely synthesis of information. The latter criterion often constitutes a major technical bottleneck to traditional GIS-based media, featuring large file or image sizes and requiring special processing before web deployment. Many tools and design patterns have appeared in recent years to ease the situation somewhat. In this project, we explore the use of Web 2.0 technologies for “pushing” location-based content to multigroups involved in surface water quality management and decision making. In particular, our granular bottom-up approach facilitates effective delivery of information to most relevant user groups. Our location-based content includes in-situ and remotely sensed data disseminated by NASA and other national and local agencies. Our project is demonstrated for managing the total maximum daily load (TMDL) program in the Arroyo Colorado coastal river basin in Texas. The overall design focuses on assigning spatial information to decision support elements and on efficiently using Web 2.0 technologies to relay scientific information to the nonscientific community. We conclude that (i) social networking, if appropriately used, has great potential for mitigating difficulty associated with multigroup decision making; (ii) all potential stakeholder groups should be involved in creating a useful decision support system; and (iii) environmental decision support systems should be considered a must-have, instead of an optional component of TMDL decision support projects. Acknowledgment: This project was supported by NASA grant NNX09AR63G.

Designing Computerized Decision Support That Works for Clinicians and Families

PubMed Central

Fiks, Alexander G.

2011-01-01

Evidence-based decision-making is central to the practice of pediatrics. Clinical trials and other biomedical research provide a foundation for this process, and practice guidelines, drawing from their results, inform the optimal management of an increasing number of childhood health problems. However, many clinicians fail to adhere to guidelines. Clinical decision support delivered using health information technology, often in the form of electronic health records, provides a tool to deliver evidence-based information to the point of care and has the potential to overcome barriers to evidence-based practice. An increasing literature now informs how these systems should be designed and implemented to most effectively improve outcomes in pediatrics. Through the examples of computerized physician order entry, as well as the impact of alerts at the point of care on immunization rates, the delivery of evidence-based asthma care, and the follow-up of children with attention deficit hyperactivity disorder, the following review addresses strategies for success in using these tools. The following review argues that, as decision support evolves, the clinician should no longer be the sole target of information and alerts. Through the Internet and other technologies, families are increasingly seeking health information and gathering input to guide health decisions. By enlisting clinical decision support systems to deliver evidence-based information to both clinicians and families, help families express their preferences and goals, and connect families to the medical home, clinical decision support may ultimately be most effective in improving outcomes. PMID:21315295

Design and realization of tourism spatial decision support system based on GIS

NASA Astrophysics Data System (ADS)

Ma, Zhangbao; Qi, Qingwen; Xu, Li

2008-10-01

In this paper, the existing problems of current tourism management information system are analyzed. GIS, tourism as well as spatial decision support system are introduced, and the application of geographic information system technology and spatial decision support system to tourism management and the establishment of tourism spatial decision support system based on GIS are proposed. System total structure, system hardware and software environment, database design and structure module design of this system are introduced. Finally, realization methods of this systemic core functions are elaborated.

A Planetary Defense Gateway for Smart Discovery of relevant Information for Decision Support

NASA Technical Reports Server (NTRS)

Bambacus, Myra; Yang, Chaowei Phil; Leung, Ronald Y.; Barbee, Brent; Nuth, Joseph A.; Seery, Bernard; Jiang, Yongyao; Qin, Han; Li, Yun; Yu, Manzhu;

Using Best Practices to Extract, Organize, and Reuse Embedded Decision Support Content Knowledge Rules from Mature Clinical Systems.

PubMed

DesAutels, Spencer J; Fox, Zachary E; Giuse, Dario A; Williams, Annette M; Kou, Qing-Hua; Weitkamp, Asli; Neal R, Patel; Bettinsoli Giuse, Nunzia

2016-01-01

Clinical decision support (CDS) knowledge, embedded over time in mature medical systems, presents an interesting and complex opportunity for information organization, maintenance, and reuse. To have a holistic view of all decision support requires an in-depth understanding of each clinical system as well as expert knowledge of the latest evidence. This approach to clinical decision support presents an opportunity to unify and externalize the knowledge within rules-based decision support. Driven by an institutional need to prioritize decision support content for migration to new clinical systems, the Center for Knowledge Management and Health Information Technology teams applied their unique expertise to extract content from individual systems, organize it through a single extensible schema, and present it for discovery and reuse through a newly created Clinical Support Knowledge Acquisition and Archival Tool (CS-KAAT). CS-KAAT can build and maintain the underlying knowledge infrastructure needed by clinical systems.

Stakeholder views of management and decision support tools to integrate climate change into Great Lakes Lake Whitefish management

USGS Publications Warehouse

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.

Developing the U.S. Wildland Fire Decision Support System

Treesearch

Erin Noonan-Wright; Tonja S. Opperman; Mark A. Finney; Tom Zimmerman; Robert C. Seli; Lisa M. Elenz; David E. Calkin; John R. Fiedler

2011-01-01

A new decision support tool, the Wildland Fire Decision Support System (WFDSS) has been developed to support risk-informed decision-making for individual fires in the United States. WFDSS accesses national weather data and forecasts, fire behavior prediction, economic assessment, smoke management assessment, and landscape databases to efficiently formulate and apply...

Decision Support System Based on Computational Collective Intelligence in Campus Information Systems

NASA Astrophysics Data System (ADS)

Saito, Yoshihito; Matsuo, Tokuro

Education institutions such as universities have a lot of information including book information, equipment administrative information, student information, and several others. The institutions also have multiple information in time series. As collective intelligence in campus, integrating and reusing these preserved information regarding career and taking a class, university can effectively support students' decision making of their getting jobs and subjects choice. Our purpose of support is to increase student's motivation. In this paper, we focus on course record and job information included in students' information, and propose the method to analyze correlation between a pattern of taking class and job lined up. Afterwards, we propose a support system regarding getting a job and taking class by using our proposed method. For a student who has his/her favorite job to get, the system supports his/her decision making of lecture choice by recommending a set of appropriate lecture groups. On another hand, for a student who does not have favorite job to get, the system supports his/her decision making of getting job by presenting appropriate job families related with lecture group in which he/she has ever taken. The contribution of this paper is showing a concrete method to reuse the campus collective information, implementing a system, and user perspectives.

Potential Information and Decision Support System Applications for a Civil Engineering RED HORSE Squadron.

DTIC Science & Technology

1987-09-01

APPLICATIONS FOR A CIVIL ENGINEERILaG RED HORSE SQUADRON THESIS Arvil E. White III Captain, USAF AFIT/GE:4/LSM/87S-27 .... DEPARTMENT OF THE AIR FORCE...DT1TO-SJAN 0 419880 POTENTIAL INFORMATION AND DECISION SUPPORT SYSTEM APPLICATIONS FOR A CIVIL ENGINEERILiG RED HORSE SQUADRON IAooession For THESIS NI R...INFORMATION AND DECISION SUPPORT SYSTrEM APPLICATIONS FOR A CIVIL ENGINEERINGX :.. 4. RED HORSE SQUADRON - THESIS -4 Presented to the Faculty of the

Perceptions of risk, risk aversion, and barriers to adoption of decision support systems and integrated pest management: an introduction.

PubMed

Gent, David H; De Wolf, Erick; Pethybridge, Sarah J

2011-06-01

Rational management of plant diseases, both economically and environmentally, involves assessing risks and the costs associated with both correct and incorrect tactical management decisions to determine when control measures are warranted. Decision support systems can help to inform users of plant disease risk and thus assist in accurately targeting events critical for management. However, in many instances adoption of these systems for use in routine disease management has been perceived as slow. The under-utilization of some decision support systems is likely due to both technical and perception constraints that have not been addressed adequately during development and implementation phases. Growers' perceptions of risk and their aversion to these perceived risks can be reasons for the "slow" uptake of decision support systems and, more broadly, integrated pest management (IPM). Decision theory provides some tools that may assist in quantifying and incorporating subjective and/or measured probabilities of disease occurrence or crop loss into decision support systems. Incorporation of subjective probabilities into IPM recommendations may be one means to reduce grower uncertainty and improve trust of these systems because management recommendations could be explicitly informed by growers' perceptions of risk and economic utility. Ultimately though, we suggest that an appropriate measure of the value and impact of decision support systems is grower education that enables more skillful and informed management decisions independent of consultation of the support tool outputs.

Social support plays a role in the attitude that people have towards taking an active role in medical decision-making.

PubMed

Brabers, Anne E M; de Jong, Judith D; Groenewegen, Peter P; van Dijk, Liset

2016-09-21

There is a growing emphasis towards including patients in medical decision-making. However, not all patients are actively involved in such decisions. Research has so far focused mainly on the influence of patient characteristics on preferences for active involvement. However, it can be argued that a patient's social context has to be taken into account as well, because social norms and resources affect behaviour. This study aims to examine the role of social resources, in the form of the availability of informational and emotional support, on the attitude towards taking an active role in medical decision-making. A questionnaire was sent to members of the Dutch Health Care Consumer Panel (response 70 %; n = 1300) in June 2013. A regression model was then used to estimate the relation between medical and lay informational support and emotional support and the attitude towards taking an active role in medical decision-making. Availability of emotional support is positively related to the attitude towards taking an active role in medical decision-making only in people with a low level of education, not in persons with a middle and high level of education. The latter have a more positive attitude towards taking an active role in medical decision-making, irrespective of the level of emotional support available. People with better access to medical informational support have a more positive attitude towards taking an active role in medical decision-making; but no significant association was found for lay informational support. This study shows that social resources are associated with the attitude towards taking an active role in medical decision-making. Strategies aimed at increasing patient involvement have to address this.

Driving with roadmaps and dashboards: using information resources to structure the decision models in service organizations.

PubMed

Chorpita, Bruce F; Bernstein, Adam; Daleiden, Eric L

2008-03-01

This paper illustrates the application of design principles for tools that structure clinical decision-making. If the effort to implement evidence-based practices in community services organizations is to be effective, attention must be paid to the decision-making context in which such treatments are delivered. Clinical research trials commonly occur in an environment characterized by structured decision making and expert supports. Technology has great potential to serve mental health organizations by supporting these potentially important contextual features of the research environment, through organization and reporting of clinical data into interpretable information to support decisions and anchor decision-making procedures. This article describes one example of a behavioral health reporting system designed to facilitate clinical and administrative use of evidence-based practices. The design processes underlying this system-mapping of decision points and distillation of performance information at the individual, caseload, and organizational levels-can be implemented to support clinical practice in a wide variety of settings.

Uncertainty and probability in wildfire management decision support: An example from the United States [Chapter 4

Treesearch

Matthew Thompson; David Calkin; Joe H. Scott; Michael Hand

2017-01-01

Wildfire risk assessment is increasingly being adopted to support federal wildfire management decisions in the United States. Existing decision support systems, specifically the Wildland Fire Decision Support System (WFDSS), provide a rich set of probabilistic and risk‐based information to support the management of active wildfire incidents. WFDSS offers a wide range...

Parenting through genetic uncertainty: themes in the disclosure of breast cancer risk information to children.

PubMed

Sharff, McKane E; DeMarco, Tiffani A; Mays, Darren; Peshkin, Beth N; Valdimarsdottir, Heiddis B; Garber, Judy E; Schneider, Katherine A; Patenaude, Andrea F; Tercyak, Kenneth P

2012-05-01

Among mothers undergoing BRCA1/2 testing and their spouses/partners, this study sought to examine decision support needs and motivations for family communication of genetic risk information to asymptomatic children. This study gathered data from 213 tested mothers and 104 of their untested parenting partners 1 month after maternal receipt of genetic test results and upon making a decision about communicating genetic information to their child (ages 8-21 years). Data include parents' perceived needs for family communication decision support, decision motivations, and parent-child communication. Parents reported high decision support needs (e.g., educational materials, professional counseling, peer assistance). Motivations for disclosure to children among mothers and partners focused on promoting the parent-child bond and maintaining family health (55.3% and 75%, respectively) and promoting positive child affect (44.7% and 25.5%, respectively). Motivations for nondisclosure to children among mothers and partners focused on the lack of appropriateness (69.6% and 51.3%, respectively) and relative importance of genetic test results (30.4% and 48.7%, respectively). Significant discrepancies in parental motivation for family communication were observed. Decision support needs were highest among disclosing mothers with affect-related motivations [t (129)=2.47; p=0.01]. Parent-child communication was poorest among nondisclosing mothers concerned about the appropriateness of genetic information for their child [t (77)=-3.29; p=.002]. Parents receiving information about hereditary cancer predisposition have unmet needs when making decisions about disclosing genetic risk information to their asymptomatic children. These data can guide the development of cancer risk communication decision support interventions for parents undergoing such testing.

Military Medical Decision Support for Homeland Defense During Emergency

DTIC Science & Technology

2004-12-01

abstraction hierarchy, three levels of information requirement for designing emergency training interface are recognized. These are epistemological ...support human decision making process is considered to be decision-centric. A typical decision-centric interface is supported by at least four design ... Designing Emergency Training Interface ......................................................................................... 5 Epistemological

Evaluating a Web-Based MMR Decision Aid to Support Informed Decision-Making by UK Parents: A Before-and-After Feasibility Study

ERIC Educational Resources Information Center

Jackson, Cath; Cheater, Francine M.; Peacock, Rose; Leask, Julie; Trevena, Lyndal

2010-01-01

Objective: The objective of this feasibility study was to evaluate the acceptability and potential effectiveness of a web-based MMR decision aid in supporting informed decision-making for the MMR vaccine. Design: This was a prospective before-and-after evaluation. Setting: Thirty parents of children eligible for MMR vaccination were recruited from…

Choosing a Model of Maternity Care: Decision Support Needs of Australian Women.

PubMed

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

2016-06-01

Access to information on the features and outcomes associated with the various models of maternity care available in Australia is vital for women's informed decision-making. This study sought to identify women's preferences for information access and decision-making involvement, as well as their priority information needs, for model of care decision-making. A convenience sample of adult women of childbearing age in Queensland, Australia were recruited to complete an online survey assessing their model of care decision support needs. Knowledge on models of care and socio-demographic characteristics were also assessed. Altogether, 641 women provided usable survey data. Of these women, 26.7 percent had heard of all available models of care before starting the survey. Most women wanted access to information on models of care (90.4%) and an active role in decision-making (99.0%). Nine priority information needs were identified: cost, access to choice of mode of birth and care provider, after hours provider contact, continuity of carer in labor/birth, mobility during labor, discussion of the pros/cons of medical procedures, rates of skin-to-skin contact after birth, and availability at a preferred birth location. This information encompassed the priority needs of women across age, birth history, and insurance status subgroups. This study demonstrates Australian women's unmet needs for information that supports them to effectively compare available options for model of maternity care. Findings provide clear direction on what information should be prioritized and ideal channels for information access to support quality decision-making in practice. © 2015 Wiley Periodicals, Inc.

Talking Points: Women's Information Needs for Informed Decision-Making About Noninvasive Prenatal Testing for Down Syndrome.

PubMed

Dane, Aimée C; Peterson, Madelyn; Miller, Yvette D

2018-03-17

Adequate knowledge is a vital component of informed decision-making; however, we do not know what information women value when making decisions about noninvasive prenatal testing (NIPT). The current study aimed to identify women's information needs for decision-making about NIPT as a first-tier, non-contingent test with out-of-pocket expense and, in turn, inform best practice by specifying the information that should be prioritized when providing pre-test counseling to women in a time-limited scenario or space-limited decision support tool. We asked women (N = 242) in Australia to indicate the importance of knowing 24 information items when making a decision about NIPT and to choose two information items they would most value. Our findings suggest that women value having complete information when making decisions about NIPT. Information about the accuracy of NIPT and the pros and cons of NIPT compared to other screening and invasive tests were perceived to be most important. The findings of this study can be used to maximize the usefulness of time-limited discussions or space-limited decision support tools, but should not be routinely relied upon as a replacement for provision of full and tailored information when feasible.

The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction.

PubMed

Palmer-Wackerly, Angela L; Krieger, Janice L; Rhodes, Nancy D

2017-01-01

Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.

A decision technology system for health care electronic commerce.

PubMed

Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

1999-08-01

Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

IONIO Project: Computer-mediated Decision Support System and Communication in Ocean Science

NASA Astrophysics Data System (ADS)

Oddo, Paolo; Acierno, Arianna; Cuna, Daniela; Federico, Ivan; Galati, Maria Barbara; Awad, Esam; Korres, Gerasimos; Lecci, Rita; Manzella, Giuseppe M. R.; Merico, Walter; Perivoliotis, Leonidas; Pinardi, Nadia; Shchekinova, Elena; Mannarini, Gianandrea; Vamvakaki, Chrysa; Pecci, Leda; Reseghetti, Franco

2013-04-01

A decision Support System is composed by four main steps. The first one is the definition of the problem, the issue to be covered, decisions to be taken. Different causes can provoke different problems, for each of the causes or its effects it is necessary to define a list of information and/or data that are required in order to take the better decision. The second step is the determination of sources from where information/data needed for decision-making can be obtained and who has that information. Furthermore it must be possible to evaluate the quality of the sources to see which of them can provide the best information, and identify the mode and format in which the information is presented. The third step is relying on the processing of knowledge, i.e. if the information/data are fitting for purposes. It has to be decided which parts of the information/data need to be used, what additional data or information is necessary to access, how can information be best presented to be able to understand the situation and take decisions. Finally, the decision making process is an interactive and inclusive process involving all concerned parties, whose different views must be taken into consideration. A knowledge based discussion forum is necessary to reach a consensus. A decision making process need to be examined closely and refined, and modified to meet differing needs over time. The report is presenting legal framework and knowledge base for a scientific based decision support system and a brief exploration of some of the skills that enhances the quality of decisions taken.

Foundations for context-aware information retrieval for proactive decision support

NASA Astrophysics Data System (ADS)

Mittu, Ranjeev; Lin, Jessica; Li, Qingzhe; Gao, Yifeng; Rangwala, Huzefa; Shargo, Peter; Robinson, Joshua; Rose, Carolyn; Tunison, Paul; Turek, Matt; Thomas, Stephen; Hanselman, Phil

2016-05-01

Intelligence analysts and military decision makers are faced with an onslaught of information. From the now ubiquitous presence of intelligence, surveillance, and reconnaissance (ISR) platforms providing large volumes of sensor data, to vast amounts of open source data in the form of news reports, blog postings, or social media postings, the amount of information available to a modern decision maker is staggering. Whether tasked with leading a military campaign or providing support for a humanitarian mission, being able to make sense of all the information available is a challenge. Due to the volume and velocity of this data, automated tools are required to help support reasoned, human decisions. In this paper we describe several automated techniques that are targeted at supporting decision making. Our approaches include modeling the kinematics of moving targets as motifs; developing normalcy models and detecting anomalies in kinematic data; automatically classifying the roles of users in social media; and modeling geo-spatial regions based on the behavior that takes place in them. These techniques cover a wide-range of potential decision maker needs.

Experiences in Bridging the Gap between Science and Decision Making at NASA's GSFC Earth Science Data and Information Services Center (GES DISC)

NASA Technical Reports Server (NTRS)

Kempler, Steven; Teng, Bill; Friedl, Lawrence; Lynnes, Chris; Leptoukh, Gregory

2008-01-01

Recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet s natural environment, NASA has implemented the Decision Support Through Earth Science Research Results program (NASA ROSES solicitations). a) This successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations. b) The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. c) In addition, GES DISC s understanding of Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, enables the GES DISC to identify challenges that come with bringing science data to decision makers. d) The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding of how decisions are made, and the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that really evaluate success will be exemplified.

Comparing a generic and individualized information decision support intervention for men newly diagnosed with localized prostate cancer.

PubMed

Davison, B Joyce; Goldenberg, S Larry; Wiens, Kristin P; Gleave, Martin E

2007-01-01

A randomized study was conducted to compare a generic and individualized approach to providing decisional support to men newly diagnosed with localized prostate cancer. Patients (N = 324) were referred by community urologists to a patient education center where they were randomly assigned to receive either an individualized or generic information intervention. Men assigned to the generic group viewed a video on the various treatments available for localized prostate cancer. Men in the individualized information group used a computer program to identify their information preferences. Computer printouts on top information preferences were individualized according to patient's specific disease characteristics, followed by a discussion of the pros and cons of each recommended treatment option. Both groups received a standardized package of written information. Men completed measures of decision control, satisfaction, and decision conflict at baseline and after a definitive treatment decision was made. Results demonstrated that overall both groups reported increased levels of decision control and lower levels of decision conflict after their treatment decision. All men reported being satisfied with their preparation to make a treatment decision. Compared to the generic information group, men who received the individualized information were more satisfied with the type, amount and method of providing information, and role played in treatment decision making with their physician (P < .002). Both information interventions seem to be similar in providing decisional support to this group of men at the time of diagnosis. Further research is required to determine how to identify men who may benefit from a more individualized approach.

Identifying components in consent information needed to support informed decision making about trial participation: An interview study with women managing cancer.

PubMed

Abhyankar, Purva; Velikova, Galina; Summers, Barbara; Bekker, Hilary L

2016-07-01

Research governance requires patients give informed consent to participate in clinical trials. However, there are concerns that consent information may not support patient participation decisions. This study investigates the utility of consent information in supporting women's trial participation decisions when receiving treatment for cancer. An interview study with women receiving cancer treatments at a medical oncology outpatient clinic in Yorkshire (UK). All women over 18 years, not admitted to a hospital ward and who had currently or previously been invited to take part in a trial were invited to take part in the study over a three month period. Interviews were audio-tape recorded, transcribed and analysed using thematic analysis. Of those eligible (n = 41), 21 women with breast (n = 11), ovarian (n = 8) and endometrial (n = 2) cancer participated (mean age = 57 years). Eighteen had made at least one trial decision and three were considering taking part in a trial. Findings are synthesised under two analytical themes: 1) Influence of the cancer and cancer treatment context on decision making for trial participation; and 2) Experiences of the consenting process and their influence on decision making. Designing trial information to represent explicitly the trial participation decision as being between standard care and study-related care options is more likely to effectively support patients in making informed decisions between standard care treatments and taking part in a trial. Copyright © 2016 Elsevier Ltd. All rights reserved.

Using Best Practices to Extract, Organize, and Reuse Embedded Decision Support Content Knowledge Rules from Mature Clinical Systems

PubMed Central

DesAutels, Spencer J.; Fox, Zachary E.; Giuse, Dario A.; Williams, Annette M.; Kou, Qing-hua; Weitkamp, Asli; Neal R, Patel; Bettinsoli Giuse, Nunzia

2016-01-01

Clinical decision support (CDS) knowledge, embedded over time in mature medical systems, presents an interesting and complex opportunity for information organization, maintenance, and reuse. To have a holistic view of all decision support requires an in-depth understanding of each clinical system as well as expert knowledge of the latest evidence. This approach to clinical decision support presents an opportunity to unify and externalize the knowledge within rules-based decision support. Driven by an institutional need to prioritize decision support content for migration to new clinical systems, the Center for Knowledge Management and Health Information Technology teams applied their unique expertise to extract content from individual systems, organize it through a single extensible schema, and present it for discovery and reuse through a newly created Clinical Support Knowledge Acquisition and Archival Tool (CS-KAAT). CS-KAAT can build and maintain the underlying knowledge infrastructure needed by clinical systems. PMID:28269846

Toward patient-centered, personalized and personal decision support and knowledge management: a survey.

PubMed

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 participatory health care model for patient-centered, personalized medicine. There is also an increasing emphasis on managing complexity with changing care models, processes, and settings.

Surface transportation weather decision support requirements : operational concept description : advanced-integrated decision support using weather information for surface transportation decisions makers : draft version 2.0

DOT National Transportation Integrated Search

2000-07-14

This is a draft document for the Surface Transportation Weather Decision Support Requirements (STWDSR) project. The STWDSR project is being conducted for the FHWAs Office of Transportation Operations (HOTO) Road Weather Management Program by Mitre...

Information management to enable personalized medicine: stakeholder roles in building clinical decision support.

PubMed

Downing, Gregory J; Boyle, Scott N; Brinner, Kristin M; Osheroff, Jerome A

2009-10-08

Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment.

Information management to enable personalized medicine: stakeholder roles in building clinical decision support

PubMed Central

2009-01-01

Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment. PMID:19814826

Prioritization of engineering support requests and advanced technology projects using decision support and industrial engineering models

NASA Technical Reports Server (NTRS)

Tavana, Madjid

1995-01-01

The evaluation and prioritization of Engineering Support Requests (ESR's) is a particularly difficult task at the Kennedy Space Center (KSC) -- Shuttle Project Engineering Office. This difficulty is due to the complexities inherent in the evaluation process and the lack of structured information. The evaluation process must consider a multitude of relevant pieces of information concerning Safety, Supportability, O&M Cost Savings, Process Enhancement, Reliability, and Implementation. Various analytical and normative models developed over the past have helped decision makers at KSC utilize large volumes of information in the evaluation of ESR's. The purpose of this project is to build on the existing methodologies and develop a multiple criteria decision support system that captures the decision maker's beliefs through a series of sequential, rational, and analytical processes. The model utilizes the Analytic Hierarchy Process (AHP), subjective probabilities, the entropy concept, and Maximize Agreement Heuristic (MAH) to enhance the decision maker's intuition in evaluating a set of ESR's.

Development of a spatial decision support system for flood risk management in Brazil that combines volunteered geographic information with wireless sensor networks

NASA Astrophysics Data System (ADS)

Horita, Flávio E. A.; Albuquerque, João Porto de; Degrossi, Lívia C.; Mendiondo, Eduardo M.; Ueyama, Jó

2015-07-01

Effective flood risk management requires updated information to ensure that the correct decisions can be made. This can be provided by Wireless Sensor Networks (WSN) which are a low-cost means of collecting updated information about rivers. Another valuable resource is Volunteered Geographic Information (VGI) which is a comparatively new means of improving the coverage of monitored areas because it is able to supply supplementary information to the WSN and thus support decision-making in flood risk management. However, there still remains the problem of how to combine WSN data with VGI. In this paper, an attempt is made to investigate AGORA-DS, which is a Spatial Decision Support System (SDSS) that is able to make flood risk management more effective by combining these data sources, i.e. WSN with VGI. This approach is built over a conceptual model that complies with the interoperable standards laid down by the Open Geospatial Consortium (OGC) - e.g. Sensor Observation Service (SOS) and Web Feature Service (WFS) - and seeks to combine and present unified information in a web-based decision support tool. This work was deployed in a real scenario of flood risk management in the town of São Carlos in Brazil. The evidence obtained from this deployment confirmed that interoperable standards can support the integration of data from distinct data sources. In addition, they also show that VGI is able to provide information about areas of the river basin which lack data since there is no appropriate station in the area. Hence it provides a valuable support for the WSN data. It can thus be concluded that AGORA-DS is able to combine information provided by WSN and VGI, and provide useful information for supporting flood risk management.

How information about other people's personal experiences can help with healthcare decision-making: a qualitative study.

PubMed

Entwistle, Vikki Ann; France, Emma F; Wyke, Sally; Jepson, Ruth; Hunt, Kate; Ziebland, Sue; Thompson, Andrew

2011-12-01

To investigate people's views of using 'general facts' and information about other people's 'personal experiences' for health-related decision-making. Sixty-two people, who between them had experience of five different focal health issues, participated in 12 focus groups and 9 interviews. Exploration of uses of the two types of information was supported by discussion of illustrative excerpts. There was less discussion of 'general facts'; participants thought it obvious that good decisions required these. Participants reported having used 'personal experiences' information to: recognise decisions that needed consideration; identify options; appraise options and make selections (including by developing and reflecting on their reasoning about possible choices); and support coping strategies. Their inclination to use 'personal experiences' information was apparently moderated by assessments of personal relevance, the motives of information providers and the 'balance' of experiences presented. People can use 'personal experiences' information in various ways to support their decision-making, and exercise some discrimination as they do. 'Personal experiences' information may help people in a number of ways in relation to decision-making. However, 'personal experiences' information does not replace the need for 'general facts' and care should be taken when it is used in resources for patients. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Conceptual framework of knowledge management for ethical decision-making support in neonatal intensive care.

PubMed

Frize, Monique; Yang, Lan; Walker, Robin C; O'Connor, Annette M

2005-06-01

This research is built on the belief that artificial intelligence estimations need to be integrated into clinical social context to create value for health-care decisions. In sophisticated neonatal intensive care units (NICUs), decisions to continue or discontinue aggressive treatment are an integral part of clinical practice. High-quality evidence supports clinical decision-making, and a decision-aid tool based on specific outcome information for individual NICU patients will provide significant support for parents and caregivers in making difficult "ethical" treatment decisions. In our approach, information on a newborn patient's likely outcomes is integrated with the physician's interpretation and parents' perspectives into codified knowledge. Context-sensitive content adaptation delivers personalized and customized information to a variety of users, from physicians to parents. The system provides structuralized knowledge translation and exchange between all participants in the decision, facilitating collaborative decision-making that involves parents at every stage on whether to initiate, continue, limit, or terminate intensive care for their infant.

Office of Environmental Information (OEI) Tribal Strategy: Partnership to Support Environmental Information and Decision-Making in Indian Country and Alaska Native Villages

EPA Pesticide Factsheets

This draft strategy provides a description of goals OEI seeks to accomplish to support tribal information and environmental decision-making. States objectives to facilitate and strengthen tribal capacity to collect, analyze and share data.

A decision support tool for vehicle infrastructure integration : understanding information effects and advancing data fusion algorithms for traffic management applications.

DOT National Transportation Integrated Search

2009-10-15

This research seeks to explore vehicle-to-vehicle information networks to understand the interplay : between the information communicated and traffic conditions on the network. A longer-term goal is to : develop a decision support tool for processing...

Essays on Visual Representation Technology and Decision Making in Teams

ERIC Educational Resources Information Center

Peng, Chih-Hung

2013-01-01

Information technology has played several important roles in group decision making, such as communication support and decision support. Little is known about how information technology can be used to persuade members of a group to reach a consensus. In this dissertation, I aim to address the issues that are related to the role of visual…

Force Structure: Better Information Needed to Support Air Force A-10 and Other Future Divestment Decisions

DTIC Science & Technology

2016-08-01

estimate should have a standardized structure that breaks costs into discrete elements with sufficient detail to ensure that cost elements are...FORCE STRUCTURE Better Information Needed to Support Air Force A-10 and Other Future Divestment Decisions Report...Accountability Office Highlights of GAO-16-816, a report to congressional committees August 2016 FORCE STRUCTURE Better Information Needed to Support

Bridging the gap: decision-making processes of women with breast cancer using complementary and alternative medicine (CAM).

PubMed

Balneaves, Lynda G; Truant, Tracy L O; Kelly, Mary; Verhoef, Marja J; Davison, B Joyce

2007-08-01

The purpose of this study was to explore the personal and social processes women with breast cancer engaged in when making decisions about complementary and alternative medicine (CAM). The overall aim was to develop a conceptual model of the treatment decision-making process specific to breast cancer care and CAM that will inform future information and decision support strategies. Grounded theory methodology explored the decisions of women with breast cancer using CAM. Semistructured interviews were conducted with 20 women diagnosed with early-stage breast cancer. Following open, axial, and selective coding, the constant comparative method was used to identify key themes in the data and develop a conceptual model of the CAM decision-making process. The final decision-making model, Bridging the Gap, was comprised of four core concepts including maximizing choices/minimizing risks, experiencing conflict, gathering and filtering information, and bridging the gap. Women with breast cancer used one of three decision-making styles to address the paradigmatic, informational, and role conflict they experienced as a result of the gap they perceived between conventional care and CAM: (1) taking it one step at a time, (2) playing it safe, and (3) bringing it all together. Women with breast cancer face conflict and anxiety when making decisions about CAM within a conventional cancer care context. Information and decision support strategies are needed to ensure women are making safe, informed treatment decisions about CAM. The model, Bridging the Gap, provides a conceptual framework for future decision support interventions.

Decision Performance Using Spatial Decision Support Systems: A Geospatial Reasoning Ability Perspective

ERIC Educational Resources Information Center

Erskine, Michael A.

2013-01-01

As many consumer and business decision makers are utilizing Spatial Decision Support Systems (SDSS), a thorough understanding of how such decisions are made is crucial for the information systems domain. This dissertation presents six chapters encompassing a comprehensive analysis of the impact of geospatial reasoning ability on…

An Introspective Critique of Past, Present, and Future USGS Decision Support

NASA Astrophysics Data System (ADS)

Neff, B. P.; Pavlick, M.

2017-12-01

In response to increasing scrutiny of publicly funded science, the Water Mission Area of USGS is shifting its approach for informing decisions that affect the country. Historically, USGS has focused on providing sound science on cutting edge, societally relevant issues with the expectation that decision makers will take action on this information. In practice, scientists often do not understand or focus on the needs of decision makers and decision makers often cannot or do not utilize information produced by scientists. The Water Mission Area of USGS has recognized that it can better serve the taxpayer by delivering information more relevant to decision making in a form more conducive to its use. To this end, the Water Mission Area of USGS is seeking greater integration with the decision making process to better inform what information it produces. In addition, recognizing that the transfer of scientific knowledge to decision making is fundamentally a social process, USGS is embracing the use of social science to better inform how it delivers scientific information and facilitates its use. This study utilizes qualitative methods to document the evolution of decision support at USGS and provide a rationale for a shift in direction. Challenges to implementation are identified and collaborative opportunities to improve decision making are discussed.

Role of Advance Care Planning in Proxy Decision Making Among Individuals With Dementia and Their Family Caregivers.

PubMed

Kwak, Jung; De Larwelle, Jessica A; Valuch, Katharine O'Connell; Kesler, Toni

2016-01-01

Health care proxies make important end-of-life decisions for individuals with dementia. A cross-sectional survey was conducted to examine the role of advance care planning in proxy decision making for 141 individuals with cognitive impairment, Alzheimer's disease, or other types of dementia. Proxies who did not know the preferences of individuals with dementia for life support treatments reported greater understanding of their values. Proxies of individuals with dementia who did not want life support treatments anticipated receiving less support and were more uncertain in decision making. The greater knowledge proxies had about dementia trajectory, family support, and trust of physicians, the more informed, clearer, and less uncertain they were in decision making. In addition to advance care planning, multiple factors influence proxy decision making, which should be considered in developing interventions and future research to support informed decision making for individuals with dementia and their families. Copyright 2016, SLACK Incorporated.

Delivering information: A descriptive study of Australian women’s information needs for decision-making about birth facility

PubMed Central

2012-01-01

Background Little information is known about what information women want when choosing a birth facility. The objective of this study was to inform the development of a consumer decision support tool about birth facility by identifying the information needs of maternity care consumers in Queensland, Australia. Methods Participants were 146 women residing in both urban and rural areas of Queensland, Australia who were pregnant and/or had recently given birth. A cross-sectional survey was administered in which participants were asked to rate the importance of 42 information items to their decision-making about birth facility. Participants could also provide up to ten additional information items of interest in an open-ended question. Results On average, participants rated 30 of the 42 information items as important to decision-making about birth facility. While the majority of information items were valued by most participants, those related to policies about support people, other women’s recommendations about the facility, freedom to choose one’s preferred position during labour and birth, the aesthetic quality of the facility, and access to on-site neonatal intensive care were particularly widely valued. Additional items of interest frequently focused on postnatal care and support, policies related to medical intervention, and access to water immersion. Conclusions The women surveyed had significant and diverse information needs for decision-making about birth facility. These findings have immediate applications for the development of decision support tools about birth facility, and highlight the need for tools which provide a large volume of information in an accessible and user-friendly format. These findings may also be used to guide communication and information-sharing by care providers involved in counselling pregnant women and families about their options for birth facility or providing referrals to birth facilities. PMID:22708648

Delivering information: a descriptive study of Australian women's information needs for decision-making about birth facility.

PubMed

Thompson, Rachel; Wojcieszek, Aleena M

2012-06-18

Little information is known about what information women want when choosing a birth facility. The objective of this study was to inform the development of a consumer decision support tool about birth facility by identifying the information needs of maternity care consumers in Queensland, Australia. Participants were 146 women residing in both urban and rural areas of Queensland, Australia who were pregnant and/or had recently given birth. A cross-sectional survey was administered in which participants were asked to rate the importance of 42 information items to their decision-making about birth facility. Participants could also provide up to ten additional information items of interest in an open-ended question. On average, participants rated 30 of the 42 information items as important to decision-making about birth facility. While the majority of information items were valued by most participants, those related to policies about support people, other women's recommendations about the facility, freedom to choose one's preferred position during labour and birth, the aesthetic quality of the facility, and access to on-site neonatal intensive care were particularly widely valued. Additional items of interest frequently focused on postnatal care and support, policies related to medical intervention, and access to water immersion. The women surveyed had significant and diverse information needs for decision-making about birth facility. These findings have immediate applications for the development of decision support tools about birth facility, and highlight the need for tools which provide a large volume of information in an accessible and user-friendly format. These findings may also be used to guide communication and information-sharing by care providers involved in counselling pregnant women and families about their options for birth facility or providing referrals to birth facilities.

Developing a Software for Fuzzy Group Decision Support System: A Case Study

ERIC Educational Resources Information Center

Baba, A. Fevzi; Kuscu, Dincer; Han, Kerem

2009-01-01

The complex nature and uncertain information in social problems required the emergence of fuzzy decision support systems in social areas. In this paper, we developed user-friendly Fuzzy Group Decision Support Systems (FGDSS) software. The software can be used for multi-purpose decision making processes. It helps the users determine the main and…

Effects of imperfect automation on decision making in a simulated command and control task.

PubMed

Rovira, Ericka; McGarry, Kathleen; Parasuraman, Raja

2007-02-01

Effects of four types of automation support and two levels of automation reliability were examined. The objective was to examine the differential impact of information and decision automation and to investigate the costs of automation unreliability. Research has shown that imperfect automation can lead to differential effects of stages and levels of automation on human performance. Eighteen participants performed a "sensor to shooter" targeting simulation of command and control. Dependent variables included accuracy and response time of target engagement decisions, secondary task performance, and subjective ratings of mental work-load, trust, and self-confidence. Compared with manual performance, reliable automation significantly reduced decision times. Unreliable automation led to greater cost in decision-making accuracy under the higher automation reliability condition for three different forms of decision automation relative to information automation. At low automation reliability, however, there was a cost in performance for both information and decision automation. The results are consistent with a model of human-automation interaction that requires evaluation of the different stages of information processing to which automation support can be applied. If fully reliable decision automation cannot be guaranteed, designers should provide users with information automation support or other tools that allow for inspection and analysis of raw data.

Supporting Neonatal Intensive Care Unit Parents Through Social Media.

PubMed

Dzubaty, Dolores R

2016-01-01

Parents of infants in the neonatal intensive care unit may often find themselves seeking healthcare information from online and social media sources. Social media applications are available to healthcare consumers and their families, as well as healthcare providers, in a variety of formats. Information that parents gather on their own, and information that is explained by providers, is then used when parents make healthcare decisions regarding their infants. Parents also seek support from peers and family while making healthcare decisions. The combination of knowledge obtained and social support given may empower the parent to feel more confident in their decision making. Healthcare professionals can guide parents to credible resources. The exchange of information between providers and parents can occur using a variety of communication methods. Misperceptions can be corrected, support given, open sharing of information occurs, and parent empowerment may result.

Quality of online information to support patient decision-making in breast cancer surgery.

PubMed

Bruce, Jordan G; Tucholka, Jennifer L; Steffens, Nicole M; Neuman, Heather B

2015-11-01

Breast cancer patients commonly use the internet as an information resource. Our objective was to evaluate the quality of online information available to support patients facing a decision for breast surgery. Breast cancer surgery-related queries were performed (Google and Bing), and reviewed for content pertinent to breast cancer surgery. The DISCERN instrument was used to evaluate websites' structural components that influence publication reliability and ability of information to support treatment decision-making. Scores of 4/5 were considered "good." 45 unique websites were identified. Websites satisfied a median 5/9 content questions. Commonly omitted topics included: having a choice between breast conservation and mastectomy (67%) and potential for 2nd surgery to obtain negative margins after breast conservation (60%). Websites had a median DISCERN score of 2.9 (range 2.0-4.5). Websites achieved higher scores on structural criteria (median 3.6 [2.1-4.7]), with 24% rated as "good." Scores on supporting decision-making questions were lower (2.6 [1.3-4.4]), with only 7% scoring "good." Although numerous breast cancer-related websites exist, most do a poor job providing women with essential information necessary to actively participate in decision-making for breast cancer surgery. Providing easily- accessible, high-quality online information has the potential to significantly improve patients' experiences with decision-making. © 2015 Wiley Periodicals, Inc.

What supports do health system organizations have in place to facilitate evidence-informed decision-making? a qualitative study

PubMed Central

2013-01-01

Background Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making. Objectives The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. Methods In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a ‘knowledge broker’) in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Results A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff’s capacity building. Conclusions This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of research evidence by decision-makers, which may then lead to more informed decisions, and hopefully to a strengthened health system and improved health. PMID:23915278

What supports do health system organizations have in place to facilitate evidence-informed decision-making? A qualitative study.

PubMed

Ellen, Moriah E; Léon, Gregory; Bouchard, Gisèle; Lavis, John N; Ouimet, Mathieu; Grimshaw, Jeremy M

2013-08-06

Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making. The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a 'knowledge broker') in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff's capacity building. This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of research evidence by decision-makers, which may then lead to more informed decisions, and hopefully to a strengthened health system and improved health.

Considering Information Up-to-Dateness to Increase the Accuracy of Therapy Decision Support Systems.

PubMed

Gaebel, Jan; Cypko, Mario A; Oeltze-Jafra, Steffen

2017-01-01

During the diagnostic process a lot of information is generated. All this information is assessed when making a final diagnosis and planning the therapy. While some patient information is stable, e.g., gender, others may become outdated, e.g., tumor size derived from CT data. Quantifying this information up-to-dateness and deriving consequences are difficult. Especially for the implementation in clinical decision support systems, this has not been studied. When information entities tend to become outdated, in practice, clinicians intuitively reduce their impact when making decisions. Therefore, in a system's calculations their impact should be reduced as well. We propose a method of decreasing the certainty of information entities based on their up-to-dateness. The method is tested in a decision support system for TNM staging based on Bayesian networks. We compared the actual N-state in records of 39 patients to the N-state calculated with and without decreasing data certainty. The results under decreased certainty correlated better with the actual states (r=0.958, p=0.008). We conclude that the up-to-dateness must be considered when processing clinical information to enhance decision making and ensure more patient safety.

Decision Support Model for Introduction of Gamification Solution Using AHP

PubMed Central

2014-01-01

Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform. PMID:24892075

Decision support model for introduction of gamification solution using AHP.

PubMed

Kim, Sangkyun

2014-01-01

Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform.

Informed Decision Making About Prostate Cancer Testing in Predominantly Immigrant Black Men: A Randomized Controlled Trial

PubMed Central

Lepore, Stephen J.; Wolf, Randi L.; Basch, Charles E.; Godfrey, Melissa; McGinty, Emma; Shmukler, Celia; Ullman, Ralph; Thomas, Nigel; Weinrich, Sally

2012-01-01

Background Decision support interventions have been developed to help men clarify their values and make informed decisions about prostate cancer testing, but they seldom target high-risk black and immigrant men. Purpose This study evaluated the efficacy of a decision support intervention focused on prostate cancer testing in a sample of predominantly immigrant black men. Methods Black men (N = 490) were randomized to tailored telephone education about prostate cancer testing or a control condition. Results Post-intervention, the intervention group had significantly greater knowledge, lower decision conflict, and greater likelihood of talking with their physician about prostate cancer testing than the control group. There were no significant intervention effects on prostate specific antigen testing, congruence between testing intention and behavior, or anxiety. Conclusions A tailored telephone decision support intervention can promote informed decision making about prostate cancer testing in black and predominantly immigrant men without increasing testing or anxiety. Clinical trial Registered in clinicaltrials.gov (NCT01415375) PMID:22825933

Patient information leaflets (PILs) for UK randomised controlled trials: a feasibility study exploring whether they contain information to support decision making about trial participation.

PubMed

Gillies, Katie; Huang, Wan; Skea, Zoë; Brehaut, Jamie; Cotton, Seonaidh

2014-02-18

Informed consent is regarded as a cornerstone of ethical healthcare research and is a requirement for most clinical research studies. Guidelines suggest that prospective randomised controlled trial (RCT) participants should understand a basic amount of key information about the RCTs they are being asked to enrol in in order to provide valid informed consent. This information is usually provided to potential participants in a patient information leaflet (PIL). There is evidence that some trial participants fail to understand key components of trial processes or rationale. As such, the existing approach to information provision for potential RCT participants may not be optimal. Decision aids have been used for a variety of treatment and screening decisions to improve knowledge, but focus more on overall decision quality, and may be helpful to those making decisions about participating in an RCT. We investigated the feasibility of using a tool to identify which items recommended for good quality decision making are present in UK PILs. PILs were sampled from UK registered Clinical Trials Unit websites across a range of clinical areas. The evaluation tool, which is based on standards for supporting decision making, was applied to 20 PILs. Two researchers independently rated each PIL using the tool. In addition, word count and readability were assessed. PILs scored poorly on the evaluation tool with the majority of leaflets scoring less than 50%. Specifically, presenting probabilities, clarifying and expressing values and structured guidance in deliberation and communication sub-sections scored consistently poorly. Tool score was associated with word count (r=0.802, P <0.01); there was no association between score and readability (r=-0.372, P=0.106). The tool was feasible to use to evaluate PILs for UK RCTs. PILs did not meet current standards of information to support good quality decision making. Writers of information leaflets could use the evaluation tool as a framework during PIL development to help ensure that items are included which promote and support more informed decisions about trial participation. Further research is required to evaluate the inclusion of such information.

The integration of quantitative information with an intelligent decision support system for residential energy retrofits

NASA Astrophysics Data System (ADS)

Mo, Yunjeong

The purpose of this research is to support the development of an intelligent Decision Support System (DSS) by integrating quantitative information with expert knowledge in order to facilitate effective retrofit decision-making. To achieve this goal, the Energy Retrofit Decision Process Framework is analyzed. Expert system shell software, a retrofit measure cost database, and energy simulation software are needed for developing the DSS; Exsys Corvid, the NREM database and BEopt were chosen for implementing an integration model. This integration model demonstrates the holistic function of a residential energy retrofit system for existing homes, by providing a prioritized list of retrofit measures with cost information, energy simulation and expert advice. The users, such as homeowners and energy auditors, can acquire all of the necessary retrofit information from this unified system without having to explore several separate systems. The integration model plays the role of a prototype for the finalized intelligent decision support system. It implements all of the necessary functions for the finalized DSS, including integration of the database, energy simulation and expert knowledge.

Surface transportation weather decision support requirements : advanced-integrated decision support using weather information for surface transportation decisions makers : draft (truncated*) version 1.0

DOT National Transportation Integrated Search

1997-09-19

This report gives an overview of the National Intelligent Transportation Infrastructure Initiative (NITI). NITI refers to the integrated electronics, communications, and hardware and software elements that are available to support Intelligent Transpo...

E-Estuary: Developing a Decision-support System for Coastal Management in the Conterminous United States

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The United States Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E...

Nurses' Clinical Decision Making on Adopting a Wound Clinical Decision Support System.

PubMed

Khong, Peck Chui Betty; Hoi, Shu Yin; Holroyd, Eleanor; Wang, Wenru

2015-07-01

Healthcare information technology systems are considered the ideal tool to inculcate evidence-based nursing practices. The wound clinical decision support system was built locally to support nurses to manage pressure ulcer wounds in their daily practice. However, its adoption rate is not optimal. The study's objective was to discover the concepts that informed the RNs' decisions to adopt the wound clinical decision support system as an evidence-based technology in their nursing practice. This was an exploratory, descriptive, and qualitative design using face-to-face interviews, individual interviews, and active participatory observation. A purposive, theoretical sample of 14 RNs was recruited from one of the largest public tertiary hospitals in Singapore after obtaining ethics approval. After consenting, the nurses were interviewed and observed separately. Recruitment stopped when data saturation was reached. All transcribed interview data underwent a concurrent thematic analysis, whereas observational data were content analyzed independently and subsequently triangulated with the interview data. Eight emerging themes were identified, namely, use of the wound clinical decision support system, beliefs in the wound clinical decision support system, influences of the workplace culture, extent of the benefits, professional control over nursing practices, use of knowledge, gut feelings, and emotions (fear, doubt, and frustration). These themes represented the nurses' mental outlook as they made decisions on adopting the wound clinical decision support system in light of the complexities of their roles and workloads. This research has provided insight on the nurses' thoughts regarding their decision to interact with the computer environment in a Singapore context. It captured the nurses' complex thoughts when deciding whether to adopt or reject information technology as they practice in a clinical setting.

An Integrated Web-based Decision Support System in Disaster Risk Management

NASA Astrophysics Data System (ADS)

Aye, Z. C.; Jaboyedoff, M.; Derron, M. H.

2012-04-01

Nowadays, web based decision support systems (DSS) play an essential role in disaster risk management because of their supporting abilities which help the decision makers to improve their performances and make better decisions without needing to solve complex problems while reducing human resources and time. Since the decision making process is one of the main factors which highly influence the damages and losses of society, it is extremely important to make right decisions at right time by combining available risk information with advanced web technology of Geographic Information System (GIS) and Decision Support System (DSS). This paper presents an integrated web-based decision support system (DSS) of how to use risk information in risk management efficiently and effectively while highlighting the importance of a decision support system in the field of risk reduction. Beyond the conventional systems, it provides the users to define their own strategies starting from risk identification to the risk reduction, which leads to an integrated approach in risk management. In addition, it also considers the complexity of changing environment from different perspectives and sectors with diverse stakeholders' involvement in the development process. The aim of this platform is to contribute a part towards the natural hazards and geosciences society by developing an open-source web platform where the users can analyze risk profiles and make decisions by performing cost benefit analysis, Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) with the support of others tools and resources provided. There are different access rights to the system depending on the user profiles and their responsibilities. The system is still under development and the current version provides maps viewing, basic GIS functionality, assessment of important infrastructures (e.g. bridge, hospital, etc.) affected by landslides and visualization of the impact-probability matrix in terms of socio-economic dimension.

Using Visualization in Cockpit Decision Support Systems

NASA Technical Reports Server (NTRS)

Aragon, Cecilia R.

2005-01-01

In order to safely operate their aircraft, pilots must make rapid decisions based on integrating and processing large amounts of heterogeneous information. Visual displays are often the most efficient method of presenting safety-critical data to pilots in real time. However, care must be taken to ensure the pilot is provided with the appropriate amount of information to make effective decisions and not become cognitively overloaded. The results of two usability studies of a prototype airflow hazard visualization cockpit decision support system are summarized. The studies demonstrate that such a system significantly improves the performance of helicopter pilots landing under turbulent conditions. Based on these results, design principles and implications for cockpit decision support systems using visualization are presented.

E-Estuary: Developing a Decision Support System for Coastal Management in the Conterminous United States (IAHR)

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

E-Estuary: Developing a Decision-support System for Coastal Management in the Counterminous Untied States (Coastal Geotools 09)

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

E-estuary: A Decision Support System for Coastal Water and Ecosystem Management in the US (CZ09)

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

Moving toward climate-informed agricultural decision support - can we use PRISM data for more than just monthly averages?

USDA-ARS?s Scientific Manuscript database

Decision support systems/models for agriculture are varied in target application and complexity, ranging from simple worksheets to near real-time forecast systems requiring significant computational and manpower resources. Until recently, most such decision support systems have been constructed with...

Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study

PubMed Central

2014-01-01

Background High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders’ views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Methods Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Results Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Conclusions Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients. PMID:25067908

Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study.

PubMed

Schuster, Anne Lr; Aslakson, Rebecca A; Bridges, John Fp

2014-01-01

High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders' views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.

Distributed decision support for the 21st century mission space

NASA Astrophysics Data System (ADS)

McQuay, William K.

2002-07-01

The past decade has produced significant changes in the conduct of military operations: increased humanitarian missions, asymmetric warfare, the reliance on coalitions and allies, stringent rules of engagement, concern about casualties, and the need for sustained air operations. Future mission commanders will need to assimilate a tremendous amount of information, make quick-response decisions, and quantify the effects of those decisions in the face of uncertainty. Integral to this process is creating situational assessment-understanding the mission space, simulation to analyze alternative futures, current capabilities, planning assessments, course-of-action assessments, and a common operational picture-keeping everyone on the same sheet of paper. Decision support tools in a distributed collaborative environment offer the capability of decomposing these complex multitask processes and distributing them over a dynamic set of execution assets. Decision support technologies can semi-automate activities, such as planning an operation, that have a reasonably well-defined process and provide machine-level interfaces to refine the myriad of information that is not currently fused. The marriage of information and simulation technologies provides the mission commander with a collaborative virtual environment for planning and decision support.

Experiences in Bridging the Gap Between Science and Decision Making at NASAs GSFC Earth Sciences Data and Information Services Center (GES DISC)

NASA Astrophysics Data System (ADS)

Kempler, S.; Teng, W.; Friedl, L.; Lynnes, C.

2008-12-01

In recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet's natural environment, NASA has implemented the 'Decision Support Through Earth Science Research Results' program to solicit "proposals that develop and demonstrate innovative and practicable applications of NASA Earth science observations and research"that focus on improving decision making activities", as stated in the NASA ROSES-2008, A.18 solicitation. This very successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations in the areas of agriculture, air quality, disaster management, ecosystems, public health, water resources, and aviation weather. The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. Coupling this experience with the GES DISC's total understanding and vast experience regarding Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, the GES DISC is in the unique position to more readily identify challenges that come with bringing science data to decision makers. These challenges consist of those that can be met within typical science data usage frameworks, as well as those challenges that arise when utilizing science data for previously unplanned applications, such as decision support systems. The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding how decisions are made, which leads to the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that 'really' evaluate success will be exemplified.

Visualising Uncertainty for Decision Support

DTIC Science & Technology

2016-12-01

25 4.2.7 The perceived trust level of information in decision making ......... 26 4.3 User issues...crucial to understanding the “reliability” of information , and consequently affect decision making (Deitrick, 2007). Olston and Mackinlay (2002...have long been regarded as a difficult topic since the commander has to make decisions in a limited time frame with information that comes from

HUMAN HEALTH METRICS FOR ENVIRONMENTAL DECISION SUPPORT TOOLS: LESSONS FROM HEALTH ECONOMICS AND DECISION ANALYSIS

EPA Science Inventory

Decision makers using environmental decision support tools are often confronted with information that predicts a multitude of different human health effects due to environmental stressors. If these health effects need to be contrasted with costs or compared with alternative scena...

Gathering Real World Evidence with Cluster Analysis for Clinical Decision Support.

PubMed

Xia, Eryu; Liu, Haifeng; Li, Jing; Mei, Jing; Li, Xuejun; Xu, Enliang; Li, Xiang; Hu, Gang; Xie, Guotong; Xu, Meilin

2017-01-01

Clinical decision support systems are information technology systems that assist clinical decision-making tasks, which have been shown to enhance clinical performance. Cluster analysis, which groups similar patients together, aims to separate patient cases into phenotypically heterogenous groups and defining therapeutically homogeneous patient subclasses. Useful as it is, the application of cluster analysis in clinical decision support systems is less reported. Here, we describe the usage of cluster analysis in clinical decision support systems, by first dividing patient cases into similar groups and then providing diagnosis or treatment suggestions based on the group profiles. This integration provides data for clinical decisions and compiles a wide range of clinical practices to inform the performance of individual clinicians. We also include an example usage of the system under the scenario of blood lipid management in type 2 diabetes. These efforts represent a step toward promoting patient-centered care and enabling precision medicine.

IBM's Health Analytics and Clinical Decision Support.

PubMed

Kohn, M S; Sun, J; Knoop, S; Shabo, A; Carmeli, B; Sow, D; Syed-Mahmood, T; Rapp, W

2014-08-15

This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation.

A Decision Support Framework for Science-Based, Multi-Stakeholder Deliberation: A Coral Reef Example

NASA Astrophysics Data System (ADS)

Rehr, Amanda P.; Small, Mitchell J.; Bradley, Patricia; Fisher, William S.; Vega, Ann; Black, Kelly; Stockton, Tom

2012-12-01

We present a decision support framework for science-based assessment and multi-stakeholder deliberation. The framework consists of two parts: a DPSIR (Drivers-Pressures-States-Impacts-Responses) analysis to identify the important causal relationships among anthropogenic environmental stressors, processes, and outcomes; and a Decision Landscape analysis to depict the legal, social, and institutional dimensions of environmental decisions. The Decision Landscape incorporates interactions among government agencies, regulated businesses, non-government organizations, and other stakeholders. It also identifies where scientific information regarding environmental processes is collected and transmitted to improve knowledge about elements of the DPSIR and to improve the scientific basis for decisions. Our application of the decision support framework to coral reef protection and restoration in the Florida Keys focusing on anthropogenic stressors, such as wastewater, proved to be successful and offered several insights. Using information from a management plan, it was possible to capture the current state of the science with a DPSIR analysis as well as important decision options, decision makers and applicable laws with a the Decision Landscape analysis. A structured elicitation of values and beliefs conducted at a coral reef management workshop held in Key West, Florida provided a diversity of opinion and also indicated a prioritization of several environmental stressors affecting coral reef health. The integrated DPSIR/Decision landscape framework for the Florida Keys developed based on the elicited opinion and the DPSIR analysis can be used to inform management decisions, to reveal the role that further scientific information and research might play to populate the framework, and to facilitate better-informed agreement among participants.

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

PubMed

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.

A multicriteria decision making model for assessment and selection of an ERP in a logistics context

NASA Astrophysics Data System (ADS)

Pereira, Teresa; Ferreira, Fernanda A.

2017-07-01

The aim of this work is to apply a methodology of decision support based on a multicriteria decision analyses (MCDA) model that allows the assessment and selection of an Enterprise Resource Planning (ERP) in a Portuguese logistics company by Group Decision Maker (GDM). A Decision Support system (DSS) that implements a MCDA - Multicriteria Methodology for the Assessment and Selection of Information Systems / Information Technologies (MMASSI / IT) is used based on its features and facility to change and adapt the model to a given scope. Using this DSS it was obtained the information system that best suited to the decisional context, being this result evaluated through a sensitivity and robustness analysis.

USER-CUSTOMIZED ENVIRONMENTAL MAPPING AND DECISION SUPPORT USING NASA WORLD WIND AND DOE GENIE PRO SOFTWARE

EPA Science Inventory

Effective environmental stewardship requires timely geospatial information about ecology and

environment for informed environmental decision support. Unprecedented public access to high resolution

imagery from earth-looking sensors via online virtual earth browsers ...

SUPPORT Tools for evidence-informed health Policymaking (STP) 1: What is evidence-informed policymaking?

PubMed Central

2009-01-01

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article, we discuss the following three questions: What is evidence? What is the role of research evidence in informing health policy decisions? What is evidence-informed policymaking? Evidence-informed health policymaking is an approach to policy decisions that aims to ensure that decision making is well-informed by the best available research evidence. It is characterised by the systematic and transparent access to, and appraisal of, evidence as an input into the policymaking process. The overall process of policymaking is not assumed to be systematic and transparent. However, within the overall process of policymaking, systematic processes are used to ensure that relevant research is identified, appraised and used appropriately. These processes are transparent in order to ensure that others can examine what research evidence was used to inform policy decisions, as well as the judgements made about the evidence and its implications. Evidence-informed policymaking helps policymakers gain an understanding of these processes. PMID:20018099

Decision support tools for proton therapy ePR: intelligent treatment planning navigator and radiation toxicity tool for evaluating of prostate cancer treatment

NASA Astrophysics Data System (ADS)

Le, Anh H.; Deshpande, Ruchi; Liu, Brent J.

2010-03-01

The electronic patient record (ePR) has been developed for prostate cancer patients treated with proton therapy. The ePR has functionality to accept digital input from patient data, perform outcome analysis and patient and physician profiling, provide clinical decision support and suggest courses of treatment, and distribute information across different platforms and health information systems. In previous years, we have presented the infrastructure of a medical imaging informatics based ePR for PT with functionality to accept digital patient information and distribute this information across geographical location using Internet protocol. In this paper, we present the ePR decision support tools which utilize the imaging processing tools and data collected in the ePR. The two decision support tools including the treatment plan navigator and radiation toxicity tool are presented to evaluate prostate cancer treatment to improve proton therapy operation and improve treatment outcomes analysis.

Do personal stories make patient decision aids more effective? A critical review of theory and evidence

PubMed Central

2013-01-01

Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources. PMID:24625283

Information support for decision making on dispatching control of water distribution in irrigation

NASA Astrophysics Data System (ADS)

Yurchenko, I. F.

2018-05-01

The research has been carried out on developing the technique of supporting decision making for on-line control, operational management of water allocation for the interfarm irrigation projects basing on the analytical patterns of dispatcher control. This technique provides an increase of labour productivity as well as higher management quality due to the improved level of automation, as well as decision making optimization taking into account diagnostics of the issues, solutions classification, information being required to the decision makers.

Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial.

PubMed

Berger-Höger, Birte; Liethmann, Katrin; Mühlhauser, Ingrid; Haastert, Burkhard; Steckelberg, Anke

2015-10-12

Women with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices. In this trial, the informed shared decision-making program will be evaluated in breast care centers. A cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2 hours) and specialized breast care and oncology nurses (4 days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited. Primary outcome is the extent of patients' involvement in shared decision-making as assessed by the MAPPIN-Odyad (Multifocal approach to the 'sharing' in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters. It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients' involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted. To our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers. Current Controlled Trials ISRCTN46305518 , date of registration: 5 June 2015.

Tools to support evidence-informed public health decision making

PubMed Central

2014-01-01

Background Public health professionals are increasingly expected to engage in evidence-informed decision making to inform practice and policy decisions. Evidence-informed decision making involves the use of research evidence along with expertise, existing public health resources, knowledge about community health issues, the local context and community, and the political climate. The National Collaborating Centre for Methods and Tools has identified a seven step process for evidence-informed decision making. Tools have been developed to support public health professionals as they work through each of these steps. This paper provides an overview of tools used in three Canadian public health departments involved in a study to develop capacity for evidence-informed decision making. Methods As part of a knowledge translation and exchange intervention, a Knowledge Broker worked with public health professionals to identify and apply tools for use with each of the steps of evidence-informed decision making. The Knowledge Broker maintained a reflective journal and interviews were conducted with a purposive sample of decision makers and public health professionals. This paper presents qualitative analysis of the perceived usefulness and usability of the tools. Results Tools were used in the health departments to assist in: question identification and clarification; searching for the best available research evidence; assessing the research evidence for quality through critical appraisal; deciphering the ‘actionable message(s)’ from the research evidence; tailoring messages to the local context to ensure their relevance and suitability; deciding whether and planning how to implement research evidence in the local context; and evaluating the effectiveness of implementation efforts. Decision makers provided descriptions of how the tools were used within the health departments and made suggestions for improvement. Overall, the tools were perceived as valuable for advancing and sustaining evidence-informed decision making. Conclusion Tools are available to support the process of evidence-informed decision making among public health professionals. The usability and usefulness of these tools for advancing and sustaining evidence-informed decision making are discussed, including recommendations for the tools’ application in other public health settings beyond this study. Knowledge and awareness of these tools may assist other health professionals in their efforts to implement evidence-informed practice. PMID:25034534

Tools to support evidence-informed public health decision making.

PubMed

Yost, Jennifer; Dobbins, Maureen; Traynor, Robyn; DeCorby, Kara; Workentine, Stephanie; Greco, Lori

2014-07-18

Public health professionals are increasingly expected to engage in evidence-informed decision making to inform practice and policy decisions. Evidence-informed decision making involves the use of research evidence along with expertise, existing public health resources, knowledge about community health issues, the local context and community, and the political climate. The National Collaborating Centre for Methods and Tools has identified a seven step process for evidence-informed decision making. Tools have been developed to support public health professionals as they work through each of these steps. This paper provides an overview of tools used in three Canadian public health departments involved in a study to develop capacity for evidence-informed decision making. As part of a knowledge translation and exchange intervention, a Knowledge Broker worked with public health professionals to identify and apply tools for use with each of the steps of evidence-informed decision making. The Knowledge Broker maintained a reflective journal and interviews were conducted with a purposive sample of decision makers and public health professionals. This paper presents qualitative analysis of the perceived usefulness and usability of the tools. Tools were used in the health departments to assist in: question identification and clarification; searching for the best available research evidence; assessing the research evidence for quality through critical appraisal; deciphering the 'actionable message(s)' from the research evidence; tailoring messages to the local context to ensure their relevance and suitability; deciding whether and planning how to implement research evidence in the local context; and evaluating the effectiveness of implementation efforts. Decision makers provided descriptions of how the tools were used within the health departments and made suggestions for improvement. Overall, the tools were perceived as valuable for advancing and sustaining evidence-informed decision making. Tools are available to support the process of evidence-informed decision making among public health professionals. The usability and usefulness of these tools for advancing and sustaining evidence-informed decision making are discussed, including recommendations for the tools' application in other public health settings beyond this study. Knowledge and awareness of these tools may assist other health professionals in their efforts to implement evidence-informed practice.

Information and decision support needs of parents considering amniocentesis: interviews with pregnant women and health professionals.

PubMed

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

2010-06-01

Our aim was to clarify and categorize information and decision support needs of pregnant women deciding about amniocentesis. Prenatal screening for Down's syndrome (implemented in routine practice) generates a quantifiable risk of chromosome abnormality. To increase certainty, chromosomal material needs to be obtained through amniocentesis or other diagnostic test. Amniocentesis carries risks of pregnancy loss. Semi-structured interviews were conducted with health professionals and pregnant women who had considered amniocentesis. The data were qualitatively analysed using a two-step thematic content analysis. A sample of 17 health professionals and 17 pregnant women were interviewed. Professionals demonstrated little consensus regarding the miscarriage rate, the potential consequences of amniocentesis testing and the uncertainty associated with the tests. Furthermore, methods employed to communicate risks varied between professionals. Pregnant women reported heightened stress and anxiety. Twelve out of 17 women described the decision as complex and difficult to make while five participants were satisfied with the information and support provided. Women would have liked more information about the risks involved, the results, the consequences of an amniocentesis and associated emotional difficulties. Women highlighted the need for personalized information, presented in multiple ways, while remaining simple and unbiased. There is variation in the provision of information related to amniocentesis testing. The majority of pregnant women reported difficulties making a decision and identified dimensions of information and decision support where improvements were needed.

Human-computer interface for the study of information fusion concepts in situation analysis and command decision support systems

NASA Astrophysics Data System (ADS)

Roy, Jean; Breton, Richard; Paradis, Stephane

2001-08-01

Situation Awareness (SAW) is essential for commanders to conduct decision-making (DM) activities. Situation Analysis (SA) is defined as a process, the examination of a situation, its elements, and their relations, to provide and maintain a product, i.e., a state of SAW for the decision maker. Operational trends in warfare put the situation analysis process under pressure. This emphasizes the need for a real-time computer-based Situation analysis Support System (SASS) to aid commanders in achieving the appropriate situation awareness, thereby supporting their response to actual or anticipated threats. Data fusion is clearly a key enabler for SA and a SASS. Since data fusion is used for SA in support of dynamic human decision-making, the exploration of the SA concepts and the design of data fusion techniques must take into account human factor aspects in order to ensure a cognitive fit of the fusion system with the decision-maker. Indeed, the tight human factor aspects in order to ensure a cognitive fit of the fusion system with the decision-maker. Indeed, the tight integration of the human element with the SA technology is essential. Regarding these issues, this paper provides a description of CODSI (Command Decision Support Interface), and operational- like human machine interface prototype for investigations in computer-based SA and command decision support. With CODSI, one objective was to apply recent developments in SA theory and information display technology to the problem of enhancing SAW quality. It thus provides a capability to adequately convey tactical information to command decision makers. It also supports the study of human-computer interactions for SA, and methodologies for SAW measurement.

Heuristic-based information acquisition and decision making among pilots.

PubMed

Wiggins, Mark W; Bollwerk, Sandra

2006-01-01

This research was designed to examine the impact of heuristic-based approaches to the acquisition of task-related information on the selection of an optimal alternative during simulated in-flight decision making. The work integrated features of naturalistic and normative decision making and strategies of information acquisition within a computer-based, decision support framework. The study comprised two phases, the first of which involved familiarizing pilots with three different heuristic-based strategies of information acquisition: frequency, elimination by aspects, and majority of confirming decisions. The second stage enabled participants to choose one of the three strategies of information acquisition to resolve a fourth (choice) scenario. The results indicated that task-oriented experience, rather than the information acquisition strategies, predicted the selection of the optimal alternative. It was also evident that of the three strategies available, the elimination by aspects information acquisition strategy was preferred by most participants. It was concluded that task-oriented experience, rather than the process of information acquisition, predicted task accuracy during the decision-making task. It was also concluded that pilots have a preference for one particular approach to information acquisition. Applications of outcomes of this research include the development of decision support systems that adapt to the information-processing capabilities and preferences of users.

EMDS users guide (version 2.0): knowledge-based decision support for ecological assessment.

Treesearch

Keith M. Reynolds

1999-01-01

The USDA Forest Service Pacific Northwest Research Station in Corvallis, Oregon, has developed the ecosystem management decision support (EMDS) system. The system integrates the logical formalism of knowledge-based reasoning into a geographic information system (GIS) environment to provide decision support for ecological landscape assessment and evaluation. The...

A decision support system for technology R&D planning: connecting the dots from information to innovation

NASA Technical Reports Server (NTRS)

Smith, Jeffrey H.; Wertz, Julie; Weisbin, Charles

2004-01-01

This paper describes an information technology innovation developed to assist decision makers faced with complex R&D tasks. The decision support system (DSS) was developed and applied to the analysis of a 10-year, 700 million dollar technology program for the exploration of Mars. The technologies were to enable a 4.8 billion dollar portfolio of exploration flight missions to Mars.

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study

PubMed Central

Farrell, Carole; Keady, John; Swarbrick, Caroline; Burgess, Lorraine; Grande, Gunn; Bellhouse, Sarah; Yorke, Janelle

2018-01-01

Objectives Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. Design Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. Setting Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. Participants Purposeful sample of 10 patients with a diagnosis of cancer–dementia, informal caregivers (n=9) and oncology HCPs (n=12). Results Four themes were identified: (1) leading to the initial consultation—HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information—informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care—patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment—there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. Conclusions Although patients with cancer–dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway. PMID:29654025

Modelling Situation Awareness Information for Naval Decision Support Design

DTIC Science & Technology

2003-10-01

Modelling Situation Awareness Information for Naval Decision Support Design Dr.-Ing. Bernhard Doering, Dipl.-Ing. Gert Doerfel, Dipl.-Ing... knowledge -based user interfaces. For developing such interfaces information of the three different SA levels which operators need in performing their...large scale on situation awareness of operators which is defined as the state of operator knowledge about the external environment resulting from

Single-process versus multiple-strategy models of decision making: evidence from an information intrusion paradigm.

PubMed

Söllner, Anke; Bröder, Arndt; Glöckner, Andreas; Betsch, Tilmann

2014-02-01

When decision makers are confronted with different problems and situations, do they use a uniform mechanism as assumed by single-process models (SPMs) or do they choose adaptively from a set of available decision strategies as multiple-strategy models (MSMs) imply? Both frameworks of decision making have gathered a lot of support, but only rarely have they been contrasted with each other. Employing an information intrusion paradigm for multi-attribute decisions from givens, SPM and MSM predictions on information search, decision outcomes, attention, and confidence judgments were derived and tested against each other in two experiments. The results consistently support the SPM view: Participants seemingly using a "take-the-best" (TTB) strategy do not ignore TTB-irrelevant information as MSMs would predict, but adapt the amount of information searched, choose alternative choice options, and show varying confidence judgments contingent on the quality of the "irrelevant" information. The uniformity of these findings underlines the adequacy of the novel information intrusion paradigm and comprehensively promotes the notion of a uniform decision making mechanism as assumed by single-process models. Copyright © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

Hypothesis-Driven Story Building: Counteracting Human Cognitive Biases to Improve Medical Diagnosis Support

ERIC Educational Resources Information Center

Zhu, Shizhuo

2010-01-01

Clinical decision-making is challenging mainly because of two factors: (1) patient conditions are often complicated with partial and changing information; (2) people have cognitive biases in their decision-making and information-seeking. Consequentially, misdiagnoses and ineffective use of resources may happen. To better support clinical…

Safety in the Science Classroom

ERIC Educational Resources Information Center

Online Submission, 2006

2006-01-01

The goal of this K-12 science safety resource is to bring together information needed by administrators, planners, teachers and support staff to help them make sound decisions regarding science safety. The document identifies areas for decision making and action at a variety of levels. It supports planning and action by providing information on…

A cross-sectional survey of supports for evidence-informed decision-making in healthcare organisations: a research protocol.

PubMed

Ouimet, Mathieu; Lavis, John N; Léon, Grégory; Ellen, Moriah E; Bédard, Pierre-Olivier; Grimshaw, Jeremy M; Gagnon, Marie-Pierre

2014-10-09

This protocol builds on the development of a) a framework that identified the various supports (i.e. positions, activities, interventions) that a healthcare organisation or health system can implement for evidence-informed decision-making (EIDM) and b) a qualitative study that showed the current mix of supports that some Canadian healthcare organisations have in place and the ones that are perceived to facilitate the use of research evidence in decision-making. Based on these findings, we developed a web survey to collect cross-sectional data about the specific supports that regional health authorities and hospitals in two Canadian provinces (Ontario and Quebec) have in place to facilitate EIDM. This paper describes the methods for a cross-sectional web survey among 32 regional health authorities and 253 hospitals in the provinces of Quebec and Ontario (Canada) to collect data on the current mix of organisational supports that these organisations have in place to facilitate evidence-informed decision-making. The data will be obtained through a two-step survey design: a 10-min survey among CEOs to identify key units and individuals in regard to our objectives (step 1) and a 20-min survey among managers of the key units identified in step 1 to collect information about the activities performed by their unit regarding the acquisition, assessment, adaptation and/or dissemination of research evidence in decision-making (step 2). The study will target three types of informants: CEOs, library/documentation centre managers and all other key managers whose unit is involved in the acquisition, assessment, adaptation/packaging and/or dissemination of research evidence in decision-making. We developed an innovative data collection system to increase the likelihood that only the best-informed respondent available answers each survey question. The reporting of the results will be done using descriptive statistics of supports by organisation type and by province. This study will be the first to collect and report large-scale cross-sectional data on the current mix of supports health system organisations in the two most populous Canadian provinces have in place for evidence-informed decision-making. The study will also provide useful information to researchers on how to collect organisation-level data with reduced risk of self-reporting bias.

Decision Support Framework (DSF) Team Research Implementation Plan

EPA Science Inventory

The mission of ORD's Ecosystem Services Research Program (ESRP) is to provide the information and methods needed by decision-makers to assess the benefits of ecosystem goods and services to human well-being for inclusion in management alternatives. The Decision Support Framework...

Performance evaluation of the machine learning algorithms used in inference mechanism of a medical decision support system.

PubMed

Bal, Mert; Amasyali, M Fatih; Sever, Hayri; Kose, Guven; Demirhan, Ayse

2014-01-01

The importance of the decision support systems is increasingly supporting the decision making process in cases of uncertainty and the lack of information and they are widely used in various fields like engineering, finance, medicine, and so forth, Medical decision support systems help the healthcare personnel to select optimal method during the treatment of the patients. Decision support systems are intelligent software systems that support decision makers on their decisions. The design of decision support systems consists of four main subjects called inference mechanism, knowledge-base, explanation module, and active memory. Inference mechanism constitutes the basis of decision support systems. There are various methods that can be used in these mechanisms approaches. Some of these methods are decision trees, artificial neural networks, statistical methods, rule-based methods, and so forth. In decision support systems, those methods can be used separately or a hybrid system, and also combination of those methods. In this study, synthetic data with 10, 100, 1000, and 2000 records have been produced to reflect the probabilities on the ALARM network. The accuracy of 11 machine learning methods for the inference mechanism of medical decision support system is compared on various data sets.

IBM’s Health Analytics and Clinical Decision Support

PubMed Central

Sun, J.; Knoop, S.; Shabo, A.; Carmeli, B.; Sow, D.; Syed-Mahmood, T.; Rapp, W.

2014-01-01

Summary Objectives This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Methods Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. Results There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Conclusion Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation. PMID:25123736

Applying voting theory in natural resource management: a case of multiple-criteria group decision support.

PubMed

Laukkanen, Sanna; Kangas, Annika; Kangas, Jyrki

2002-02-01

Voting theory has a lot in common with utility theory, and especially with group decision-making. An expected-utility-maximising strategy exists in voting situations, as well as in decision-making situations. Therefore, it is natural to utilise the achievements of voting theory also in group decision-making. Most voting systems are based on a single criterion or holistic preference information on decision alternatives. However, a voting scheme called multicriteria approval is specially developed for decision-making situations with multiple criteria. This study considers the voting theory from the group decision support point of view and compares it with some other methods applied to similar purposes in natural resource management. A case study is presented, where the approval voting approach is introduced to natural resources planning and tested in a forestry group decision-making process. Applying multicriteria approval method was found to be a potential approach for handling some challenges typical for forestry group decision support. These challenges include (i) utilising ordinal information in the evaluation of decision alternatives, (ii) being readily understandable for and treating equally all the stakeholders in possession of different levels of knowledge on the subject considered, (iii) fast and cheap acquisition of preference information from several stakeholders, and (iv) dealing with multiple criteria.

Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions?

PubMed Central

Sivell, Stephanie; Edwards, Adrian; Elwyn, Glyn; Manstead, Antony S. R.

2010-01-01

Abstract Objective  To describe the evidence about factors influencing breast cancer patients’ surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM). Background  A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients’ representations of their breast cancer and predicting surgery choices. Design  Literature search and narrative synthesis of data. Synthesis  Twenty‐six studies reported women’s surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients. Conclusions  The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients’ surgery choices. PMID:20579123

Adaptation of a Knowledge-Based Decision-Support System in the Tactical Environment.

DTIC Science & Technology

1981-12-01

002-04-6411S1CURITY CL All PICATION OF 1,416 PAGE (00HIR Onto ea0aOW .L10 *GU9WVC 4bGSI.CAYON S. Voss 10466lVka t... OftesoE ’ making decisons . The...noe..aaw Ad tdlalttt’ IV 680011 MMib) Artificial Intelligence; Decision-Support Systems; Tactical Decision- making ; Knowledge-based Decision-support...tactical information to assist tactical commanders in making decisions. The system, TAC*, for "Tactical Adaptable Consultant," incorporates a database

The design of aircraft using the decision support problem technique

NASA Technical Reports Server (NTRS)

Mistree, Farrokh; Marinopoulos, Stergios; Jackson, David M.; Shupe, Jon A.

1988-01-01

The Decision Support Problem Technique for unified design, manufacturing and maintenance is being developed at the Systems Design Laboratory at the University of Houston. This involves the development of a domain-independent method (and the associated software) that can be used to process domain-dependent information and thereby provide support for human judgment. In a computer assisted environment, this support is provided in the form of optimal solutions to Decision Support Problems.

Cognitive Works Aids for C2 Planning: Actionable Information to Support Operational Decision Making

DTIC Science & Technology

2005-06-01

Information to Support Operational Decision Making Topic: Decisionmaking and Cognitive Science Jeffrey Wampler†*, Randall Whitaker§, Emilie...channeled through this state-of- the- art mobility C2 hub. It is a global AOC with several hundred people planning and executing around 350 missions...2005 Topical Area: Decisionmaking and Cognitive Science CONFERENCE PRESENTATION BY: RANDALL WHITAKER, PH.D. NORTHROP GRUMMAN INFORMATION TECHNOLOGY

39 CFR 501.6 - Suspension and revocation of authorization.

Code of Federal Regulations, 2014 CFR

2014-07-01

... decision of PT shall become a final decision of the Postal Service. The appeal may be filed with the Chief Information Officer of the Postal Service and must include all supporting evidence and state with specificity... Information Officer shall constitute a final decision of the Postal Service. (f) An order or final decision...

Intended parents' motivations and information and support needs when seeking extraterritorial compensated surrogacy.

PubMed

Hammarberg, Karin; Stafford-Bell, Martyn; Everingham, Sam

2015-11-01

Cross-border reproductive care (CBRC) is becoming increasingly common. Little is known about the motivations and information and support needs of people who cross borders to access surrogacy. This study aimed to explore: how those considering or undertaking extraterritorial surrogacy reach their decision; what other avenues they have considered and tried to have children; their sources of information and support; and perceptions of how others view their decision. Members of two Australian parenting support forums completed an anonymous online survey. Of the 249 respondents, 51% were gay men, 43% heterosexual women and 7% heterosexual men. Most heterosexual respondents had tried to conceive spontaneously and with assisted reproductive technology before considering surrogacy. Most respondents felt supported in their decision to try extraterritorial surrogacy by close family and friends. Surrogacy-related information was mostly sourced online and from other parents through surrogacy. Few sought information from a local general practitioner or IVF clinic and those who did reported IVF clinic staff were significantly (P < 0.001) more likely than other groups to communicate negative reactions to their decision to seek surrogacy. The apparent negative attitudes to cross-border surrogacy among health professionals warrants further research into health professionals' knowledge, beliefs and attitudes relating to surrogacy. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Information/Knowledge Acquisition Methods for Decision Support Systems and Expert Systems.

ERIC Educational Resources Information Center

Yang, Heng-Li

1995-01-01

Compares information requirement-elicitation (IRE) methods for decision support systems (DSS) with knowledge acquisition (KA) methods for expert systems (ES) development. The definition and architectures of ES and DSS are compared and the systems' development cycles and IRE/KA methods are discussed. Differences are noted between ES and DSS…

Decision Support Framework (DSF) For Evaluating Planned Land And Resource Use Decisions: Hypothetical Application Of The DSF To Address Nutrient Loads In The Florida Keys

EPA Science Inventory

The mission of ORD's Ecosystme Services Research Program (ESRP) is to provide the information and methods needed by decision-makers to assess the benefits of ecosystem goods and services to human well-being for inclusion in management alternatives. The Decision Support Framework...

Using old technology to implement modern computer-aided decision support for primary diabetes care.

PubMed Central

Hunt, D. L.; Haynes, R. B.; Morgan, D.

2001-01-01

BACKGROUND: Implementation rates of interventions known to be beneficial for people with diabetes mellitus are often suboptimal. Computer-aided decision support systems (CDSSs) can improve these rates. The complexity of establishing a fully integrated electronic medical record that provides decision support, however, often prevents their use. OBJECTIVE: To develop a CDSS for diabetes care that can be easily introduced into primary care settings and diabetes clinics. THE SYSTEM: The CDSS uses fax-machine-based optical character recognition software for acquiring patient information. Simple, 1-page paper forms, completed by patients or health practitioners, are faxed to a central location. The information is interpreted and recorded in a database. This initiates a routine that matches the information against a knowledge base so that patient-specific recommendations can be generated. These are formatted and faxed back within 4-5 minutes. IMPLEMENTATION: The system is being introduced into 2 diabetes clinics. We are collecting information on frequency of use of the system, as well as satisfaction with the information provided. CONCLUSION: Computer-aided decision support can be provided in any setting with a fax machine, without the need for integrated electronic medical records or computerized data-collection devices. PMID:11825194

Using old technology to implement modern computer-aided decision support for primary diabetes care.

PubMed

Hunt, D L; Haynes, R B; Morgan, D

2001-01-01

Implementation rates of interventions known to be beneficial for people with diabetes mellitus are often suboptimal. Computer-aided decision support systems (CDSSs) can improve these rates. The complexity of establishing a fully integrated electronic medical record that provides decision support, however, often prevents their use. To develop a CDSS for diabetes care that can be easily introduced into primary care settings and diabetes clinics. THE SYSTEM: The CDSS uses fax-machine-based optical character recognition software for acquiring patient information. Simple, 1-page paper forms, completed by patients or health practitioners, are faxed to a central location. The information is interpreted and recorded in a database. This initiates a routine that matches the information against a knowledge base so that patient-specific recommendations can be generated. These are formatted and faxed back within 4-5 minutes. The system is being introduced into 2 diabetes clinics. We are collecting information on frequency of use of the system, as well as satisfaction with the information provided. Computer-aided decision support can be provided in any setting with a fax machine, without the need for integrated electronic medical records or computerized data-collection devices.

A Virtual Information-Action Workspace for Command and Control

NASA Astrophysics Data System (ADS)

Lintern, Gavan; Naikar, Neelam

2002-10-01

Information overload has become a critical challenge within military Command and Control. However, the problem is not so much one of too much information but of abundant information that is poorly organized and poorly represented. In addition, the capabilities to test the effects of decisions before they are implemented and to monitor the progress of events after a decision is implemented are primitive. A virtual information-action workspace could be designed to resolve these issues. The design of such a space would require a detailed understanding of the specific information needed to support decision making in Command and Control. That information can be obtained with the use of knowledge acquisition and knowledge representation tools from the field of applied cognitive psychology. In addition, it will be necessary to integrate forms for perception and action into a virtual space that will support access to the information and that will provide means for testing and implementing decisions. This paper presents a rationale for a virtual information-action workspace and outlines an approach to its design.

A systematic review of online resources to support patient decision-making for full-thickness rectal prolapse surgery.

PubMed

Fowler, G E; Baker, D M; Lee, M J; Brown, S R

2017-11-01

The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information is variable and largely unregulated. The aim of this study was to assess the quality of online resources to support patient decision-making for full-thickness rectal prolapse surgery. This systematic review was registered on the PROSPERO database (CRD42017058319). Searches were performed on Google and specialist decision aid repositories using a pre-defined search strategy. Sources were analysed according to three measures: (1) their readability using the Flesch-Kincaid Reading Ease score, (2) DISCERN score and (3) International Patient Decision Aids Standards (IPDAS) minimum standards criteria score (IPDASi, v4.0). Overall, 95 sources were from Google and the specialist decision aid repositories. There were 53 duplicates removed, and 18 sources did not meet the pre-defined eligibility criteria, leaving 24 sources included in the full-text analysis. The mean Flesch-Kincaid Reading Ease score was higher than recommended for patient education materials (48.8 ± 15.6, range 25.2-85.3). Overall quality of sources supporting patient decision-making for full-thickness rectal prolapse surgery was poor (median DISCERN score 1/5 ± 1.18, range 1-5). No sources met minimum decision-making standards (median IPDASi score 5/12 ± 2.01, range 1-8). Currently, easily accessible online health information to support patient decision-making for rectal surgery is of poor quality, difficult to read and does not support shared decision-making. It is recommended that professional bodies and medical professionals seek to develop decision aids to support decision-making for full-thickness rectal prolapse surgery.

Displaying contextual information reduces the costs of imperfect decision automation in rapid retasking of ISR assets.

PubMed

Rovira, Ericka; Cross, Austin; Leitch, Evan; Bonaceto, Craig

2014-09-01

The impact of a decision support tool designed to embed contextual mission factors was investigated. Contextual information may enable operators to infer the appropriateness of data underlying the automation's algorithm. Research has shown the costs of imperfect automation are more detrimental than perfectly reliable automation when operators are provided with decision support tools. Operators may trust and rely on the automation more appropriately if they understand the automation's algorithm. The need to develop decision support tools that are understandable to the operator provides the rationale for the current experiment. A total of 17 participants performed a simulated rapid retasking of intelligence, surveillance, and reconnaissance (ISR) assets task with manual, decision automation, or contextual decision automation differing in two levels of task demand: low or high. Automation reliability was set at 80%, resulting in participants experiencing a mixture of reliable and automation failure trials. Dependent variables included ISR coverage and response time of replanning routes. Reliable automation significantly improved ISR coverage when compared with manual performance. Although performance suffered under imperfect automation, contextual decision automation helped to reduce some of the decrements in performance. Contextual information helps overcome the costs of imperfect decision automation. Designers may mitigate some of the performance decrements experienced with imperfect automation by providing operators with interfaces that display contextual information, that is, the state of factors that affect the reliability of the automation's recommendation.

Semantic Clinical Guideline Documents

PubMed Central

Eriksson, Henrik; Tu, Samson W.; Musen, Mark

2005-01-01

Decision-support systems based on clinical practice guidelines can support physicians and other health-care personnel in the process of following best practice consistently. A knowledge-based approach to represent guidelines makes it possible to encode computer-interpretable guidelines in a formal manner, perform consistency checks, and use the guidelines directly in decision-support systems. Decision-support authors and guideline users require guidelines in human-readable formats in addition to computer-interpretable ones (e.g., for guideline review and quality assurance). We propose a new document-oriented information architecture that combines knowledge-representation models with electronic and paper documents. The approach integrates decision-support modes with standard document formats to create a combined clinical-guideline model that supports on-line viewing, printing, and decision support. PMID:16779037

Decision Support Systems (DSSs) For Contaminated Land Management - Gaps And Challenges

EPA Science Inventory

A plethora of information is available when considering decision support systems for risk-based management of contaminated land. Broad issues of what is contaminated land, what is a brownfield, and what is remediation are discussed in EU countries and the U.S. Making decisions ...

Supporting Evidence-Informed Teaching in Biomedical and Health Professions Education Through Knowledge Translation: An Interdisciplinary Literature Review.

PubMed

Tractenberg, Rochelle E; Gordon, Morris

2017-01-01

Phenomenon: The purpose of "systematic" reviews/reviewers of medical and health professions educational research is to identify best practices. This qualitative article explores the question of whether systematic reviews can support "evidence informed" teaching and contrasts traditional systematic reviewing with a knowledge translation (KT) approach to this objective. Degrees of freedom analysis (DOFA) is used to examine the alignment of systematic review methods with educational research and the pedagogical strategies and approaches that might be considered with a decision-making framework developed to support valid assessment. This method is also used to explore how KT can be used to inform teaching and learning. The nature of educational research is not compatible with most (11/14) methods for systematic review. The inconsistency of systematic reviewing with the nature of educational research impedes both the identification and implementation of "best-evidence" pedagogy and teaching. This is primarily because research questions that do support the purposes of review do not support educational decision making. By contrast to systematic reviews of the literature, both a DOFA and KT are fully compatible with informing teaching using evidence. A DOFA supports the translation of theory to a specific teaching or learning case, so could be considered a type of KT. The DOFA results in a test of alignment of decision options with relevant educational theory, and KT leads to interventions in teaching or learning that can be evaluated. Examples of how to structure evaluable interventions are derived from a KT approach that are simply not available from a systematic review. Insights: Systematic reviewing of current empirical educational research is not suitable for deriving or supporting best practices in education. However, both "evidence-informed" and scholarly approaches to teaching can be supported as KT projects, which are inherently evaluable and can generate actionable evidence about whether the decision or intervention worked for students, instructors, and the institution. A DOFA can also support evidence- and theory-informed teaching to develop an understanding of what works, why, and for whom. Thus KT, but not systematic reviewing, can support decision making around pedagogy (and pedagogical innovation) that can also inform new teaching and learning initiatives; it can also point to new avenues of empirical research in education that are informed by, and can inform, theory.

Autonomous Task Management and Decision Support Tools

NASA Technical Reports Server (NTRS)

Burian, Barbara

2017-01-01

For some time aircraft manufacturers and researchers have been pursuing mechanisms for reducing crew workload and providing better decision support to the pilots, especially during non-normal situations. Some previous attempts to develop task managers or pilot decision support tools have not resulted in robust and fully functional systems. However, the increasing sophistication of sensors and automated reasoners, and the exponential surge in the amount of digital data that is now available create a ripe environment for the development of a robust, dynamic, task manager and decision support tool that is context sensitive and integrates information from a wide array of on-board and off aircraft sourcesa tool that monitors systems and the overall flight situation, anticipates information needs, prioritizes tasks appropriately, keeps pilots well informed, and is nimble and able to adapt to changing circumstances. This presentation will discuss the many significant challenges and issues associated with the development and functionality of such a system for use on the aircraft flight deck.

Grand Challenges in Clinical Decision Support v10

PubMed Central

Sittig, Dean F.; Wright, Adam; Osheroff, Jerome A.; Middleton, Blackford; Teich, Jonathan M.; Ash, Joan S.; Campbell, Emily; Bates, David W.

2008-01-01

There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: Improve the human-computer interface; Disseminate best practices in CDS design, development, and implementation; Summarize patient-level information; Prioritize and filter recommendations to the user; Create an architecture for sharing executable CDS modules and services; Combine recommendations for patients with co-morbidities; Prioritize CDS content development and implementation; Create internet-accessible clinical decision support repositories; Use freetext information to drive clinical decision support; Mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare. PMID:18029232

Strategic analytics: towards fully embedding evidence in healthcare decision-making.

PubMed

Garay, Jason; Cartagena, Rosario; Esensoy, Ali Vahit; Handa, Kiren; Kane, Eli; Kaw, Neal; Sadat, Somayeh

2015-01-01

Cancer Care Ontario (CCO) has implemented multiple information technology solutions and collected health-system data to support its programs. There is now an opportunity to leverage these data and perform advanced end-to-end analytics that inform decisions around improving health-system performance. In 2014, CCO engaged in an extensive assessment of its current data capacity and capability, with the intent to drive increased use of data for evidence-based decision-making. The breadth and volume of data at CCO uniquely places the organization to contribute to not only system-wide operational reporting, but more advanced modelling of current and future state system management and planning. In 2012, CCO established a strategic analytics practice to assist the agency's programs contextualize and inform key business decisions and to provide support through innovative predictive analytics solutions. This paper describes the organizational structure, services and supporting operations that have enabled progress to date, and discusses the next steps towards the vision of embedding evidence fully into healthcare decision-making. Copyright © 2014 Longwoods Publishing.

32 CFR 651.40 - Introduction.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., allowing public review and comment on the proposal and providing a basis for informed decision-making. (b) The NEPA process should support sound, informed, and timely (early) decision-making; not produce...

Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system.

PubMed

Kalogeropoulos, Dimitris A; Carson, Ewart R; Collinson, Paul O

2003-09-01

Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study.

PubMed

McWilliams, Lorna; Farrell, Carole; Keady, John; Swarbrick, Caroline; Burgess, Lorraine; Grande, Gunn; Bellhouse, Sarah; Yorke, Janelle

2018-04-12

Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. Purposeful sample of 10 patients with a diagnosis of cancer-dementia, informal caregivers (n=9) and oncology HCPs (n=12). Four themes were identified: (1) leading to the initial consultation-HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information-informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care-patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment-there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. Although patients with cancer-dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway. © 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.

Perspectives of self-direction: a systematic review of key areas contributing to service users' engagement and choice-making in self-directed disability services and supports.

PubMed

Lakhani, Ali; McDonald, Donna; Zeeman, Heidi

2018-05-01

Self-directed disability support policies aim to encourage greater choice and control for service users in terms of the health and social care they receive. The proliferation of self-directed disability support policies throughout the developed world has resulted in a growing amount of research exploring the outcomes for service users, and their families and carers. Our understanding of the issues faced by people with disabilities, particularly how they make health and social care decisions and the key areas that determine their engagement with service providers within a self-directed environment is limited. A synthesis of research is timely and can provide knowledge for service users and health and social care support providers to ensure their successful participation. A systematic review guided by the PRISMA approach explored (i) the key areas determining service users' engagement with self-directed disability services and supports, and (ii) how service users make informed decisions about providers. In October 2014 and April 2016, three databases - MEDLINE, CINAHL and Web of Science - were searched for research and review articles. Eighteen sources met the search criteria. Findings were mapped into either: key areas determining service user engagement, or service users' informed decision-making. Findings concerning key areas determining engagement fell into three themes - personal responsibility for budgeting, personalised approaches, and a cultural shift in practice and delivery among service providers. Findings about decision-making yielded two themes - supporting informed decision-making and inhibiting informed decision-making. Literature suggests that self-directed models of care may provide service users with increased control over the services that they receive. Increased control for some service users and their families requires independent external decision-making support, particularly around the domains of budgeting, planning and hiring. Future research must continue to investigate the perspectives of service users pertaining to their engagement, as their participation is central to the effectiveness of the approach. © 2016 John Wiley & Sons Ltd.

7 CFR 4290.620 - Requirements to obtain information from Portfolio Concerns.

Code of Federal Regulations, 2010 CFR

2010-01-01

... English. (a) Information for initial Financing decision. Before extending any Financing, you must require... financing proceeds), cash flow analyses, projections, and such economic development information about the Enterprise, as are necessary to support your investment decision. The information submitted must be...

Developing Information Systems for Competitive Intelligence Support.

ERIC Educational Resources Information Center

Hohhof, Bonnie

1994-01-01

Discusses issues connected with developing information systems for competitive intelligence support; defines the elements of an effective competitive information system; and summarizes issues affecting system design and implementation. Highlights include intelligence information; information needs; information sources; decision making; and…

Development of an integrated medical supply information system

NASA Astrophysics Data System (ADS)

Xu, Eric; Wermus, Marek; Blythe Bauman, Deborah

2011-08-01

The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.

A Decision-Oriented Investigation of Air Force Civil Engineering’s Operations Branch and the Implications for a Decision Support System.

DTIC Science & Technology

1984-09-01

information when making a decision [ Szilagyi and Wallace , 1983:3201." Driver and Mock used cognitive complexity ideas to develop this two dimensional...flexible AMOUNT OF INFORMATION USED High hierarchic integrative Figure 6. Cognitive Complexity Model ( Szilagyi and Wallace , 1983:321) Decisive Style. The...large amount of inform- ation. However, he processes this information with a multiple focus approach ( Szilagyi and Wallace , 1983:320-321). 26 McKenney

Data warehousing as a healthcare business solution.

PubMed

Scheese, R

1998-02-01

Because of the trend toward consolidation in the healthcare field, many organizations have massive amounts of data stored in various information systems organizationwide, but access to the data by end users may be difficult. Healthcare organizations are being pressured to provide managers easy access to the data needed for critical decision making. One solution many organizations are turning to is implementing decision-support data warehouses. A data warehouse instantly delivers information directly to end users, freeing healthcare information systems staff for strategic operations. If designed appropriately, data warehouses can be a cost-effective tool for business analysis and decision support.

AN EPA SPONSORED LITERATURE REVIEW DATABASE TO SUPPORT STRESSOR IDENTIFICATION

EPA Science Inventory

The Causal Analysis/Diagnosis Decision Information System (CADDIS) is an EPA decision-support system currently under development for evaluating the biological impact of stressors on water bodies. In support of CADDIS, EPA is developing CADLIT, a searchable database of the scient...

E-DECIDER Disaster Response and Decision Support Cyberinfrastructure: Technology and Challenges

NASA Astrophysics Data System (ADS)

Glasscoe, M. T.; Parker, J. W.; Pierce, M. E.; Wang, J.; Eguchi, R. T.; Huyck, C. K.; Hu, Z.; Chen, Z.; Yoder, M. R.; Rundle, J. B.; Rosinski, A.

2014-12-01

Timely delivery of critical information to decision makers during a disaster is essential to response and damage assessment. Key issues to an efficient emergency response after a natural disaster include rapidly processing and delivering this critical information to emergency responders and reducing human intervention as much as possible. Essential elements of information necessary to achieve situational awareness are often generated by a wide array of organizations and disciplines, using any number of geospatial and non-geospatial technologies. A key challenge is the current state of practice does not easily support information sharing and technology interoperability. NASA E-DECIDER (Emergency Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response) has worked with the California Earthquake Clearinghouse and its partners to address these issues and challenges by adopting the XChangeCore Web Service Data Orchestration technology and participating in several earthquake response exercises. The E-DECIDER decision support system provides rapid delivery of advanced situational awareness data products to operations centers and emergency responders in the field. Remote sensing and hazard data, model-based map products, information from simulations, damage detection, and crowdsourcing is integrated into a single geospatial view and delivered through a service oriented architecture for improved decision-making and then directly to mobile devices of responders. By adopting a Service Oriented Architecture based on Open Geospatial Consortium standards, the system provides an extensible, comprehensive framework for geospatial data processing and distribution on Cloud platforms and other distributed environments. While the Clearinghouse and its partners are not first responders, they do support the emergency response community by providing information about the damaging effects earthquakes. It is critical for decision makers to maintain a situational awareness that is knowledgeable of potential and current conditions, possible impacts on populations and infrastructure, and other key information. E-DECIDER and the Clearinghouse have worked together to address many of these issues and challenges to deliver interoperable, authoritative decision support products.

What's New in Decision Support: Executive Information Systems. AIR 1990 Annual Forum Paper.

ERIC Educational Resources Information Center

Viehland, Dennis W.

The Executive information System (EIS), a decision support system for the executive, is defined, a comparison is made between EIS and its predecessors, and the differences between EIS in academic institutions vis-a-vis private business firms are discussed. An outline is also provided of the technological and data requirements for executive…

NED-IIS: An Intelligent Information System for Forest Ecosystem Management

Treesearch

W.D. Potter; S. Somasekar; R. Kommineni; H.M. Rauscher

1999-01-01

We view Intelligent Information System (IIS) as composed of a unified knowledge base, database, and model base. The model base includes decision support models, forecasting models, and cvsualization models for example. In addition, we feel that the model base should include domain specific porblems solving modules as well as decision support models. This, then,...

The Utilization of a Clinical Decision Support System to Manage Adult Type 2 Diabetes: A Correlational Study

ERIC Educational Resources Information Center

Faught, I. Charie

2012-01-01

While the Institute of Medicine (2001) has promoted health information technology to improve the process of care such as compliance with clinical practice guidelines and quicker access to clinical information, diagnostic tests, and treatment results, very little was known about how a clinical decision support system can contribute to diabetes…

Operationalizing Semantic Medline for meeting the information needs at point of care.

PubMed

Rastegar-Mojarad, Majid; Li, Dingcheng; Liu, Hongfang

2015-01-01

Scientific literature is one of the popular resources for providing decision support at point of care. It is highly desirable to bring the most relevant literature to support the evidence-based clinical decision making process. Motivated by the recent advance in semantically enhanced information retrieval, we have developed a system, which aims to bring semantically enriched literature, Semantic Medline, to meet the information needs at point of care. This study reports our work towards operationalizing the system for real time use. We demonstrate that the migration of a relational database implementation to a NoSQL (Not only SQL) implementation significantly improves the performance and makes the use of Semantic Medline at point of care decision support possible.

Operationalizing Semantic Medline for meeting the information needs at point of care

PubMed Central

Rastegar-Mojarad, Majid; Li, Dingcheng; Liu, Hongfang

2015-01-01

Scientific literature is one of the popular resources for providing decision support at point of care. It is highly desirable to bring the most relevant literature to support the evidence-based clinical decision making process. Motivated by the recent advance in semantically enhanced information retrieval, we have developed a system, which aims to bring semantically enriched literature, Semantic Medline, to meet the information needs at point of care. This study reports our work towards operationalizing the system for real time use. We demonstrate that the migration of a relational database implementation to a NoSQL (Not only SQL) implementation significantly improves the performance and makes the use of Semantic Medline at point of care decision support possible. PMID:26306259

Data for Renewable Energy Planning, Policy, and Investment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cox, Sarah L

Reliable, robust, and validated data are critical for informed planning, policy development, and investment in the clean energy sector. The Renewable Energy (RE) Explorer was developed to support data-driven renewable energy analysis that can inform key renewable energy decisions globally. This document presents the types of geospatial and other data at the core of renewable energy analysis and decision making. Individual data sets used to inform decisions vary in relation to spatial and temporal resolution, quality, and overall usefulness. From Data to Decisions, a complementary geospatial data and analysis decision guide, provides an in-depth view of these and other considerationsmore » to enable data-driven planning, policymaking, and investment. Data support a wide variety of renewable energy analyses and decisions, including technical and economic potential assessment, renewable energy zone analysis, grid integration, risk and resiliency identification, electrification, and distributed solar photovoltaic potential. This fact sheet provides information on the types of data that are important for renewable energy decision making using the RE Data Explorer or similar types of geospatial analysis tools.« less

Complex Decision-Making in Heart Failure: A Systematic Review and Thematic Analysis.

PubMed

Hamel, Aimee V; Gaugler, Joseph E; Porta, Carolyn M; Hadidi, Niloufar Niakosari

Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical circulatory support, and heart transplantation. The course of decision-making across multiple treatments is unclear yet integral to providing informed and shared decision-making. Recognizing commonalities across treatment decisions could help nurses and physicians to identify opportunities to introduce discussions and support shared decision-making. The specific aims of this review are to examine complex treatment decision-making, specifically implantable cardiac defibrillators, ventricular assist device, and cardiac transplantation, and to recognize commonalities and key points in the decisional process. MEDLINE, CINAHL, PsycINFO, and Web of Science were searched for English-language studies that included qualitative findings reflecting the complexity of heart failure decision-making. Using a 3-step process, findings were synthesized into themes and subthemes. Twelve articles met criteria for inclusion. Participants included patients, caregivers, and clinicians and included decisions to undergo and decline treatment. Emergent themes were "processing the decision," "timing and prognostication," and "considering the future." Subthemes described how participants received and understood information about the therapy, making and changing a treatment decision, timing their decision and gauging health status outcomes in the context of their decision, the influence of a life or death decision, and the future as a factor in their decisional process. Commonalities were present across therapies, which involved the timing of discussions, the delivery of information, and considerations of the future. Exploring this further could help support patient-centered care and optimize shared decision-making interventions.

A study on spatial decision support systems for HIV/AIDS prevention based on COM GIS technology

NASA Astrophysics Data System (ADS)

Yang, Kun; Luo, Huasong; Peng, Shungyun; Xu, Quanli

2007-06-01

Based on the deeply analysis of the current status and the existing problems of GIS technology applications in Epidemiology, this paper has proposed the method and process for establishing the spatial decision support systems of AIDS epidemic prevention by integrating the COM GIS, Spatial Database, GPS, Remote Sensing, and Communication technologies, as well as ASP and ActiveX software development technologies. One of the most important issues for constructing the spatial decision support systems of AIDS epidemic prevention is how to integrate the AIDS spreading models with GIS. The capabilities of GIS applications in the AIDS epidemic prevention have been described here in this paper firstly. Then some mature epidemic spreading models have also been discussed for extracting the computation parameters. Furthermore, a technical schema has been proposed for integrating the AIDS spreading models with GIS and relevant geospatial technologies, in which the GIS and model running platforms share a common spatial database and the computing results can be spatially visualized on Desktop or Web GIS clients. Finally, a complete solution for establishing the decision support systems of AIDS epidemic prevention has been offered in this paper based on the model integrating methods and ESRI COM GIS software packages. The general decision support systems are composed of data acquisition sub-systems, network communication sub-systems, model integrating sub-systems, AIDS epidemic information spatial database sub-systems, AIDS epidemic information querying and statistical analysis sub-systems, AIDS epidemic dynamic surveillance sub-systems, AIDS epidemic information spatial analysis and decision support sub-systems, as well as AIDS epidemic information publishing sub-systems based on Web GIS.

EnviroAtlas Webinar

EPA Pesticide Factsheets

EnviroAtlas is a web-based decision support tool that combines maps, analysis tools, downloadable data and informational resources that states, tribes and communities can use to help inform policy and planning decisions impacting their surroundings.

TIUPAM: A Framework for Trustworthiness-Centric Information Sharing

NASA Astrophysics Data System (ADS)

Xu, Shouhuai; Sandhu, Ravi; Bertino, Elisa

Information is essential to decision making. Nowadays, decision makers are often overwhelmed with large volumes of information, some of which may be inaccurate, incorrect, inappropriate, misleading, or maliciously introduced. With the advocated shift of information sharing paradigm from “need to know” to “need to share” this problem will be further compounded. This poses the challenge of achieving assured information sharing so that decision makers can always get and utilize the up-to-date information for making the right decisions, despite the existence of malicious attacks and without breaching privacy of honest participants. As a first step towards answering this challenge this paper proposes a systematic framework we call TIUPAM, which stands for “Trustworthiness-centric Identity, Usage, Provenance, and Attack Management.” The framework is centered at the need of trustworthiness and risk management for decision makers, and supported by four key components: identity management, usage management, provenance management and attack management. We explore the characterization of both the core functions and the supporting components in the TIUPAM framework, which may guide the design and realization of concrete schemes in the future.

Medicare Hospice Benefits

MedlinePlus

... Choosing to start hospice care is a difficult decision. The information in this booklet and support from a doctor ... may need hospice care in all health care decisions. The information in this booklet describes the Medicare Program at ...

The Selection of Test Items for Decision Making with a Computer Adaptive Test.

ERIC Educational Resources Information Center

Spray, Judith A.; Reckase, Mark D.

The issue of test-item selection in support of decision making in adaptive testing is considered. The number of items needed to make a decision is compared for two approaches: selecting items from an item pool that are most informative at the decision point or selecting items that are most informative at the examinee's ability level. The first…

Prioritization of information using decision support systems for seismic risk in Bucharest city

NASA Astrophysics Data System (ADS)

Armas, Iuliana; Gheorghe, Diana

2014-05-01

Nowadays, because of the ever increasing volume of information, policymakers are faced with decision making problems. Achieving an objective and suitable decision making may become a challenge. In such situations decision support systems (DSS) have been developed. DSS can assist in the decision making process, offering support on how a decision should be made, rather than what decision should be made (Simon, 1979). This in turn potentially involves a huge number of stakeholders and criteria. Regarding seismic risk, Bucharest City is highly vulnerable (Mandrescu et al., 2007). The aim of this study is to implement a spatial decision support system in order to secure a suitable shelter in case of an earthquake occurrence in the historical centre of Bucharest City. In case of a seismic risk, a shelter is essential for sheltering people who lost their homes or whose homes are in danger of collapsing while people at risk receive first aid in the post-disaster phase. For the present study, the SMCE Module for ILWIS 3.4 was used. The methodology included structuring the problem by creating a decision tree, standardizing and weighting of the criteria. The results showed that the most suitable buildings are Tania Hotel, Hanul lui Manuc, The National Bank of Romania, The Romanian Commercial Bank and The National History Museum.

A qualitative study of professional and client perspectives on information flows and decision aid use.

PubMed

Stirling, Christine; Lloyd, Barbara; Scott, Jenn; Abbey, Jenny; Croft, Toby; Robinson, Andrew

2012-03-29

This paper explores the meanings given by a diverse range of stakeholders to a decision aid aimed at helping carers of people in early to moderate stages of dementia (PWD) to select community based respite services. Decision aids aim to empower clients to share decision making with health professionals. However, the match between health professionals' perspectives on decision support needs and their clients' perspective is an important and often unstudied aspect of decision aid use. A secondary analysis was undertaken of qualitative data collected as part of a larger study. The data included twelve interviews with carers of people with dementia, three interviews with expert advisors, and three focus groups with health professionals. A theoretical analysis was conducted, drawing on theories of 'positioning' and professional identity. Health professionals are seen to hold varying attitudes and beliefs about carers' decision support needs, and these appeared to be grounded in the professional identity of each group. These attitudes and beliefs shaped their attitudes towards decision aids, the information they believed should be offered to dementia carers, and the timing of its offering. Some groups understood carers as needing to be protected from realistic information and consequently saw a need to filter information to carer clients. Health professionals' beliefs may cause them to restrict information flows, which can limit carers' ability to make decisions, and limit health services' ability to improve partnering and shared decision making. In an era where information is freely available to those with the resources to access it, we question whether health professionals should filter information.

Ten Years, Forty Decision Aids, And Thousands Of Patient Uses: Shared Decision Making At Massachusetts General Hospital.

PubMed

Sepucha, Karen R; Simmons, Leigh H; Barry, Michael J; Edgman-Levitan, Susan; Licurse, Adam M; Chaguturu, Sreekanth K

2016-04-01

Shared decision making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital's integration of shared decision making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, shared decision making conversations; using patient decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of shared decision making in practice. In the period 2005-15, more than 900 clinicians and other staff members were trained in shared decision making, and more than 28,000 orders for one of about forty patient decision aids were placed to support informed patient-centered decisions. We profile two different implementation initiatives that increased the use of patient decision aids at the hospital's eighteen adult primary care practices, and we summarize key elements of the shared decision making program. Project HOPE—The People-to-People Health Foundation, Inc.

Integrating cost information with health management support system: an enhanced methodology to assess health care quality drivers.

PubMed

Kohli, R; Tan, J K; Piontek, F A; Ziege, D E; Groot, H

1999-08-01

Changes in health care delivery, reimbursement schemes, and organizational structure have required health organizations to manage the costs of providing patient care while maintaining high levels of clinical and patient satisfaction outcomes. Today, cost information, clinical outcomes, and patient satisfaction results must become more fully integrated if strategic competitiveness and benefits are to be realized in health management decision making, especially in multi-entity organizational settings. Unfortunately, traditional administrative and financial systems are not well equipped to cater to such information needs. This article presents a framework for the acquisition, generation, analysis, and reporting of cost information with clinical outcomes and patient satisfaction in the context of evolving health management and decision-support system technology. More specifically, the article focuses on an enhanced costing methodology for determining and producing improved, integrated cost-outcomes information. Implementation issues and areas for future research in cost-information management and decision-support domains are also discussed.

Evidence and Obesity Prevention: Developing Evidence Summaries to Support Decision Making

ERIC Educational Resources Information Center

Clark, Rachel; Waters, Elizabeth; Armstrong, Rebecca; Conning, Rebecca; Allender, Steven; Swinburn, Boyd

2013-01-01

Public health practitioners make decisions based on research evidence in combination with a variety of other influences. Evidence summaries are one of a range of knowledge translation options used to support evidence-informed decision making. The literature relevant to obesity prevention requires synthesis for it to be accessible and relevant to…

Perceptions of risk, risk aversion, and barriers to adoption of decision support systems and integrated pest management: An introduction

USDA-ARS?s Scientific Manuscript database

Rational management of plant diseases, both economically and environmentally, involves assessing risks and the costs associated with both correct and incorrect management decisions to determine when control measures are warranted. Decision support systems can help to inform users of plant disease r...

A decision support system for map projections of small scale data

USGS Publications Warehouse

Finn, Michael P.; Usery, E. Lynn; Posch, Stephan T.; Seong, Jeong Chang

2004-01-01

The use of commercial geographic information system software to process large raster datasets of terrain elevation, population, land cover, vegetation, soils, temperature, and rainfall requires both projection from spherical coordinates to plane coordinate systems and transformation from one plane system to another. Decision support systems deliver information resulting in knowledge that assists in policies, priorities, or processes. This paper presents an approach to handling the problems of raster dataset projection and transformation through the development of a Web-enabled decision support system to aid users of transformation processes with the selection of appropriate map projections based on data type, areal extent, location, and preservation properties.

Familiarity, Utility, and Supportiveness as Determinants of Information Receptivity

ERIC Educational Resources Information Center

Brock, Timothy C.

1970-01-01

Analyzes the interaction of commitment to a decision with three aspects of a subsequent message--familiarity, utility, and supportiveness. The data suggested thatcommitted subjects preferred supportive, novel information. Tables and bibliography. (RW)

Apply creative thinking of decision support in electrical nursing record.

PubMed

Hao, Angelica Te-Hui; Hsu, Chien-Yeh; Li-Fang, Huang; Jian, Wen-Shan; Wu, Li-Bin; Kao, Ching-Chiu; Lu, Mei-Show; Chang, Her-Kung

2006-01-01

The nursing process consists of five interrelated steps: assessment, diagnosis, planning, intervention, and evaluation. In the nursing process, the nurse collects a great deal of data and information. The amount of data and information may exceed the amount the nurse can process efficiently and correctly. Thus, the nurse needs assistance to become proficient in the planning of nursing care, due to the difficulty of simultaneously processing a large set of information. Computer systems are viewed as tools to expand the capabilities of the nurse's mind. Using computer technology to support clinicians' decision making may provide high-quality, patient-centered, and efficient healthcare. Although some existing nursing information systems aid in the nursing process, they only provide the most fundamental decision support--i.e., standard care plans associated with common nursing diagnoses. Such a computerized decision support system helps the nurse develop a care plan step-by-step. But it does not assist the nurse in the decision-making process. The decision process about how to generate nursing diagnoses from data and how to individualize the care plans still reminds of the nurse. The purpose of this study is to develop a pilot structure in electronic nursing record system integrated with international nursing standard for improving the proficiency and accuracy of plan of care in clinical pathway process. The proposed pilot systems not only assist both student nurses and nurses who are novice in nursing practice, but also experts who need to work in a practice area which they are not familiar with.

How Decision Support Systems Can Benefit from a Theory of Change Approach.

PubMed

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.

How Decision Support Systems Can Benefit from a Theory of Change Approach

NASA Astrophysics Data System (ADS)

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.

The process of decision-making in home-care case management: implications for the introduction of universal assessment and information technology.

PubMed

Egan, Mary; Wells, Jennie; Byrne, Kerry; Jaglal, Susan; Stolee, Paul; Chesworth, Bert M; Hillier, Loretta M

2009-07-01

Increasingly, jurisdictions are adopting universal assessment procedures and information technology to aid in healthcare data collection and care planning. Before their potential can be realised, a better understanding is needed of how these systems can best be used to support clinical practice. We investigated the decision-making process and information needs of home-care case managers in Ontario, Canada, prior to the widespread use of universal assessment, with a view of determining how universal assessment and information technology could best support this work. Three focus groups and two individual interviews were conducted; questioning focused on decision-making in the post-acute care of individuals recovering from a hip fracture. We found that case managers' decisional process was one of a clinician-broker, combining clinical expertise and information about local services to support patient goals within the context of limited resources. This process represented expert decision-making, and the case managers valued their ability to carry out non-standardised interviews and override system directives when they noted that data may be misleading. Clear information needs were found in four areas: services available outside of their regions, patient medical information, patient pre-morbid functional status and partner/spouse health and functional status. Implications for the use of universal assessment are discussed. Recommendations are made for further research to determine the impact of universal assessment and information technology on the process and outcome of home-care case manager decision-making.

Consensus Recommendations for Systematic Evaluation of Drug-Drug Interaction Evidence for Clinical Decision Support

PubMed Central

Scheife, Richard T.; Hines, Lisa E.; Boyce, Richard D.; Chung, Sophie P.; Momper, Jeremiah; Sommer, Christine D.; Abernethy, Darrell R.; Horn, John; Sklar, Stephen J.; Wong, Samantha K.; Jones, Gretchen; Brown, Mary; Grizzle, Amy J.; Comes, Susan; Wilkins, Tricia Lee; Borst, Clarissa; Wittie, Michael A.; Rich, Alissa; Malone, Daniel C.

2015-01-01

Background Healthcare organizations, compendia, and drug knowledgebase vendors use varying methods to evaluate and synthesize evidence on drug-drug interactions (DDIs). This situation has a negative effect on electronic prescribing and medication information systems that warn clinicians of potentially harmful medication combinations. Objective To provide recommendations for systematic evaluation of evidence from the scientific literature, drug product labeling, and regulatory documents with respect to DDIs for clinical decision support. Methods A conference series was conducted to develop a structured process to improve the quality of DDI alerting systems. Three expert workgroups were assembled to address the goals of the conference. The Evidence Workgroup consisted of 15 individuals with expertise in pharmacology, drug information, biomedical informatics, and clinical decision support. Workgroup members met via webinar from January 2013 to February 2014. Two in-person meetings were conducted in May and September 2013 to reach consensus on recommendations. Results We developed expert-consensus answers to three key questions: 1) What is the best approach to evaluate DDI evidence?; 2) What evidence is required for a DDI to be applicable to an entire class of drugs?; and 3) How should a structured evaluation process be vetted and validated? Conclusion Evidence-based decision support for DDIs requires consistent application of transparent and systematic methods to evaluate the evidence. Drug information systems that implement these recommendations should be able to provide higher quality information about DDIs in drug compendia and clinical decision support tools. PMID:25556085

Understanding nurses' decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece.

PubMed

Kydonaki, Kalliopi; Huby, Guro; Tocher, Jennifer; Aitken, Leanne M

2016-02-01

To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support. Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described. A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting. Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained. Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task. Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning. Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation. © 2016 John Wiley & Sons Ltd.

A conceptual evolutionary aseismic decision support framework for hospitals

NASA Astrophysics Data System (ADS)

Hu, Yufeng; Dargush, Gary F.; Shao, Xiaoyun

2012-12-01

In this paper, aconceptual evolutionary framework for aseismic decision support for hospitalsthat attempts to integrate a range of engineering and sociotechnical models is presented. Genetic algorithms are applied to find the optimal decision sets. A case study is completed to demonstrate how the frameworkmay applytoa specific hospital.The simulations show that the proposed evolutionary decision support framework is able to discover robust policy sets in either uncertain or fixed environments. The framework also qualitatively identifies some of the characteristicbehavior of the critical care organization. Thus, by utilizing the proposedframework, the decision makers are able to make more informed decisions, especially toenhance the seismic safety of the hospitals.

Longitudinal associations between mothers' perceptions of nonresidential fathers' investment of resources and influence in decision-making.

PubMed

Fagan, Jay; Palkovitz, Rob

2018-02-01

Nonresidential fathers are challenged to remain involved with their children across time in both direct and indirect ways, including influencing decision-making around important issues such as school attendance and medical care. An analytic sample of 1,350 families with residential mothers and nonresidential fathers was selected from the Early Childhood Longitudinal Survey-Birth Cohort (ECLS-B) to examine the longitudinal relationships between mothers' reports of nonresidential fathers' influence in decision-making and their provision of resources to their children. Findings indicate that fathers' voluntary contribution of tangible resources (informal child support, caregiving time) when children are 2 years old positively predict fathers' influence in decision-making regarding the care of their 4-year-old children. Fathers' early formal child support is not related to later decision-making. Fathers' communication with mother about the child at 24 months is related to later decision-making among daughters but not sons. Fathers' early decision-making is longitudinally related to later informal child support, caregiving time, and coparenting communication. The findings support the utility of a resource theory of fathering for understanding and predicting observed patterns of father involvement. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Privacy-Preserving Patient-Centric Clinical Decision Support System on Naïve Bayesian Classification.

PubMed

Liu, Ximeng; Lu, Rongxing; Ma, Jianfeng; Chen, Le; Qin, Baodong

2016-03-01

Clinical decision support system, which uses advanced data mining techniques to help clinician make proper decisions, has received considerable attention recently. The advantages of clinical decision support system include not only improving diagnosis accuracy but also reducing diagnosis time. Specifically, with large amounts of clinical data generated everyday, naïve Bayesian classification can be utilized to excavate valuable information to improve a clinical decision support system. Although the clinical decision support system is quite promising, the flourish of the system still faces many challenges including information security and privacy concerns. In this paper, we propose a new privacy-preserving patient-centric clinical decision support system, which helps clinician complementary to diagnose the risk of patients' disease in a privacy-preserving way. In the proposed system, the past patients' historical data are stored in cloud and can be used to train the naïve Bayesian classifier without leaking any individual patient medical data, and then the trained classifier can be applied to compute the disease risk for new coming patients and also allow these patients to retrieve the top- k disease names according to their own preferences. Specifically, to protect the privacy of past patients' historical data, a new cryptographic tool called additive homomorphic proxy aggregation scheme is designed. Moreover, to leverage the leakage of naïve Bayesian classifier, we introduce a privacy-preserving top- k disease names retrieval protocol in our system. Detailed privacy analysis ensures that patient's information is private and will not be leaked out during the disease diagnosis phase. In addition, performance evaluation via extensive simulations also demonstrates that our system can efficiently calculate patient's disease risk with high accuracy in a privacy-preserving way.

How users adopt healthcare information: An empirical study of an online Q&A community.

PubMed

Jin, Jiahua; Yan, Xiangbin; Li, Yijun; Li, Yumei

2016-02-01

The emergence of social media technology has led to the creation of many online healthcare communities, where patients can easily share and look for healthcare-related information from peers who have experienced a similar problem. However, with increased user-generated content, there is a need to constantly analyse which content should be trusted as one sifts through enormous amounts of healthcare information. This study aims to explore patients' healthcare information seeking behavior in online communities. Based on dual-process theory and the knowledge adoption model, we proposed a healthcare information adoption model for online communities. This model highlights that information quality, emotional support, and source credibility are antecedent variables of adoption likelihood of healthcare information, and competition among repliers and involvement of recipients moderate the relationship between the antecedent variables and adoption likelihood. Empirical data were collected from the healthcare module of China's biggest Q&A community-Baidu Knows. Text mining techniques were adopted to calculate the information quality and emotional support contained in each reply text. A binary logistics regression model and hierarchical regression approach were employed to test the proposed conceptual model. Information quality, emotional support, and source credibility have significant and positive impact on healthcare information adoption likelihood, and among these factors, information quality has the biggest impact on a patient's adoption decision. In addition, competition among repliers and involvement of recipients were tested as moderating effects between these antecedent factors and the adoption likelihood. Results indicate competition among repliers positively moderates the relationship between source credibility and adoption likelihood, and recipients' involvement positively moderates the relationship between information quality, source credibility, and adoption decision. In addition to information quality and source credibility, emotional support has significant positive impact on individuals' healthcare information adoption decisions. Moreover, the relationships between information quality, source credibility, emotional support, and adoption decision are moderated by competition among repliers and involvement of recipients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Models, Measurements, and Local Decisions: Assessing and ...

EPA Pesticide Factsheets

This presentation includes a combination of modeling and measurement results to characterize near-source air quality in Newark, New Jersey with consideration of how this information could be used to inform decision making to reduce risk of health impacts. Decisions could include either exposure or emissions reduction, and a host of stakeholders, including residents, academics, NGOs, local and federal agencies. This presentation includes results from the C-PORT modeling system, and from a citizen science project from the local area. The National Exposure Research Laboratory (NERL) Computational Exposure Division (CED) develops and evaluates data, decision-support tools, and models to be applied to media-specific or receptor-specific problem areas. CED uses modeling-based approaches to characterize exposures, evaluate fate and transport, and support environmental diagnostics/forensics with input from multiple data sources. It also develops media- and receptor-specific models, process models, and decision support tools for use both within and outside of EPA.

New approaches for real time decision support systems

NASA Technical Reports Server (NTRS)

Hair, D. Charles; Pickslay, Kent

1994-01-01

NCCOSC RDT&E Division (NRaD) is conducting research into ways of improving decision support systems (DSS) that are used in tactical Navy decision making situations. The research has focused on the incorporation of findings about naturalistic decision-making processes into the design of the DSS. As part of that research, two computer tools were developed that model the two primary naturalistic decision-making strategies used by Navy experts in tactical settings. Current work is exploring how best to incorporate the information produced by those tools into an existing simulation of current Navy decision support systems. This work has implications for any applications involving the need to make decisions under time constraints, based on incomplete or ambiguous data.

Quality of online information on type 2 diabetes: a cross-sectional study.

PubMed

Weymann, Nina; Härter, Martin; Dirmaier, Jörg

2015-12-01

Evidence-based health information is a prerequisite for patients with type 2 diabetes to engage in self-management and to make informed medical decisions. The Internet is an important source of health information. In the present study, we systematically assessed formal quality, quality of decision support and usability of German and English language websites on type 2 diabetes. The search term 'type 2 diabetes' was entered in the two most popular search engines. Descriptive data on website quality are presented. Additionally, associations between website quality and affiliation (commercial vs. non-commercial), presence of the HON code quality seal and website traffic were explored. Forty-six websites were included. Most websites provided basic information necessary for decision-making, while only one website also provided decision support. Websites with a HON code had significantly better formal quality than websites without HON code. We found a highly significant correlation between usability and website traffic and a significant correlation between formal quality and website traffic. Most websites do not provide sufficient information to support patients in medical decision-making. Our finding that usability and website traffic are tightly associated is consistent with previous research indicating that design is the most important cue for users assessing website credibility. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: methods of a decision-maker-researcher partnership systematic review.

PubMed

Haynes, R Brian; Wilczynski, Nancy L

2010-02-05

Computerized clinical decision support systems are information technology-based systems designed to improve clinical decision-making. As with any healthcare intervention with claims to improve process of care or patient outcomes, decision support systems should be rigorously evaluated before widespread dissemination into clinical practice. Engaging healthcare providers and managers in the review process may facilitate knowledge translation and uptake. The objective of this research was to form a partnership of healthcare providers, managers, and researchers to review randomized controlled trials assessing the effects of computerized decision support for six clinical application areas: primary preventive care, therapeutic drug monitoring and dosing, drug prescribing, chronic disease management, diagnostic test ordering and interpretation, and acute care management; and to identify study characteristics that predict benefit. The review was undertaken by the Health Information Research Unit, McMaster University, in partnership with Hamilton Health Sciences, the Hamilton, Niagara, Haldimand, and Brant Local Health Integration Network, and pertinent healthcare service teams. Following agreement on information needs and interests with decision-makers, our earlier systematic review was updated by searching Medline, EMBASE, EBM Review databases, and Inspec, and reviewing reference lists through 6 January 2010. Data extraction items were expanded according to input from decision-makers. Authors of primary studies were contacted to confirm data and to provide additional information. Eligible trials were organized according to clinical area of application. We included randomized controlled trials that evaluated the effect on practitioner performance or patient outcomes of patient care provided with a computerized clinical decision support system compared with patient care without such a system. Data will be summarized using descriptive summary measures, including proportions for categorical variables and means for continuous variables. Univariable and multivariable logistic regression models will be used to investigate associations between outcomes of interest and study specific covariates. When reporting results from individual studies, we will cite the measures of association and p-values reported in the studies. If appropriate for groups of studies with similar features, we will conduct meta-analyses. A decision-maker-researcher partnership provides a model for systematic reviews that may foster knowledge translation and uptake.

Reducing Diagnostic Error with Computer-Based Clinical Decision Support

ERIC Educational Resources Information Center

Greenes, Robert A.

2009-01-01

Information technology approaches to delivering diagnostic clinical decision support (CDS) are the subject of the papers to follow in the proceedings. These will address the history of CDS and present day approaches (Miller), evaluation of diagnostic CDS methods (Friedman), and the role of clinical documentation in supporting diagnostic decision…

Decision Support Preferences Among Hispanic and Non-Hispanic White Older Adults With Chronic Musculoskeletal Pain.

PubMed

Riffin, Catherine; Pillemer, Karl; Reid, Manny C; Lӧckenhoff, Corinna E

2016-09-01

Despite broad recognition that social networks play a key role in the management of chronic musculoskeletal pain (CMP), little is known about when and why older adults with CMP choose to involve others in treatment decisions. This study investigates the types (i.e., informational, emotional, and instrumental) and sources (i.e., formal and informal) of support Hispanic and non-Hispanic White CMP patients desire and receive when making decisions about their pain care. Semi-structured interviews were conducted with Hispanic and non-Hispanic White older adults with CMP (N = 63) recruited from one medical center and one senior center in New York City. Interviews were transcribed and then analyzed using content analysis. CMP patients sought network members who supported their emotional well-being throughout the decision-making process. When considering high-stakes treatment decisions, participants selectively involved individuals who had similar pain conditions or first-hand experience with the procedure. Participants' perceptions of the decision-making process were contingent upon the congruence between the decision they made and the support they received for it. For Spanish-speaking participants, positive perceptions were linked with satisfactory language competence by their providers. On the other hand, lack of language competence among providers hindered Spanish speakers' ability to obtain adequate informational support. Results reveal the importance of empathic patient-provider exchanges across diverse patient populations and cultural sensitivity for Spanish-speaking patients. Findings suggest that social networks beyond the patient-provider dyad influence patients' decision-making satisfaction. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Harnessing ecosystem models and multi-criteria decision analysis for the support of forest management.

PubMed

Wolfslehner, Bernhard; Seidl, Rupert

2010-12-01

The decision-making environment in forest management (FM) has changed drastically during the last decades. Forest management planning is facing increasing complexity due to a widening portfolio of forest goods and services, a societal demand for a rational, transparent decision process and rising uncertainties concerning future environmental conditions (e.g., climate change). Methodological responses to these challenges include an intensified use of ecosystem models to provide an enriched, quantitative information base for FM planning. Furthermore, multi-criteria methods are increasingly used to amalgamate information, preferences, expert judgments and value expressions, in support of the participatory and communicative dimensions of modern forestry. Although the potential of combining these two approaches has been demonstrated in a number of studies, methodological aspects in interfacing forest ecosystem models (FEM) and multi-criteria decision analysis (MCDA) are scarcely addressed explicitly. In this contribution we review the state of the art in FEM and MCDA in the context of FM planning and highlight some of the crucial issues when combining ecosystem and preference modeling. We discuss issues and requirements in selecting approaches suitable for supporting FM planning problems from the growing body of FEM and MCDA concepts. We furthermore identify two major challenges in a harmonized application of FEM-MCDA: (i) the design and implementation of an indicator-based analysis framework capturing ecological and social aspects and their interactions relevant for the decision process, and (ii) holistic information management that supports consistent use of different information sources, provides meta-information as well as information on uncertainties throughout the planning process.

Harnessing Ecosystem Models and Multi-Criteria Decision Analysis for the Support of Forest Management

NASA Astrophysics Data System (ADS)

Wolfslehner, Bernhard; Seidl, Rupert

2010-12-01

The decision-making environment in forest management (FM) has changed drastically during the last decades. Forest management planning is facing increasing complexity due to a widening portfolio of forest goods and services, a societal demand for a rational, transparent decision process and rising uncertainties concerning future environmental conditions (e.g., climate change). Methodological responses to these challenges include an intensified use of ecosystem models to provide an enriched, quantitative information base for FM planning. Furthermore, multi-criteria methods are increasingly used to amalgamate information, preferences, expert judgments and value expressions, in support of the participatory and communicative dimensions of modern forestry. Although the potential of combining these two approaches has been demonstrated in a number of studies, methodological aspects in interfacing forest ecosystem models (FEM) and multi-criteria decision analysis (MCDA) are scarcely addressed explicitly. In this contribution we review the state of the art in FEM and MCDA in the context of FM planning and highlight some of the crucial issues when combining ecosystem and preference modeling. We discuss issues and requirements in selecting approaches suitable for supporting FM planning problems from the growing body of FEM and MCDA concepts. We furthermore identify two major challenges in a harmonized application of FEM-MCDA: (i) the design and implementation of an indicator-based analysis framework capturing ecological and social aspects and their interactions relevant for the decision process, and (ii) holistic information management that supports consistent use of different information sources, provides meta-information as well as information on uncertainties throughout the planning process.

Development and feasibility testing of decision support for patients who are candidates for a prophylactic implantable defibrillator: a study protocol for a pilot randomized controlled trial

PubMed Central

2013-01-01

Background Patients, identified to be at risk for but who have never experienced a potentially lethal cardiac arrhythmia, have the option of receiving an implantable cardioverter defibrillator (ICD) as prophylaxis against sudden cardiac death - a primary prevention indication. In Canada, there is no clear framework to support patients’ decision-making for these devices. Decision support, using a decision aid, could moderate treatment-related uncertainty and prepare patients to make well-informed decisions. Patient decision aids provide information on treatment options, risks, and benefits, to help patients clarify their values for outcomes of treatment options. The objectives of this research are: 1) develop a decision aid, 2) evaluate the decision aid, and 3) determine the feasibility of conducting a trial. Methods/design A development panel comprised of the core investigative team, health service researchers, decision science experts, cardiovascular healthcare practitioners, and ICD patient representatives will collaborate to provide input on the content and format of the aid. To generate probabilities to include in the aid, we will synthesize primary prevention ICD evidence. To obtain anonymous input about the facts and content, we will employ a modified Delphi process. To evaluate the draft decision aid will invite ICD patients and their families (n = 30) to rate its acceptability. After we evaluate the aid, to determine the feasibility, we will conduct a feasibility pilot randomized controlled trial (RCT) in new ICD candidates (n = 80). Participants will be randomized to receive a decision aid prior to specialist consultation versus usual care. Results from the pilot RCT will determine the feasibility of research processes; inform sample size calculation, measure decision quality (knowledge, values, decision conflict) and the influence of health related quality of life on decision-making. Discussion Our study seeks to develop a decision aid, for patients offered their first ICD for prophylaxis against sudden cardiac death. This paper outlines the background and methods of a pilot randomized trial which will inform a larger multicenter trial. Ultimately, decision support prior to specialist consultation could enhance the decision-making process between patients, physicians, and families, associated with life-prolonging medical devices like the ICD. Trial registration ClinicalTrials.gov: NCT01876173 PMID:24148851

Development and feasibility testing of decision support for patients who are candidates for a prophylactic implantable defibrillator: a study protocol for a pilot randomized controlled trial.

PubMed

Carroll, Sandra L; McGillion, Michael; Stacey, Dawn; Healey, Jeff S; Browne, Gina; Arthur, Heather M; Thabane, Lehana

2013-10-22

Patients, identified to be at risk for but who have never experienced a potentially lethal cardiac arrhythmia, have the option of receiving an implantable cardioverter defibrillator (ICD) as prophylaxis against sudden cardiac death - a primary prevention indication. In Canada, there is no clear framework to support patients' decision-making for these devices. Decision support, using a decision aid, could moderate treatment-related uncertainty and prepare patients to make well-informed decisions. Patient decision aids provide information on treatment options, risks, and benefits, to help patients clarify their values for outcomes of treatment options. The objectives of this research are: 1) develop a decision aid, 2) evaluate the decision aid, and 3) determine the feasibility of conducting a trial. A development panel comprised of the core investigative team, health service researchers, decision science experts, cardiovascular healthcare practitioners, and ICD patient representatives will collaborate to provide input on the content and format of the aid. To generate probabilities to include in the aid, we will synthesize primary prevention ICD evidence. To obtain anonymous input about the facts and content, we will employ a modified Delphi process. To evaluate the draft decision aid will invite ICD patients and their families (n = 30) to rate its acceptability. After we evaluate the aid, to determine the feasibility, we will conduct a feasibility pilot randomized controlled trial (RCT) in new ICD candidates (n = 80). Participants will be randomized to receive a decision aid prior to specialist consultation versus usual care. Results from the pilot RCT will determine the feasibility of research processes; inform sample size calculation, measure decision quality (knowledge, values, decision conflict) and the influence of health related quality of life on decision-making. Our study seeks to develop a decision aid, for patients offered their first ICD for prophylaxis against sudden cardiac death. This paper outlines the background and methods of a pilot randomized trial which will inform a larger multicenter trial. Ultimately, decision support prior to specialist consultation could enhance the decision-making process between patients, physicians, and families, associated with life-prolonging medical devices like the ICD. ClinicalTrials.gov: NCT01876173.

A decision support system for telemedicine through the mobile telecommunications platform.

PubMed

Eren, Ali; Subasi, Abdulhamit; Coskun, Osman

2008-02-01

In this paper we have discussed the application of artificial intelligence in telemedicine using mobile device. The main goal of our research is to develop methods and systems to collect, analyze, distribute and use medical diagnostics information from multiple knowledge sources and areas of expertise. Physicians may collect and analyze information obtained from experts worldwide with the help of a medical decision support system. In this information retrieval system, modern communication tools such as computers and mobile phones can be used efficiently. In this work we propose a medical decision support system using the general packet radio service (GPRS). GPRS, a data extension of the mobile telephony standard Global system for mobile communications (GSM) is emerging as the first true packet-switched architecture to allow mobile subscribers to benefit from high-speed transmission rates and run JAVA based applications from their mobile terminals. An academic prototype of a medical decision support system using mobile device was implemented. The results reveal that the system could find acceptance from the medical community and it could be an effective means of providing quality health care in developing countries.

Towards public health decision support: a systematic review of bidirectional communication approaches.

PubMed

Dixon, Brian E; Gamache, Roland E; Grannis, Shaun J

2013-05-01

To summarize the literature describing computer-based interventions aimed at improving bidirectional communication between clinical and public health. A systematic review of English articles using MEDLINE and Google Scholar. Search terms included public health, epidemiology, electronic health records, decision support, expert systems, and decision-making. Only articles that described the communication of information regarding emerging health threats from public health agencies to clinicians or provider organizations were included. Each article was independently reviewed by two authors. Ten peer-reviewed articles highlight a nascent but promising area of research and practice related to alerting clinicians about emerging threats. Current literature suggests that additional research and development in bidirectional communication infrastructure should focus on defining a coherent architecture, improving interoperability, establishing clear governance, and creating usable systems that will effectively deliver targeted, specific information to clinicians in support of patient and population decision-making. Increasingly available clinical information systems make it possible to deliver timely, relevant knowledge to frontline clinicians in support of population health. Future work should focus on developing a flexible, interoperable infrastructure for bidirectional communications capable of integrating public health knowledge into clinical systems and workflows.

Disaster Response and Decision Support in Partnership with the California Earthquake Clearinghouse

NASA Astrophysics Data System (ADS)

Glasscoe, M. T.; Rosinski, A.; Vaughan, D.; Morentz, J.

2014-12-01

Getting the right information to the right people at the right time is critical during a natural disaster. E-DECIDER (Emergency Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response) is a NASA decision support system designed to produce remote sensing and geophysical modeling data products that are relevant to the emergency preparedness and response communities and serve as a gateway to enable the delivery of NASA decision support products to these communities. The E-DECIDER decision support system has several tools, services, and products that have been used to support end-user exercises in partnership with the California Earthquake Clearinghouse since 2012, including near real-time deformation modeling results and on-demand maps of critical infrastructure that may have been potentially exposed to damage by a disaster. E-DECIDER's underlying service architecture allows the system to facilitate delivery of NASA decision support products to the Clearinghouse through XchangeCore Web Service Data Orchestration that allows trusted information exchange among partner agencies. This in turn allows Clearinghouse partners to visualize data products produced by E-DECIDER and other NASA projects through incident command software such as SpotOnResponse or ArcGIS Online.

A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder.

PubMed

Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

2018-02-01

Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. To explore patient and family perspectives of treatment decision-making in BPII. Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment; (2) Influences on decision-making; (3) The nature and flow of decision-making; (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.

Distributed collaborative environments for predictive battlespace awareness

NASA Astrophysics Data System (ADS)

McQuay, William K.

2003-09-01

The past decade has produced significant changes in the conduct of military operations: asymmetric warfare, the reliance on dynamic coalitions, stringent rules of engagement, increased concern about collateral damage, and the need for sustained air operations. Mission commanders need to assimilate a tremendous amount of information, make quick-response decisions, and quantify the effects of those decisions in the face of uncertainty. Situational assessment is crucial in understanding the battlespace. Decision support tools in a distributed collaborative environment offer the capability of decomposing complex multitask processes and distributing them over a dynamic set of execution assets that include modeling, simulations, and analysis tools. Decision support technologies can semi-automate activities, such as analysis and planning, that have a reasonably well-defined process and provide machine-level interfaces to refine the myriad of information that the commander must fused. Collaborative environments provide the framework and integrate models, simulations, and domain specific decision support tools for the sharing and exchanging of data, information, knowledge, and actions. This paper describes ongoing AFRL research efforts in applying distributed collaborative environments to predictive battlespace awareness.

Modifications and integration of the electronic tracking board in a pediatric emergency department.

PubMed

Dexheimer, Judith W; Kennebeck, Stephanie

2013-07-01

Electronic health records (EHRs) are used for data storage; provider, laboratory, and patient communication; clinical decision support; procedure and medication orders; and decision support alerts. Clinical decision support is part of any EHR and is designed to help providers make better decisions. The emergency department (ED) poses a unique environment to the use of EHRs and clinical decision support. Used effectively, computerized tracking boards can help improve flow, communication, and the dissemination of pertinent visit information between providers and other departments in a busy ED. We discuss the unique modifications and decisions made in the implementation of an EHR and computerized tracking board in a pediatric ED. We discuss the changing views based on provider roles, customization to the user interface including the layout and colors, decision support, tracking board best practices collected from other institutions and colleagues, and a case study of using reminders on the electronic tracking board to drive pain reassessments.

The Goal of Consistency as a Cause of Information Distortion

ERIC Educational Resources Information Center

Russo, J. Edward; Carlson, Kurt A.; Meloy, Margaret G.; Yong, Kevyn

2008-01-01

Why, during a decision between new alternatives, do people bias their evaluations of information to support a tentatively preferred option? The authors test the following 3 decision process goals as the potential drivers of such distortion of information: (a) to reduce the effort of evaluating new information, (b) to increase the separation…

Decision aids for randomised controlled trials: a qualitative exploration of stakeholders’ views

PubMed Central

Gillies, Katie; Skea, Zoë C; Campbell, Marion K

2014-01-01

Objectives To explore stakeholders’ perceptions of decision aids designed to support the informed consent decision-making process for randomised controlled trials. Design Qualitative semistructured interviews. Participants were provided with prototype trial decision aids in advance to stimulate discussion. Interviews were analysed using an established interpretive approach. Participants 23 stakeholders: Trial Managers (n=5); Research Nurses (n=5); Ethics Committee Chairs (n=5); patients (n=4) and Clinical Principal Investigators (n=4). Setting Embedded within two ongoing randomised controlled trials. All interviews conducted with UK-based participants. Results Certain key aspects (eg, values clarification exercises, presentation of probabilities, experiences of others and balance of options) in the prototype decision aids were perceived by all stakeholders as having a significant advantage (over existing patient information leaflets) in terms of supporting well informed appropriate decisions. However, there were some important differences between the stakeholder groups on specific content (eg, language used in the section on positive and negative features of taking part in a trial and the overall length of the trial decision aids). Generally the stakeholders believed trial decision aids have the potential to better engage potential participants in the decision-making process and allow them to make more personally relevant decisions about their participation. Conclusions Compared to existing patient information leaflets, stakeholders perceived decision aids for trial participation to have the potential to promote a more ‘informed’ decision-making process. Further efforts to develop, refine and formally evaluate trial decision aids should be explored. PMID:25138811

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

EPA Science Inventory

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...

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients.

PubMed

Velickovski, Filip; Ceccaroni, Luigi; Roca, Josep; Burgos, Felip; Galdiz, Juan B; Marina, Nuria; Lluch-Ariet, Magí

2014-11-28

The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients

PubMed Central

2014-01-01

Background The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. Objectives The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. Methods The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. Results A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Conclusions Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems. PMID:25471545

Executive Support Systems: An Innovation Decision Perspective

DTIC Science & Technology

1990-01-01

of the requirements for the degree of Master of Science Department of Management Science and Information Systems 1990 0 4 28 071 This thesis for the...Master of Science degree by Vern Edwin Hasenstein has been approved for the Department of Management Science and -formation Systems by James C...Dist Speolal Hasenstein, Vern Edwin (M.S., Management Science and Information Systems) Executive Support Systems: An Innovation-decision Perspective

Incorporating Pharmacogenomics into Health Information Technology, Electronic Health Record and Decision Support System: An Overview.

PubMed

Alanazi, Abdullah

2017-02-01

As the adoption of information technology in healthcare is rising, the potentiality of moving Pharmacogenomics from benchside to bedside is aggravated. This paper reviews the current status of Pharmacogenomics (PGx) information and the attempts for incorporating them into the Electronic Health Record (EHR) system through Decision Support Systems (DSSs). Rigorous review strategies of PGx information and providing context-relevant recommendations in form of action plan- dose adjustment, lab tests rather than just information- would be ideal for making clinical recommendations out of PGx information. Lastly, realistic projections of what pharmacogenomics can provide is another important aspect in incorporating Pharmacogenomics into health information technology.

Performance measurement integrated information framework in e-Manufacturing

NASA Astrophysics Data System (ADS)

Teran, Hilaida; Hernandez, Juan Carlos; Vizán, Antonio; Ríos, José

2014-11-01

The implementation of Internet technologies has led to e-Manufacturing technologies becoming more widely used and to the development of tools for compiling, transforming and synchronising manufacturing data through the Web. In this context, a potential area for development is the extension of virtual manufacturing to performance measurement (PM) processes, a critical area for decision making and implementing improvement actions in manufacturing. This paper proposes a PM information framework to integrate decision support systems in e-Manufacturing. Specifically, the proposed framework offers a homogeneous PM information exchange model that can be applied through decision support in e-Manufacturing environment. Its application improves the necessary interoperability in decision-making data processing tasks. It comprises three sub-systems: a data model, a PM information platform and PM-Web services architecture. A practical example of data exchange for measurement processes in the area of equipment maintenance is shown to demonstrate the utility of the model.

Practical considerations to guide development of access controls and decision support for genetic information in electronic medical records.

PubMed

Darcy, Diana C; Lewis, Eleanor T; Ormond, Kelly E; Clark, David J; Trafton, Jodie A

2011-11-02

Genetic testing is increasingly used as a tool throughout the health care system. In 2011 the number of clinically available genetic tests is approaching 2,000, and wide variation exists between these tests in their sensitivity, specificity, and clinical implications, as well as the potential for discrimination based on the results. As health care systems increasingly implement electronic medical record systems (EMRs) they must carefully consider how to use information from this wide spectrum of genetic tests, with whom to share information, and how to provide decision support for clinicians to properly interpret the information. Although some characteristics of genetic tests overlap with other medical test results, there are reasons to make genetic test results widely available to health care providers and counterbalancing reasons to restrict access to these test results to honor patient preferences, and avoid distracting or confusing clinicians with irrelevant but complex information. Electronic medical records can facilitate and provide reasonable restrictions on access to genetic test results and deliver education and decision support tools to guide appropriate interpretation and use. This paper will serve to review some of the key characteristics of genetic tests as they relate to design of access control and decision support of genetic test information in the EMR, emphasizing the clear need for health information technology (HIT) to be part of optimal implementation of genetic medicine, and the importance of understanding key characteristics of genetic tests when designing HIT applications.

Automated Modular Magnetic Resonance Imaging Clinical Decision Support System (MIROR): An Application in Pediatric Cancer Diagnosis

PubMed Central

Zarinabad, Niloufar; Meeus, Emma M; Manias, Karen; Foster, Katharine

2018-01-01

Background Advances in magnetic resonance imaging and the introduction of clinical decision support systems has underlined the need for an analysis tool to extract and analyze relevant information from magnetic resonance imaging data to aid decision making, prevent errors, and enhance health care. Objective The aim of this study was to design and develop a modular medical image region of interest analysis tool and repository (MIROR) for automatic processing, classification, evaluation, and representation of advanced magnetic resonance imaging data. Methods The clinical decision support system was developed and evaluated for diffusion-weighted imaging of body tumors in children (cohort of 48 children, with 37 malignant and 11 benign tumors). Mevislab software and Python have been used for the development of MIROR. Regions of interests were drawn around benign and malignant body tumors on different diffusion parametric maps, and extracted information was used to discriminate the malignant tumors from benign tumors. Results Using MIROR, the various histogram parameters derived for each tumor case when compared with the information in the repository provided additional information for tumor characterization and facilitated the discrimination between benign and malignant tumors. Clinical decision support system cross-validation showed high sensitivity and specificity in discriminating between these tumor groups using histogram parameters. Conclusions MIROR, as a diagnostic tool and repository, allowed the interpretation and analysis of magnetic resonance imaging images to be more accessible and comprehensive for clinicians. It aims to increase clinicians’ skillset by introducing newer techniques and up-to-date findings to their repertoire and make information from previous cases available to aid decision making. The modular-based format of the tool allows integration of analyses that are not readily available clinically and streamlines the future developments. PMID:29720361

Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial.

PubMed

Gimbel, Ronald W; Pirrallo, Ronald G; Lowe, Steven C; Wright, David W; Zhang, Lu; Woo, Min-Jae; Fontelo, Paul; Liu, Fang; Connor, Zachary

2018-03-12

The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering. Understanding what type and how information may influence clinical decision making in the ordering advanced medical imaging is important in shaping the optimal design and implementation of related clinical decision support systems. Multi-center, double-blinded simulation-based randomized controlled trial. Following standardized clinical vignette presentation, clinicians made an initial imaging decision for the patient. This was followed by additional information on decision support rules, malpractice outcome review, and patient cost; each with opportunity to modify their initial order. The malpractice and cost information differed by assigned group to test the any temporal relationship. The simulation closed with a second vignette and an imaging decision. One hundred sixteen of the 167 participants (66.9%) initially ordered a brain CT scan. After CCHR presentation, the number of clinicians ordering a CT dropped to 76 (45.8%), representing a 21.1% reduction in CT ordering (P = 0.002). This reduction in CT ordering was maintained, in comparison to initial imaging orders, when presented with malpractice review information (p = 0.002) and patient cost information (p = 0.002). About 57% of clinicians changed their order during study, while 43% never modified their imaging order. This study suggests that ED clinician brain CT imaging decisions may be influenced by clinical decision support rules, patient out-of-pocket cost information and findings from malpractice case review. NCT03449862 , February 27, 2018, Retrospectively registered.

“The problem often is that we do not have a family spokesperson but a spokesgroup”: Family Member Informal Roles in End-of-Life Decision-Making in Adult ICUs

PubMed Central

Quinn, Jill R.; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A.; Dombeck, Mary T.; Sellers, Craig R.

2013-01-01

Background To support the process of effective family decision-making, it is important to recognize and understand informal roles various family members may play in the end-of-life decision-making process. Objective The purpose of this study was to describe some informal roles consistently enacted by family members involved in the process of end-of-life decision-making in intensive care units (ICUs). Methods Ethnographic study. Data were collected via participant observation with field notes and semi-structured interviews on four ICUs in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical ICU, a surgical ICU, a burn and trauma ICU, and a cardiovascular ICU. Participants Participants included health care clinicians, patients, and family members. Results Informal roles for family members consistently observed were:, Primary Caregiver, Primary Decision Maker, Family Spokesperson, Out-of-Towner, Patient Wishes Expert, Protector, Vulnerable Member, and Health Care Expert. The identified informal roles were part of family decision making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision-making within the family system, and between the family and health care domains. Conclusions These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these family member informal roles can assist clinicians to recognize and understand the functions of these roles in family decision making at the end-of-life, and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes. PMID:22210699

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

PubMed

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.

DISPLA: decision information system for procurement and logistics analysis

NASA Astrophysics Data System (ADS)

Calvo, Alberto B.; Danish, Alexander J.; Lamonakis, Gregory G.

2002-08-01

This paper describes an information-exchange system for Display systems acquisition and logistics support. DISPLA (Decision Information System for Procurement and Logistics Analysis) is an Internet-based system concept for bringing sellers (display system and component suppliers) and buyers (Government Program Offices and System Integrators) together in an electronic exchange to improve the acquisition and logistics analysis support of Flat Panel Displays for the military. A proof-of-concept demonstration is presented in this paper using sample data from vendor Web sites and Government data sources.

Application of a web-based Decision Support System in risk management

NASA Astrophysics Data System (ADS)

Aye, Zar Chi; Jaboyedoff, Michel; Derron, Marc-Henri

2013-04-01

Increasingly, risk information is widely available with the help of advanced technologies such as earth observation satellites, global positioning technologies, coupled with hazard modeling and analysis, and geographical information systems (GIS). Even though it exists, no effort will be put into action if it is not properly presented to the decision makers. These information need to be communicated clearly and show its usefulness so that people can make better informed decision. Therefore, communicating available risk information has become an important challenge and decision support systems have been one of the significant approaches which can help not only in presenting risk information to the decision makers but also in making efficient decisions while reducing human resources and time needed. In this study, the conceptual framework of an internet-based decision support system is presented to highlight its importance role in risk management framework and how it can be applied in case study areas chosen. The main purpose of the proposed system is to facilitate the available risk information in risk reduction by taking into account of the changes in climate, land use and socio-economic along with the risk scenarios. It allows the users to formulate, compare and select risk reduction scenarios (mainly for floods and landslides) through an enhanced participatory platform with diverse stakeholders' involvement in the decision making process. It is based on the three-tier (client-server) architecture which integrates web-GIS plus DSS functionalities together with cost benefit analysis and other supporting tools. Embedding web-GIS provides its end users to make better planning and informed decisions referenced to a geographical location, which is the one of the essential factors in disaster risk reduction programs. Different risk reduction measures of a specific area (local scale) will be evaluated using this web-GIS tool, available risk scenarios obtained from Probabilistic Risk Assessment (PRA) model and the knowledge collected from experts. The visualization of the risk reduction scenarios can also be shared among the users on the web to support the on-line participatory process. In addition, cost-benefit ratios of the different risk reduction scenarios can be prepared in order to serve as inputs for high-level decision makers. The most appropriate risk reduction scenarios will be chosen using Multi-Criteria Evaluation (MCE) method by weighting different parameters according to the preferences and criteria defined by the users. The role of public participation has been changing from one-way communication between authorities, experts, stakeholders and citizens towards more intensive two-way interaction. Involving the affected public and interest groups can enhance the level of legitimacy, transparency, and confidence in the decision making process. Due to its important part in decision making, online participatory tool is included in the DSS in order to allow the involved stakeholders interactively in risk reduction and be aware of the existing vulnerability conditions of the community. Moreover, it aims to achieve a more transparent and better informed decision-making process. The system is under in progress and the first tools implemented will be presented showing the wide possibilities of new web technologies which can have a great impact on the decision making process. It will be applied in four pilot areas in Europe: French Alps, North Eastern Italy, Romania and Poland. Nevertheless, the framework will be designed and implemented in a way to be applicable in any other regions.

Translational Cognition for Decision Support in Critical Care Environments: A Review

PubMed Central

Patel, Vimla L.; Zhang, Jiajie; Yoskowitz, Nicole A.; Green, Robert; Sayan, Osman R.

2008-01-01

The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers. PMID:18343731

Translational cognition for decision support in critical care environments: a review.

PubMed

Patel, Vimla L; Zhang, Jiajie; Yoskowitz, Nicole A; Green, Robert; Sayan, Osman R

2008-06-01

The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real-world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers.

Emergency physicians' attitudes and preferences regarding computed tomography, radiation exposure, and imaging decision support.

PubMed

Griffey, Richard T; Jeffe, Donna B; Bailey, Thomas

2014-07-01

Although computerized decision support for imaging is often recommended for optimizing computed tomography (CT) use, no studies have evaluated emergency physicians' (EPs') preferences regarding computerized decision support in the emergency department (ED). In this needs assessment, the authors sought to determine if EPs view overutilization as a problem, if they want decision support, and if so, the kinds of support they prefer. A 42-item, Web-based survey of EPs was developed and used to measure EPs' attitudes, preferences, and knowledge. Key contacts at local EDs sent letters describing the study to their physicians. Exploratory principal components analysis (PCA) was used to determine the underlying factor structure of multi-item scales, Cronbach's alpha was used to measure internal consistency of items on a scale, Spearman correlations were used to describe bivariate associations, and multivariable linear regression analysis was used to identify variables independently associated with physician interest in decision support. Of 235 surveys sent, 155 (66%) EPs responded. Five factors emerged from the PCA. EPs felt that: 1) CT overutilization is a problem in the ED (α = 0.75); 2) a patient's cumulative CT study count affects decisions of whether and what type of imaging study to order only some of the time (α = 0.75); 3) knowledge that a patient has had prior CT imaging for the same indication makes EPs less likely to order a CT (α = 0.42); 4) concerns about malpractice, patient satisfaction, or insistence on CTs affect CT ordering decisions (α = 0.62); and 5) EPs want decision support before ordering CTs (α = 0.85). Performance on knowledge questions was poor, with only 18% to 39% correctly responding to each of the three multiple-choice items about effective radiation doses of chest radiograph and single-pass abdominopelvic CT, as well as estimated increased risk of cancer from a 10-mSv exposure. Although EPs wanted information on patients' cumulative exposures, they feel inadequately familiar with this information to make use of it clinically. If provided with patients' cumulative radiation exposures from CT, 87% of EPs said that they would use this information to discuss imaging options with their patients. In the multiple regression model, which included all variables associated with interest in decision support at p < 0.10 in bivariate tests, items independently associated with EPs' greater interest in all types of decision support proposed included lower total knowledge scores, greater frequency that cumulative CT study count affects EP's decision to order CTs, and greater agreement that overutilization of CT is a problem and that awareness of multiple prior CTs for a given indication affects CT ordering decisions. Emergency physicians view overutilization of CT scans as a problem with potential for improvement in the ED and would like to have more information to discuss risks with their patients. EPs are interested in all types of imaging decision support proposed to help optimize imaging ordering in the ED and to reduce radiation to their patients. Findings reveal several opportunities that could potentially affect CT utilization. © 2014 by the Society for Academic Emergency Medicine.

Emergency Physicians’ Attitudes and Preferences Regarding Computed Tomography, Radiation Exposure, and Imaging Decision Support

PubMed Central

Griffey, Richard T.; Jeffe, Donna B.; Bailey, Thomas

2014-01-01

Objectives Although computerized decision support for imaging is often recommended for optimizing computed tomography (CT) use, no studies have evaluated emergency physicians’ (EPs’) preferences regarding computerized decision support in the emergency department (ED). In this needs assessment, the authors sought to determine if EPs view overutilization as a problem, if they want decision support, and if so, the kinds of support they prefer. Methods A 42-item, Web-based survey of EPs was developed and used to measure EPs’ attitudes, preferences, and knowledge. Key contacts at local EDs sent letters describing the study to their physicians. Exploratory principal components analysis (PCA) was used to determine the underlying factor structure of multi-item scales, Cronbach’s alpha was used to measure internal consistency of items on a scale, Spearman correlations were used to describe bivariate associations, and multivariable linear regression analysis was used to identify variables independently associated with physician interest in decision support. Results Of 235 surveys sent, 155 (66%) EPs responded. Five factors emerged from the PCA. EPs felt that: 1) CT overutilization is a problem in the ED (α = 0.75); 2) a patient’s cumulative CT study count affects decisions of whether and what type of imaging study to order only some of the time (α = 0.75); 3) knowledge that a patient has had prior CT imaging for the same indication makes EPs less likely to order a CT (α = 0.42); 4) concerns about malpractice, patient satisfaction, or insistence on CTs affect CT ordering decisions (α = 0.62); and 5) EPs want decision support before ordering CTs (α = 0.85). Performance on knowledge questions was poor, with only 18% to 39% correctly responding to each of the three multiple-choice items about effective radiation doses of chest radiograph and single-pass abdominopelvic CT, as well as estimated increased risk of cancer from a 10-mSv exposure. Although EPs wanted information on patients’ cumulative exposures, they feel inadequately familiar with this information to make use of it clinically. If provided with patients’ cumulative radiation exposures from CT, 87% of EPs said that they would use this information to discuss imaging options with their patients. In the multiple regression model, which included all variables associated with interest in decision support at p < 0.10 in bivariate tests, items independently associated with EPs’ greater interest in all types of decision support proposed included lower total knowledge scores, greater frequency that cumulative CT study count affects EP’s decision to order CTs, and greater agreement that overutilization of CT is a problem and that awareness of multiple prior CTs for a given indication affects CT ordering decisions. Conclusions Emergency physicians view overutilization of CT scans as a problem with potential for improvement in the ED and would like to have more information to discuss risks with their patients. EPs are interested in all types of imaging decision support proposed to help optimize imaging ordering in the ED and to reduce radiation to their patients. Findings reveal several opportunities that could potentially affect CT utilization. PMID:25125272

Involvement and Influence of Healthcare Providers, Family Members, and Other Mutation Carriers in the Cancer Risk Management Decision-Making Process of BRCA1 and BRCA2 Mutation Carriers.

PubMed

Puski, Athena; Hovick, Shelly; Senter, Leigha; Toland, Amanda Ewart

2018-03-29

Deciding between increased cancer screening or prophylactic surgery and the timing of such procedures can be a difficult and complex process for women with BRCA mutations. There are gaps in our understanding of involvement of others in the decision-making process for women with BRCA mutations. This study evaluated the management decision-making process of women with BRCA mutations, focusing on the involvement of others. Grounded theory was used to analyze and code risk management decision-making information from interviews with 20 BRCA mutation carriers. Unaffected at-risk participants with a BRCA mutation, those under age 40, and those with no children described having a difficult time making risk management decisions. Physicians were an integral part of the decision-making process by providing decisional support and management recommendations. Family members and other mutation carriers filled similar yet distinct roles by providing experiential information as well as decisional and emotional support for carriers. Participants described genetic counselors as short-term providers of risk information and management recommendations. The study findings suggest that unaffected at-risk women, women under 40, and those who do not have children may benefit from additional support and information during the decision-making process. Genetic counselors are well trained to help women through this process and connect them with resources, and may be under-utilized in long-term follow-up for women with a BRCA mutation.

GET SMARTE: A DECISION SUPPORT SYSTEM TO REVITALIZE COMMUNITIES - CABERNET 2007

EPA Science Inventory

Sustainable Management Approaches and Revitalization Tools - electronic (SMARTe), is an open-source, web-based, decision support system for developing and evaluating future reuse scenarios for potentially contaminated land. SMARTe contains information and analysis tools for all a...

Improving Information Products for System 2 Decision Support

ERIC Educational Resources Information Center

Gibson, Neal

2010-01-01

The creation, maintenance, and management of Information Product (IP) systems that are used by organizations for complex decisions represent a unique set of challenges. These challenges are compounded when the purpose of such a systems is also for knowledge creation and dissemination. Information quality research to date has focused mainly upon…

13 CFR 107.620 - Requirements to obtain information from Portfolio Concerns.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and must be in English. (a) Information for initial Financing decision. Before extending any Financing... intended use of financing proceeds), cash flow analyses and projections as are necessary to support your investment decision. The information submitted must be consistent with the size and type of the business and...

75 FR 51864 - Self-Regulatory Organizations; Municipal Securities Rulemaking Board; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-23

... decisions. Data elements with respect to the SHORT subscription service that would be provided through the... information about technical data elements to support transmission and data-integrity processes between the... for making well-informed investment decisions. Broad access to the information collected by the SHORT...

Shared Decision Making for Better Schools.

ERIC Educational Resources Information Center

Brost, Paul

2000-01-01

Delegating decision making to those closest to implementation can result in better decisions, more support for improvement initiatives, and increased student performance. Shared decision making depends on capable school leadership, a professional community, instructional guidance mechanisms, knowledge and skills, information sharing, power, and…

Big-Data Based Decision-Support Systems to Improve Clinicians' Cognition.

PubMed

Roosan, Don; Samore, Matthew; Jones, Makoto; Livnat, Yarden; Clutter, Justin

2016-01-01

Complex clinical decision-making could be facilitated by using population health data to inform clinicians. In two previous studies, we interviewed 16 infectious disease experts to understand complex clinical reasoning. For this study, we focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. We found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians' cognition to deal with complex problems. These cognitive strategies could be supported by population health data, and all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records. Our findings provide directions for task allocation and design of decision-support applications for health care industry development of Big data based decision-support systems.

A decision-supported outpatient practice system.

PubMed Central

Barrows, R. C.; Allen, B. A.; Smith, K. C.; Arni, V. V.; Sherman, E.

1996-01-01

We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed. PMID:8947774

Big-Data Based Decision-Support Systems to Improve Clinicians’ Cognition

PubMed Central

Roosan, Don; Samore, Matthew; Jones, Makoto; Livnat, Yarden; Clutter, Justin

2016-01-01

Complex clinical decision-making could be facilitated by using population health data to inform clinicians. In two previous studies, we interviewed 16 infectious disease experts to understand complex clinical reasoning. For this study, we focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. We found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians’ cognition to deal with complex problems. These cognitive strategies could be supported by population health data, and all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records. Our findings provide directions for task allocation and design of decision-support applications for health care industry development of Big data based decision-support systems. PMID:27990498

Health preferences and decision-making needs of disadvantaged women.

PubMed

Bunn, Helen; Lange, Ilta; Urrutia, Mila; Campos, Maria Sylvia; Campos, Solange; Jaimovich, Sonia; Campos, Cecilia; Jacobsen, Mary Jane; Gaboury, Isabelle

2006-11-01

This paper reports the results of a survey of disadvantaged women in La Pintana, a municipality of Santiago, Chile, to determine their health decision-making needs. Research is needed as there is no published community-based study focusing specifically on health decision-making needs of disadvantaged women. From April to November 1999, we conducted a cross-sectional interview survey of women registered at primary healthcare centres in La Pintana, an impoverished municipality of Santiago, Chile. The survey participants were 554 adult women over 15 years of age. Seventy-five percent reported making current health-related decisions. Types of decisions were primarily about navigation: where, when and from whom to seek care. The most common role in decision-making was sharing the decision with others, specifically husbands and other family members. Fifty-four percent experienced decisional conflict or uncertainty about options. Those reporting more manifestations of decisional conflict were more likely to lack information on available options, pros and cons of the options, and chances of benefits and harms associated with the options; they were also more likely to be unclear about what was important to them, to feel pressure from others, lack skill or ability in decision-making and be older. The most common strategies used when making all types of decisions were obtaining information on options and recommendations, and getting support from others. Participants preferred to receive information about options through counselling from their physicians, rather than nurses, from printed materials and from discussion groups of people facing the same decision. The majority of disadvantaged women were actively involved in decision-making and needed decision support to navigate the healthcare system. Nurses should play a more pivotal role in providing health decision support. This study needs to be replicated in other countries and cultural contexts.

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

PubMed

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.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations.

PubMed

Quigley, Matthew; Dillon, Michael P; Fatone, Stefania

2018-02-01

Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

Facilitating informed choice in prenatal testing: how well are we doing?

PubMed

Marteau, T M; Dormandy, E

2001-01-01

There is a consensus that prenatal testing services need to provide the information and support necessary for women to make informed choices about prenatal testing. Informed choices are those based on relevant information that reflect the decision-maker's values. To date, most research has focused on the information provided to women deciding whether to undergo tests. This has highlighted the poor quality of information provided to many women. There is agreement on the need to provide information on three key aspects of any test: the condition for which testing is being offered, characteristics of the test, and the implications of testing. Very little research has been conducted on decisions after the diagnosis of a fetal abnormality and how information and emotional and decisional support are and should be provided. Research is now needed in four key areas: first, on the optimal ways of organizing services to facilitate choices that are not only based on relevant information, but also reflect the decision-maker's values; second, on the most effective ways of framing information needed for the different decisions involved in prenatal testing; third, on the most effective media in which to deliver information; and, fourth, to identify aspects of counseling that facilitate informed choices following diagnoses of fetal abnormality. If we value women's ability to make informed choices about prenatal tests as highly as we value reliable laboratory tests, evidence-based quality standards need to be developed for the information and support women are given at all stages of the process of prenatal testing.

Decision Making and Cancer

PubMed Central

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Pignone, Michael P.

2014-01-01

We review decision-making along the cancer continuum in the contemporary context of informed and shared decision making, in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PMID:25730718

An innovative approach to addressing childhood obesity: a knowledge-based infrastructure for supporting multi-stakeholder partnership decision-making in Quebec, Canada.

PubMed

Addy, Nii Antiaye; Shaban-Nejad, Arash; Buckeridge, David L; Dubé, Laurette

2015-01-23

Multi-stakeholder partnerships (MSPs) have become a widespread means for deploying policies in a whole of society strategy to address the complex problem of childhood obesity. However, decision-making in MSPs is fraught with challenges, as decision-makers are faced with complexity, and have to reconcile disparate conceptualizations of knowledge across multiple sectors with diverse sets of indicators and data. These challenges can be addressed by supporting MSPs with innovative tools for obtaining, organizing and using data to inform decision-making. The purpose of this paper is to describe and analyze the development of a knowledge-based infrastructure to support MSP decision-making processes. The paper emerged from a study to define specifications for a knowledge-based infrastructure to provide decision support for community-level MSPs in the Canadian province of Quebec. As part of the study, a process assessment was conducted to understand the needs of communities as they collect, organize, and analyze data to make decisions about their priorities. The result of this process is a "portrait", which is an epidemiological profile of health and nutrition in their community. Portraits inform strategic planning and development of interventions, and are used to assess the impact of interventions. Our key findings indicate ambiguities and disagreement among MSP decision-makers regarding causal relationships between actions and outcomes, and the relevant data needed for making decisions. MSP decision-makers expressed a desire for easy-to-use tools that facilitate the collection, organization, synthesis, and analysis of data, to enable decision-making in a timely manner. Findings inform conceptual modeling and ontological analysis to capture the domain knowledge and specify relationships between actions and outcomes. This modeling and analysis provide the foundation for an ontology, encoded using OWL 2 Web Ontology Language. The ontology is developed to provide semantic support for the MSP process, defining objectives, strategies, actions, indicators, and data sources. In the future, software interacting with the ontology can facilitate interactive browsing by decision-makers in the MSP in the form of concepts, instances, relationships, and axioms. Our ontology also facilitates the integration and interpretation of community data, and can help in managing semantic interoperability between different knowledge sources. Future work will focus on defining specifications for the development of a database of indicators and an information system to help decision-makers to view, analyze and organize indicators for their community. This work should improve MSP decision-making in the development of interventions to address childhood obesity.

An Innovative Approach to Addressing Childhood Obesity: A Knowledge-Based Infrastructure for Supporting Multi-Stakeholder Partnership Decision-Making in Quebec, Canada

PubMed Central

Addy, Nii Antiaye; Shaban-Nejad, Arash; Buckeridge, David L.; Dubé, Laurette

2015-01-01

Multi-stakeholder partnerships (MSPs) have become a widespread means for deploying policies in a whole of society strategy to address the complex problem of childhood obesity. However, decision-making in MSPs is fraught with challenges, as decision-makers are faced with complexity, and have to reconcile disparate conceptualizations of knowledge across multiple sectors with diverse sets of indicators and data. These challenges can be addressed by supporting MSPs with innovative tools for obtaining, organizing and using data to inform decision-making. The purpose of this paper is to describe and analyze the development of a knowledge-based infrastructure to support MSP decision-making processes. The paper emerged from a study to define specifications for a knowledge-based infrastructure to provide decision support for community-level MSPs in the Canadian province of Quebec. As part of the study, a process assessment was conducted to understand the needs of communities as they collect, organize, and analyze data to make decisions about their priorities. The result of this process is a “portrait”, which is an epidemiological profile of health and nutrition in their community. Portraits inform strategic planning and development of interventions, and are used to assess the impact of interventions. Our key findings indicate ambiguities and disagreement among MSP decision-makers regarding causal relationships between actions and outcomes, and the relevant data needed for making decisions. MSP decision-makers expressed a desire for easy-to-use tools that facilitate the collection, organization, synthesis, and analysis of data, to enable decision-making in a timely manner. Findings inform conceptual modeling and ontological analysis to capture the domain knowledge and specify relationships between actions and outcomes. This modeling and analysis provide the foundation for an ontology, encoded using OWL 2 Web Ontology Language. The ontology is developed to provide semantic support for the MSP process, defining objectives, strategies, actions, indicators, and data sources. In the future, software interacting with the ontology can facilitate interactive browsing by decision-makers in the MSP in the form of concepts, instances, relationships, and axioms. Our ontology also facilitates the integration and interpretation of community data, and can help in managing semantic interoperability between different knowledge sources. Future work will focus on defining specifications for the development of a database of indicators and an information system to help decision-makers to view, analyze and organize indicators for their community. This work should improve MSP decision-making in the development of interventions to address childhood obesity. PMID:25625409

Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study.

PubMed

Ellen, Moriah E; Léon, Grégory; Bouchard, Gisèle; Ouimet, Mathieu; Grimshaw, Jeremy M; Lavis, John N

2014-12-05

Mobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place. This qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Limited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to implementing supports for EIDM. The most frequently cited views about emerging development of supports for EIDM were implementing accessible and efficient systems to support the use of research in decision-making (e.g., documentation and reporting tools, communication tools, and decision support tools) and developing and implementing an infrastructure or position where the accountability for encouraging knowledge use lies. The most frequently stated priorities for bridging the gaps in the current mix of supports that these organizations have in place were implementing technical infrastructures to support research use and to ensure access to research evidence and establishing formal or informal ties to researchers and knowledge brokers outside the organization who can assist in EIDM. These results provide insights on the type of practical implementation imperatives involved in supporting EIDM.

Science and Systems in Support of Multi-hazard Early Warnings and Decisions

NASA Astrophysics Data System (ADS)

Pulwarty, R. S.

2015-12-01

The demand for improved climate knowledge and information is well documented. As noted in the IPCC (SREX, AR5), the UNISDR Global Assessment Reports and other assessments, this demand has increased pressure for information to support planning under changing rates and emergence of multiple hazards including climate extremes (drought, heat waves, floods). "Decision support" is now a popular term in the climate applications research community. While existing decision support activities can be identified in many disparate settings (e.g. federal, academic, private), the challenge of changing environments (coupled physical and social) is actually one of crafting implementation strategies for improving decision quality (not just meeting "user needs"). This includes overcoming weaknesses in co-production models, moving beyond DSSs as simply "software", coordinating innovation mapping and diffusion, and providing fora and gaming tools to identify common interests and differences in the way risks are perceived and managed among the affected groups. We outline the development and evolution of multi-hazard early warning systems in the United States and elsewhere, focusing on climate-related hazards. In particular, the presentation will focus on the climate science and information needed for (1) improved monitoring and modeling, (2) generating risk profiles, (3) developing information systems and scenarios for critical thresholds, (4) the net benefits of using new information (5) characterizing and bridging the "last mile" in the context of longer-term risk management.

Methods to assess landscape-scale risk of bark beetle infestation to support forest management decisions

Treesearch

T. L. Shore; A. Fall; W. G. Riel; J. Hughes; M. Eng

2010-01-01

The objective of our paper is to provide practitioners with suggestions on how to select appropriate methods for risk assessment of bark beetle infestations at the landscape scale in order to support their particular management decisions and to motivate researchers to refine novel risk assessment methods. Methods developed to assist and inform management decisions for...

Using a Context-aware Medical Application to Address Information Needs for Extubation Decisions

PubMed Central

Zhu, Xinxin; Lord, William

2005-01-01

Information overload has been one of the causes of preventable medical errors [1] and escalating costs [2]. A context-aware application with embedded clinical knowledge is proposed to provide practitioners with the appropriate amount of information and content. We developed a prototype of a context-aware medical application to address clinicians’ information needs that arise in a data-intensive unit, the Cardio-Thoracic Intensive Care Unit (CTICU). A major clinical decision supported by the prototype, the extubation decision, is illustrated. PMID:16779455

Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles.

PubMed

Horne, Avril C; Szemis, Joanna M; Webb, J Angus; Kaur, Simranjit; Stewardson, Michael J; Bond, Nick; Nathan, Rory

2018-03-01

One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles

NASA Astrophysics Data System (ADS)

Horne, Avril C.; Szemis, Joanna M.; Webb, J. Angus; Kaur, Simranjit; Stewardson, Michael J.; Bond, Nick; Nathan, Rory

2018-03-01

One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

Decision support model for assessing archaeological survey needs for bridge replacement projects in Iowa.

DOT National Transportation Integrated Search

2006-01-01

The Bridges Decision Support Model is a geographic information system (GIS) that assembles existing : data on archaeological sites, surveys, and their geologic contexts to assess the risk of bridge replacement : projects encountering 13,000- to 150-y...

Incorporating exposure information into the toxicological prioritization index decision support framework

EPA Science Inventory

The Toxicological Prioritization Index (ToxPi) decision support framework was previously developed to facilitate incorporation of diverse data to prioritize chemicals based on potential hazard. This ToxPi index was demonstrated by considering results of bioprofiling related to po...

Geospatial decision support systems for societal decision making

USGS Publications Warehouse

Bernknopf, R.L.

2005-01-01

While science provides reliable information to describe and understand the earth and its natural processes, it can contribute more. There are many important societal issues in which scientific information can play a critical role. Science can add greatly to policy and management decisions to minimize loss of life and property from natural and man-made disasters, to manage water, biological, energy, and mineral resources, and in general, to enhance and protect our quality of life. However, the link between science and decision-making is often complicated and imperfect. Technical language and methods surround scientific research and the dissemination of its results. Scientific investigations often are conducted under different conditions, with different spatial boundaries, and in different timeframes than those needed to support specific policy and societal decisions. Uncertainty is not uniformly reported in scientific investigations. If society does not know that data exist, what the data mean, where to use the data, or how to include uncertainty when a decision has to be made, then science gets left out -or misused- in a decision making process. This paper is about using Geospatial Decision Support Systems (GDSS) for quantitative policy analysis. Integrated natural -social science methods and tools in a Geographic Information System that respond to decision-making needs can be used to close the gap between science and society. The GDSS has been developed so that nonscientists can pose "what if" scenarios to evaluate hypothetical outcomes of policy and management choices. In this approach decision makers can evaluate the financial and geographic distribution of potential policy options and their societal implications. Actions, based on scientific information, can be taken to mitigate hazards, protect our air and water quality, preserve the planet's biodiversity, promote balanced land use planning, and judiciously exploit natural resources. Applications using the GDSS have demonstrated the benefits of utilizing science for policy decisions. Investment in science reduces decision-making uncertainty and reducing that uncertainty has economic value.

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed

Gadd, C S; Baskaran, P; Lobach, D F

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings.

Integrated Forecast-Decision Systems For River Basin Planning and Management

NASA Astrophysics Data System (ADS)

Georgakakos, A. P.

2005-12-01

A central application of climatology, meteorology, and hydrology is the generation of reliable forecasts for water resources management. In principle, effective use of forecasts could improve water resources management by providing extra protection against floods, mitigating the adverse effects of droughts, generating more hydropower, facilitating recreational activities, and minimizing the impacts of extreme events on the environment and the ecosystems. In practice, however, realization of these benefits depends on three requisite elements. First is the skill and reliability of forecasts. Second is the existence of decision support methods/systems with the ability to properly utilize forecast information. And third is the capacity of the institutional infrastructure to incorporate the information provided by the decision support systems into the decision making processes. This presentation discusses several decision support systems (DSS) using ensemble forecasting that have been developed by the Georgia Water Resources Institute for river basin management. These DSS are currently operational in Africa, Europe, and the US and address integrated water resources and energy planning and management in river basins with multiple water uses, multiple relevant temporal and spatial scales, and multiple decision makers. The article discusses the methods used and advocates that the design, development, and implementation of effective forecast-decision support systems must bring together disciplines, people, and institutions necessary to address today's complex water resources challenges.

Hypothesis-confirming information search strategies and computerized information-retrieval systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jacobs, S.M.

A recent trend in information-retrieval systems technology is the development of on-line information retrieval systems. One objective of these systems has been to attempt to enhance decision effectiveness by allowing users to preferentially seek information, thereby facilitating the reduction or elimination of information overload. These systems do not necessarily lead to more-effective decision making, however. Recent research in information-search strategy suggests that when users are seeking information subsequent to forming initial beliefs, they may preferentially seek information to confirm these beliefs. It seems that effective computer-based decision support requires an information retrieval system capable of: (a) retrieving a subset ofmore » all available information, in order to reduce information overload, and (b) supporting an information search strategy that considers all relevant information, rather than merely hypothesis-confirming information. An information retrieval system with an expert component (i.e., a knowledge-based DSS) should be able to provide these capabilities. Results of this study are non conclusive; there was neither strong confirmatory evidence nor strong disconfirmatory evidence regarding the effectiveness of the KBDSS.« less

Development of an evidence-based decision pathway for vestibular schwannoma treatment options.

PubMed

Linkov, Faina; Valappil, Benita; McAfee, Jacob; Goughnour, Sharon L; Hildrew, Douglas M; McCall, Andrew A; Linkov, Igor; Hirsch, Barry; Snyderman, Carl

To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS). This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS. Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model. The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives. Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways. Copyright © 2016 Elsevier Inc. All rights reserved.

Developing Mobile Clinical Decision Support for Nursing Home Staff Assessment of Urinary Tract Infection using Goal-Directed Design.

PubMed

Jones, Wallace; Drake, Cynthia; Mack, David; Reeder, Blaine; Trautner, Barbara; Wald, Heidi

2017-06-20

Unique characteristics of nursing homes (NHs) contribute to high rates of inappropriate antibiotic use for asymptomatic bacteriuria (ASB), a benign condition. A mobile clinical decision support system (CDSS) may support NH staff in differentiating urinary tract infections (UTI) from ASB and reducing antibiotic days. We used Goal-Directed Design to: 1) Characterize information needs for UTI identification and management in NHs; 2) Develop UTI Decide, a mobile CDSS prototype informed by personas and scenarios of use constructed from Aim 1 findings; 3) Evaluate the UTI Decide prototype with NH staff. Focus groups were conducted with providers and nurses in NHs in Denver, Colorado (n= 24). Qualitative descriptive analysis was applied to focus group transcripts to identify information needs and themes related to mobile clinical decision support for UTI identification and management. Personas representing typical end users were developed; typical clinical context scenarios were constructed using information needs as goals. Usability testing was performed using cognitive walk-throughs and a think-aloud protocol. Four information needs were identified including guidance regarding resident assessment; communication with providers; care planning; and urine culture interpretation. Design of a web-based application incorporating a published decision support algorithm for evidence-based UTI diagnoses proceeded with a focus on nursing information needs during resident assessment and communication with providers. Certified nursing assistant (CNA) and registered nurse (RN) personas were constructed in 4 context scenarios with associated key path scenarios. After field testing, a high fidelity prototype of UTI Decide was completed and evaluated by potential end users. Design recommendations and content recommendations were elicited. Goal-Directed Design informed the development of a mobile CDSS supporting participant-identified information needs for UTI assessment and communication in NHs. Future work will include iterative deployment and evaluation of UTI Decide in NHs to decrease inappropriate use of antibiotics for suspected UTI.

Use of handheld computers in clinical practice: a systematic review.

PubMed

Mickan, Sharon; Atherton, Helen; Roberts, Nia Wyn; Heneghan, Carl; Tilson, Julie K

2014-07-06

Many healthcare professionals use smartphones and tablets to inform patient care. Contemporary research suggests that handheld computers may support aspects of clinical diagnosis and management. This systematic review was designed to synthesise high quality evidence to answer the question; Does healthcare professionals' use of handheld computers improve their access to information and support clinical decision making at the point of care? A detailed search was conducted using Cochrane, MEDLINE, EMBASE, PsycINFO, Science and Social Science Citation Indices since 2001. Interventions promoting healthcare professionals seeking information or making clinical decisions using handheld computers were included. Classroom learning and the use of laptop computers were excluded. Two authors independently selected studies, assessed quality using the Cochrane Risk of Bias tool and extracted data. High levels of data heterogeneity negated statistical synthesis. Instead, evidence for effectiveness was summarised narratively, according to each study's aim for assessing the impact of handheld computer use. We included seven randomised trials investigating medical or nursing staffs' use of Personal Digital Assistants. Effectiveness was demonstrated across three distinct functions that emerged from the data: accessing information for clinical knowledge, adherence to guidelines and diagnostic decision making. When healthcare professionals used handheld computers to access clinical information, their knowledge improved significantly more than peers who used paper resources. When clinical guideline recommendations were presented on handheld computers, clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper resources. Finally, healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on handheld computers compared to colleagues who did not have access to these tools. For these clinical decisions, the numbers need to test/screen were all less than 11. Healthcare professionals' use of handheld computers may improve their information seeking, adherence to guidelines and clinical decision making. Handheld computers can provide real time access to and analysis of clinical information. The integration of clinical decision support systems within handheld computers offers clinicians the highest level of synthesised evidence at the point of care. Future research is needed to replicate these early results and to identify beneficial clinical outcomes.

Use of handheld computers in clinical practice: a systematic review

PubMed Central

2014-01-01

Background Many healthcare professionals use smartphones and tablets to inform patient care. Contemporary research suggests that handheld computers may support aspects of clinical diagnosis and management. This systematic review was designed to synthesise high quality evidence to answer the question; Does healthcare professionals’ use of handheld computers improve their access to information and support clinical decision making at the point of care? Methods A detailed search was conducted using Cochrane, MEDLINE, EMBASE, PsycINFO, Science and Social Science Citation Indices since 2001. Interventions promoting healthcare professionals seeking information or making clinical decisions using handheld computers were included. Classroom learning and the use of laptop computers were excluded. Two authors independently selected studies, assessed quality using the Cochrane Risk of Bias tool and extracted data. High levels of data heterogeneity negated statistical synthesis. Instead, evidence for effectiveness was summarised narratively, according to each study’s aim for assessing the impact of handheld computer use. Results We included seven randomised trials investigating medical or nursing staffs’ use of Personal Digital Assistants. Effectiveness was demonstrated across three distinct functions that emerged from the data: accessing information for clinical knowledge, adherence to guidelines and diagnostic decision making. When healthcare professionals used handheld computers to access clinical information, their knowledge improved significantly more than peers who used paper resources. When clinical guideline recommendations were presented on handheld computers, clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper resources. Finally, healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on handheld computers compared to colleagues who did not have access to these tools. For these clinical decisions, the numbers need to test/screen were all less than 11. Conclusion Healthcare professionals’ use of handheld computers may improve their information seeking, adherence to guidelines and clinical decision making. Handheld computers can provide real time access to and analysis of clinical information. The integration of clinical decision support systems within handheld computers offers clinicians the highest level of synthesised evidence at the point of care. Future research is needed to replicate these early results and to identify beneficial clinical outcomes. PMID:24998515

Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: Implications for eHealth.

PubMed

Cooley, Mary E; Nayak, Manan M; Abrahm, Janet L; Braun, Ilana M; Rabin, Michael S; Brzozowski, Jane; Lathan, Christopher; Berry, Donna L

2017-08-01

Adequate symptom and quality-of-life (SQL) management is a priority during cancer treatment. eHealth is a timely way to enhance patient-engagement, facilitate communication, and improve health outcomes. The objectives of this study were to describe patient and caregivers' perspectives for providing, processing, and managing SQL data to enhance communication and identify desired components for decision support. Data were collected from 64 participants through questionnaires and focus groups. Analysis was conducted using NVivo. Open and axial coding was completed, grouping commonalities and large constructs into nodes to identify and synthesize themes. Face-to-face meetings with clinicians were the prime time to communicate, and patients strove to understand treatment options and the effect on SQL by bringing caregivers to their visits, taking notes, tracking symptoms, and creating portable health records. Patients/caregivers struggled to self-manage their symptoms and were uncertain when to contact clinicians when experiencing uncontrolled symptoms. Most participants identified eHealth solutions for decision support. However, 38% of participants (n = 24) rarely used computers and identified non-eHealth options for decision support. Core components for both eHealth and non-eHealth systems were access to (1) cancer information, (2) medical records, (3) peer support, and (4) improved support and understanding on when to contact clinicians. Patients were faced with an overwhelming amount of information and relied on their caregivers to help navigate the complexities of cancer care and self-manage SQL. Health technologies can provide informational support; however, decision support needs to span multiple venues to avoid increasing disparities caused by a digital divide. Copyright © 2017 John Wiley & Sons, Ltd.

Improvement of sand filter and constructed wetland design using an environmental decision support system.

PubMed

Turon, Clàudia; Comas, Joaquim; Torrens, Antonina; Molle, Pascal; Poch, Manel

2008-01-01

With the aim of improving effluent quality of waste stabilization ponds, different designs of vertical flow constructed wetlands and intermittent sand filters were tested on an experimental full-scale plant within the framework of a European project. The information extracted from this study was completed and updated with heuristic and bibliographic knowledge. The data and knowledge acquired were difficult to integrate into mathematical models because they involve qualitative information and expert reasoning. Therefore, it was decided to develop an environmental decision support system (EDSS-Filter-Design) as a tool to integrate mathematical models and knowledge-based techniques. This paper describes the development of this support tool, emphasizing the collection of data and knowledge and representation of this information by means of mathematical equations and a rule-based system. The developed support tool provides the main design characteristics of filters: (i) required surface, (ii) media type, and (iii) media depth. These design recommendations are based on wastewater characteristics, applied load, and required treatment level data provided by the user. The results of the EDSS-Filter-Design provide appropriate and useful information and guidelines on how to design filters, according to the expert criteria. The encapsulation of the information into a decision support system reduces the design period and provides a feasible, reasoned, and positively evaluated proposal.

Concept of information technology of monitoring and decision-making support

NASA Astrophysics Data System (ADS)

Kovalenko, Aleksandr S.; Tymchyk, Sergey V.; Kostyshyn, Sergey V.; Zlepko, Sergey M.; Wójcik, Waldemar; Kalizhanova, Aliya; Burlibay, Aron; Kozbekova, Ainur

2017-08-01

Presented concept of information technology monitoring and decision support to determine the health of students. The preconditions of a concept formulated its goal and purpose. Subject area concepts proposed to consider a set of problems, grouped into 8 categories, which in turn necessitates the application when creating technology basic principles from the principles of "first head" and "systems approach" to the principles of "interoperability" and "system integration ". The content of the information providing IT, its position in the segment of single information space, stages of creation. To evaluate the efficiency of the IT system developed proposed criteria.

Clinical decision support for whole genome sequence information leveraging a service-oriented architecture: a prototype.

PubMed

Welch, Brandon M; Rodriguez-Loya, Salvador; Eilbeck, Karen; Kawamoto, Kensaku

2014-01-01

Whole genome sequence (WGS) information could soon be routinely available to clinicians to support the personalized care of their patients. At such time, clinical decision support (CDS) integrated into the clinical workflow will likely be necessary to support genome-guided clinical care. Nevertheless, developing CDS capabilities for WGS information presents many unique challenges that need to be overcome for such approaches to be effective. In this manuscript, we describe the development of a prototype CDS system that is capable of providing genome-guided CDS at the point of care and within the clinical workflow. To demonstrate the functionality of this prototype, we implemented a clinical scenario of a hypothetical patient at high risk for Lynch Syndrome based on his genomic information. We demonstrate that this system can effectively use service-oriented architecture principles and standards-based components to deliver point of care CDS for WGS information in real-time.

Situationally-Sensitive Knowledge Translation and Relational Decision Making in Hyperacute Stroke: A Qualitative Study

PubMed Central

Murtagh, Madeleine J.; Burges Watson, Duika L.; Jenkings, K. Neil; Lie, Mabel L. S.; Mackintosh, Joan E.; Ford, Gary A.; Thomson, Richard G.

2012-01-01

Stroke is a leading cause of disability. Early treatment of acute ischaemic stroke with rtPA reduces the risk of longer term dependency but carries an increased risk of causing immediate bleeding complications. To understand the challenges of knowledge translation and decision making about treatment with rtPA in hyperacute stroke and hence to inform development of appropriate decision support we interviewed patients, their family and health professionals. The emergency setting and the symptomatic effects of hyper-acute stroke shaped the form, content and manner of knowledge translation to support decision making. Decision making about rtPA in hyperacute stroke presented three conundrums for patients, family and clinicians. 1) How to allow time for reflection in a severely time-limited setting. 2) How to facilitate knowledge translation regarding important treatment risks and benefits when patient and family capacity is blunted by the effects and shock of stroke. 3) How to ensure patient and family views are taken into account when the situation produces reliance on the expertise of clinicians. Strategies adopted to meet these conundrums were fourfold: face to face communication; shaping decisions; incremental provision of information; and communication tailored to the individual patient. Relational forms of interaction were understood to engender trust and allay anxiety. Shaping decisions with patients was understood as an expression of confidence by clinicians that helped alleviate anxiety and offered hope and reassurance to patients and their family experiencing the shock of the stroke event. Neutral presentations of information and treatment options promoted uncertainty and contributed to anxiety. ‘Drip feeding’ information created moments for reflection: clinicians literally made time. Tailoring information to the particular patient and family situation allowed clinicians to account for social and emotional contexts. The principal responses to the challenges of decision making about rtPA in hyperacute stroke were relational decision support and situationally-sensitive knowledge translation. PMID:22675477

Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study.

PubMed

Murtagh, Madeleine J; Burges Watson, Duika L; Jenkings, K Neil; Lie, Mabel L S; Mackintosh, Joan E; Ford, Gary A; Thomson, Richard G

2012-01-01

Stroke is a leading cause of disability. Early treatment of acute ischaemic stroke with rtPA reduces the risk of longer term dependency but carries an increased risk of causing immediate bleeding complications. To understand the challenges of knowledge translation and decision making about treatment with rtPA in hyperacute stroke and hence to inform development of appropriate decision support we interviewed patients, their family and health professionals. The emergency setting and the symptomatic effects of hyper-acute stroke shaped the form, content and manner of knowledge translation to support decision making. Decision making about rtPA in hyperacute stroke presented three conundrums for patients, family and clinicians. 1) How to allow time for reflection in a severely time-limited setting. 2) How to facilitate knowledge translation regarding important treatment risks and benefits when patient and family capacity is blunted by the effects and shock of stroke. 3) How to ensure patient and family views are taken into account when the situation produces reliance on the expertise of clinicians. Strategies adopted to meet these conundrums were fourfold: face to face communication; shaping decisions; incremental provision of information; and communication tailored to the individual patient. Relational forms of interaction were understood to engender trust and allay anxiety. Shaping decisions with patients was understood as an expression of confidence by clinicians that helped alleviate anxiety and offered hope and reassurance to patients and their family experiencing the shock of the stroke event. Neutral presentations of information and treatment options promoted uncertainty and contributed to anxiety. 'Drip feeding' information created moments for reflection: clinicians literally made time. Tailoring information to the particular patient and family situation allowed clinicians to account for social and emotional contexts. The principal responses to the challenges of decision making about rtPA in hyperacute stroke were relational decision support and situationally-sensitive knowledge translation.

Just in Time: How Evidence-on-Demand Services Support Decision Making in Ontario's Child and Youth Mental Health Sector

ERIC Educational Resources Information Center

Notarianni, Maryann; Sundar, Purnima; Carter, Charles

2016-01-01

Using the best available evidence to inform decision making is important for the design or delivery of effective health-related services and broader public policy. Several studies identify barriers and facilitators to evidence-informed decision making in Canadian health settings. This paper describes how the Ontario Centre of Excellence for Child…

Towards public health decision support: a systematic review of bidirectional communication approaches

PubMed Central

Dixon, Brian E; Gamache, Roland E; Grannis, Shaun J

2013-01-01

Objective To summarize the literature describing computer-based interventions aimed at improving bidirectional communication between clinical and public health. Materials and Methods A systematic review of English articles using MEDLINE and Google Scholar. Search terms included public health, epidemiology, electronic health records, decision support, expert systems, and decision-making. Only articles that described the communication of information regarding emerging health threats from public health agencies to clinicians or provider organizations were included. Each article was independently reviewed by two authors. Results Ten peer-reviewed articles highlight a nascent but promising area of research and practice related to alerting clinicians about emerging threats. Current literature suggests that additional research and development in bidirectional communication infrastructure should focus on defining a coherent architecture, improving interoperability, establishing clear governance, and creating usable systems that will effectively deliver targeted, specific information to clinicians in support of patient and population decision-making. Conclusions Increasingly available clinical information systems make it possible to deliver timely, relevant knowledge to frontline clinicians in support of population health. Future work should focus on developing a flexible, interoperable infrastructure for bidirectional communications capable of integrating public health knowledge into clinical systems and workflows. PMID:23467470

Integrated Modeling and Simulation Verification, Validation, and Accreditation Strategy for Exploration Systems Mission Directorate

NASA Technical Reports Server (NTRS)

Hale, Joseph P.

2006-01-01

Models and simulations (M&S) are critical resources in the exploration of space. They support program management, systems engineering, integration, analysis, test, and operations and provide critical information and data supporting key analyses and decisions (technical, cost and schedule). Consequently, there is a clear need to establish a solid understanding of M&S strengths and weaknesses, and the bounds within which they can credibly support decision-making. Their usage requires the implementation of a rigorous approach to verification, validation and accreditation (W&A) and establishment of formal process and practices associated with their application. To ensure decision-making is suitably supported by information (data, models, test beds) from activities (studies, exercises) from M&S applications that are understood and characterized, ESMD is establishing formal, tailored W&A processes and practices. In addition, to ensure the successful application of M&S within ESMD, a formal process for the certification of analysts that use M&S is being implemented. This presentation will highlight NASA's Exploration Systems Mission Directorate (ESMD) management approach for M&S W&A to ensure decision-makers receive timely information on the model's fidelity, credibility, and quality.

Health information technology: use it well, or don't! Findings from the use of a decision support system for breast cancer management.

PubMed

Bouaud, Jacques; Blaszka-Jaulerry, Brigitte; Zelek, Laurent; Spano, Jean-Philippe; Lefranc, Jean-Pierre; Cojean-Zelek, Isabelle; Durieux, Axel; Tournigand, Christophe; Rousseau, Alexandra; Séroussi, Brigitte

2014-01-01

The potential of health information technology is hampered by new types of errors which impact is not totally assessed. OncoDoc2 is a decision support system designed to support treatment decisions of multidisciplinary meetings (MDMs) for breast cancer patients. We evaluated how the way the system was used had an impact on MDM decision compliance with clinical practice guidelines. We distinguished "correct navigations" (N+), "incorrect navigations" (N-), and "missing navigations" (N0), according to the quality of data entry when using OncoDoc2. We collected 557 MDM decisions from three hospitals of Paris area (France) where OncoDoc2 was routinely used. We observed 33.9% N+, 36.8% N-, and 29.3% N0. The compliance rate was significantly different according to the quality of navigations, 94.2%, 80.0%, and 90.2% for N+, N-, and N0 respectively. Surprinsingly, it was better not to use the system (N0) than to use it improperly (N-).

E-DECIDER Decision Support Gateway For Earthquake Disaster Response

NASA Astrophysics Data System (ADS)

Glasscoe, M. T.; Stough, T. M.; Parker, J. W.; Burl, M. C.; Donnellan, A.; Blom, R. G.; Pierce, M. E.; Wang, J.; Ma, Y.; Rundle, J. B.; Yoder, M. R.

2013-12-01

Earthquake Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response (E-DECIDER) is a NASA-funded project developing capabilities for decision-making utilizing remote sensing data and modeling software in order to provide decision support for earthquake disaster management and response. E-DECIDER incorporates earthquake forecasting methodology and geophysical modeling tools developed through NASA's QuakeSim project in order to produce standards-compliant map data products to aid in decision-making following an earthquake. Remote sensing and geodetic data, in conjunction with modeling and forecasting tools, help provide both long-term planning information for disaster management decision makers as well as short-term information following earthquake events (i.e. identifying areas where the greatest deformation and damage has occurred and emergency services may need to be focused). E-DECIDER utilizes a service-based GIS model for its cyber-infrastructure in order to produce standards-compliant products for different user types with multiple service protocols (such as KML, WMS, WFS, and WCS). The goal is to make complex GIS processing and domain-specific analysis tools more accessible to general users through software services as well as provide system sustainability through infrastructure services. The system comprises several components, which include: a GeoServer for thematic mapping and data distribution, a geospatial database for storage and spatial analysis, web service APIs, including simple-to-use REST APIs for complex GIS functionalities, and geoprocessing tools including python scripts to produce standards-compliant data products. These are then served to the E-DECIDER decision support gateway (http://e-decider.org), the E-DECIDER mobile interface, and to the Department of Homeland Security decision support middleware UICDS (Unified Incident Command and Decision Support). The E-DECIDER decision support gateway features a web interface that delivers map data products including deformation modeling results (slope change and strain magnitude) and aftershock forecasts, with remote sensing change detection results under development. These products are event triggered (from the USGS earthquake feed) and will be posted to event feeds on the E-DECIDER webpage and accessible via the mobile interface and UICDS. E-DECIDER also features a KML service that provides infrastructure information from the FEMA HAZUS database through UICDS and the mobile interface. The back-end GIS service architecture and front-end gateway components form a decision support system that is designed for ease-of-use and extensibility for end-users.

Information systems: the key to evidence-based health practice.

PubMed Central

Rodrigues, R. J.

2000-01-01

Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems. PMID:11143195

Assessing electronic health record systems in emergency departments: Using a decision analytic Bayesian model.

PubMed

Ben-Assuli, Ofir; Leshno, Moshe

2016-09-01

In the last decade, health providers have implemented information systems to improve accuracy in medical diagnosis and decision-making. This article evaluates the impact of an electronic health record on emergency department physicians' diagnosis and admission decisions. A decision analytic approach using a decision tree was constructed to model the admission decision process to assess the added value of medical information retrieved from the electronic health record. Using a Bayesian statistical model, this method was evaluated on two coronary artery disease scenarios. The results show that the cases of coronary artery disease were better diagnosed when the electronic health record was consulted and led to more informed admission decisions. Furthermore, the value of medical information required for a specific admission decision in emergency departments could be quantified. The findings support the notion that physicians and patient healthcare can benefit from implementing electronic health record systems in emergency departments. © The Author(s) 2015.

A decision support framework for characterizing and managing dermal exposures to chemicals during Emergency Management and Operations.

PubMed

Dotson, G Scott; Hudson, Naomi L; Maier, Andrew

2015-01-01

Emergency Management and Operations (EMO) personnel are in need of resources and tools to assist in understanding the health risks associated with dermal exposures during chemical incidents. This article reviews available resources and presents a conceptual framework for a decision support system (DSS) that assists in characterizing and managing risk during chemical emergencies involving dermal exposures. The framework merges principles of three decision-making techniques: 1) scenario planning, 2) risk analysis, and 3) multicriteria decision analysis (MCDA). This DSS facilitates dynamic decision making during each of the distinct life cycle phases of an emergency incident (ie, preparedness, response, or recovery) and identifies EMO needs. A checklist tool provides key questions intended to guide users through the complexities of conducting a dermal risk assessment. The questions define the scope of the framework for resource identification and application to support decision-making needs. The framework consists of three primary modules: 1) resource compilation, 2) prioritization, and 3) decision. The modules systematically identify, organize, and rank relevant information resources relating to the hazards of dermal exposures to chemicals and risk management strategies. Each module is subdivided into critical elements designed to further delineate the resources based on relevant incident phase and type of information. The DSS framework provides a much needed structure based on contemporary decision analysis principles for 1) documenting key questions for EMO problem formulation and 2) a method for systematically organizing, screening, and prioritizing information resources on dermal hazards, exposures, risk characterization, and management.

A decision support framework for characterizing and managing dermal exposures to chemicals during Emergency Management and Operations

PubMed Central

Dotson, G. Scott; Hudson, Naomi L.; Maier, Andrew

2016-01-01

Emergency Management and Operations (EMO) personnel are in need of resources and tools to assist in understanding the health risks associated with dermal exposures during chemical incidents. This article reviews available resources and presents a conceptual framework for a decision support system (DSS) that assists in characterizing and managing risk during chemical emergencies involving dermal exposures. The framework merges principles of three decision-making techniques: 1) scenario planning, 2) risk analysis, and 3) multicriteria decision analysis (MCDA). This DSS facilitates dynamic decision making during each of the distinct life cycle phases of an emergency incident (ie, preparedness, response, or recovery) and identifies EMO needs. A checklist tool provides key questions intended to guide users through the complexities of conducting a dermal risk assessment. The questions define the scope of the framework for resource identification and application to support decision-making needs. The framework consists of three primary modules: 1) resource compilation, 2) prioritization, and 3) decision. The modules systematically identify, organize, and rank relevant information resources relating to the hazards of dermal exposures to chemicals and risk management strategies. Each module is subdivided into critical elements designed to further delineate the resources based on relevant incident phase and type of information. The DSS framework provides a much needed structure based on contemporary decision analysis principles for 1) documenting key questions for EMO problem formulation and 2) a method for systematically organizing, screening, and prioritizing information resources on dermal hazards, exposures, risk characterization, and management. PMID:26312660

Capturing information needs of care providers to support knowledge sharing and distributed decision making.

PubMed

Rogers, M; Zach, L; An, Y; Dalrymple, P

2012-01-01

This paper reports on work carried out to elicit information needs at a trans-disciplinary, nurse-managed health care clinic that serves a medically disadvantaged urban population. The trans-disciplinary model provides a "one-stop shop" for patients who can receive a wide range of services beyond traditional primary care. However, this model of health care presents knowledge sharing challenges because little is known about how data collected from the non-traditional services can be integrated into the traditional electronic medical record (EMR) and shared with other care providers. There is also little known about how health information technology (HIT) can be used to support the workflow in such a practice. The objective of this case study was to identify the information needs of care providers in order to inform the design of HIT to support knowledge sharing and distributed decision making. A participatory design approach is presented as a successful technique to specify requirements for HIT applications that can support a trans-disciplinary model of care. Using this design approach, the researchers identified the information needs of care providers working at the clinic and suggested HIT improvements to integrate non-traditional information into the EMR. These modifications allow knowledge sharing among care providers and support better health decisions. We have identified information needs of care providers as they are relevant to the design of health information systems. As new technology is designed and integrated into various workflows it is clear that understanding information needs is crucial to acceptance of that technology.

Linking guidelines to Electronic Health Record design for improved chronic disease management.

PubMed

Barretto, Sistine A; Warren, Jim; Goodchild, Andrew; Bird, Linda; Heard, Sam; Stumptner, Markus

2003-01-01

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and workflow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR.

Linking Guidelines to Electronic Health Record Design for Improved Chronic Disease Management

PubMed Central

Barretto, Sistine A.; Warren, Jim; Goodchild, Andrew; Bird, Linda; Heard, Sam; Stumptner, Markus

2003-01-01

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and work-flow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR. PMID:14728135

SUPPORT Tools for evidence-informed health Policymaking (STP)

PubMed Central

2009-01-01

This article is the Introduction to a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Knowing how to find and use research evidence can help policymakers and those who support them to do their jobs better and more efficiently. Each article in this series presents a proposed tool that can be used by those involved in finding and using research evidence to support evidence-informed health policymaking. The series addresses four broad areas: 1. Supporting evidence-informed policymaking 2. Identifying needs for research evidence in relation to three steps in policymaking processes, namely problem clarification, options framing, and implementation planning 3. Finding and assessing both systematic reviews and other types of evidence to inform these steps, and 4. Going from research evidence to decisions. Each article begins with between one and three typical scenarios relating to the topic. These scenarios are designed to help readers decide on the level of detail relevant to them when applying the tools described. Most articles in this series are structured using a set of questions that guide readers through the proposed tools and show how to undertake activities to support evidence-informed policymaking efficiently and effectively. These activities include, for example, using research evidence to clarify problems, assessing the applicability of the findings of a systematic review about the effects of options selected to address problems, organising and using policy dialogues to support evidence-informed policymaking, and planning policy monitoring and evaluation. In several articles, the set of questions presented offers more general guidance on how to support evidence-informed policymaking. Additional information resources are listed and described in every article. The evaluation of ways to support evidence-informed health policymaking is a developing field and feedback about how to improve the series is welcome. PMID:20018098

Affective influences on partner choice: role of mood in social decisions.

PubMed

Forgas, J P

1991-11-01

Does mood influence our information search and decision strategies when choosing a partner? In Experiment 1 (N = 60), sad Ss preferred rewarding to competent partners and remembered information supporting that choice better. In Experiment 2 (N = 96), mood effects on information selectivity, decision speed, and processing strategy in partner choices were found. In Experiment 3 (N = 42), a computerized stimulus presentation revealed mood-induced differences in the latency, self-exposure, and eventual recall of interpersonal information. These results are interpreted as evidence for mood-induced selectivity in information search and decision strategies when making realistic partner choices. The implications of the findings for research on interpersonal relations and for contemporary affect-cognition theories are considered.

Environmental Public Health Indicators Impact Report: Data and methods that support environmental public health decision-making by communities

EPA Science Inventory

This report presents the results of twenty competitively funded Science-To-Achieve-Results (STAR) grants in EPA's Environmental Public Health Indicators (EPHI) research program. The grantsdirectly supported health interventions, informed policy and decision-making, and improved t...

DEVELOPMENT OF PROTOCOLS AND DECISION SUPPORT TOOLS FOR ASSESSING WATERSHED SYSTEM ASSIMILATIVE

EPA Science Inventory

Investigations are underway on Lake Texoma, a Corps of Engineers lake on the Oklahoma/Texas border, to develop decision support tools and information to evaluate the transport and attenuation of contaminants and stressors in a lake ecosystem, and link them to observable ecologica...

Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas

PubMed Central

2013-01-01

Background In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension—the delivery of patient decision aids on the Internet—is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. Methods An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. Results The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration’s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and identifying emerging areas of research. Conclusions As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies. PMID:24625064

Clinical, information and business process modeling to promote development of safe and flexible software.

PubMed

Liaw, Siaw-Teng; Deveny, Elizabeth; Morrison, Iain; Lewis, Bryn

2006-09-01

Using a factorial vignette survey and modeling methodology, we developed clinical and information models - incorporating evidence base, key concepts, relevant terms, decision-making and workflow needed to practice safely and effectively - to guide the development of an integrated rule-based knowledge module to support prescribing decisions in asthma. We identified workflows, decision-making factors, factor use, and clinician information requirements. The Unified Modeling Language (UML) and public domain software and knowledge engineering tools (e.g. Protégé) were used, with the Australian GP Data Model as the starting point for expressing information needs. A Web Services service-oriented architecture approach was adopted within which to express functional needs, and clinical processes and workflows were expressed in the Business Process Execution Language (BPEL). This formal analysis and modeling methodology to define and capture the process and logic of prescribing best practice in a reference implementation is fundamental to tackling deficiencies in prescribing decision support software.

Characterizing uncertain sea-level rise projections to support investment decisions.

PubMed

Sriver, Ryan L; Lempert, Robert J; Wikman-Svahn, Per; Keller, Klaus

2018-01-01

Many institutions worldwide are considering how to include uncertainty about future changes in sea-levels and storm surges into their investment decisions regarding large capital infrastructures. Here we examine how to characterize deeply uncertain climate change projections to support such decisions using Robust Decision Making analysis. We address questions regarding how to confront the potential for future changes in low probability but large impact flooding events due to changes in sea-levels and storm surges. Such extreme events can affect investments in infrastructure but have proved difficult to consider in such decisions because of the deep uncertainty surrounding them. This study utilizes Robust Decision Making methods to address two questions applied to investment decisions at the Port of Los Angeles: (1) Under what future conditions would a Port of Los Angeles decision to harden its facilities against extreme flood scenarios at the next upgrade pass a cost-benefit test, and (2) Do sea-level rise projections and other information suggest such conditions are sufficiently likely to justify such an investment? We also compare and contrast the Robust Decision Making methods with a full probabilistic analysis. These two analysis frameworks result in similar investment recommendations for different idealized future sea-level projections, but provide different information to decision makers and envision different types of engagement with stakeholders. In particular, the full probabilistic analysis begins by aggregating the best scientific information into a single set of joint probability distributions, while the Robust Decision Making analysis identifies scenarios where a decision to invest in near-term response to extreme sea-level rise passes a cost-benefit test, and then assembles scientific information of differing levels of confidence to help decision makers judge whether or not these scenarios are sufficiently likely to justify making such investments. Results highlight the highly-localized and context dependent nature of applying Robust Decision Making methods to inform investment decisions.

Characterizing uncertain sea-level rise projections to support investment decisions

PubMed Central

Lempert, Robert J.; Wikman-Svahn, Per; Keller, Klaus

2018-01-01

Many institutions worldwide are considering how to include uncertainty about future changes in sea-levels and storm surges into their investment decisions regarding large capital infrastructures. Here we examine how to characterize deeply uncertain climate change projections to support such decisions using Robust Decision Making analysis. We address questions regarding how to confront the potential for future changes in low probability but large impact flooding events due to changes in sea-levels and storm surges. Such extreme events can affect investments in infrastructure but have proved difficult to consider in such decisions because of the deep uncertainty surrounding them. This study utilizes Robust Decision Making methods to address two questions applied to investment decisions at the Port of Los Angeles: (1) Under what future conditions would a Port of Los Angeles decision to harden its facilities against extreme flood scenarios at the next upgrade pass a cost-benefit test, and (2) Do sea-level rise projections and other information suggest such conditions are sufficiently likely to justify such an investment? We also compare and contrast the Robust Decision Making methods with a full probabilistic analysis. These two analysis frameworks result in similar investment recommendations for different idealized future sea-level projections, but provide different information to decision makers and envision different types of engagement with stakeholders. In particular, the full probabilistic analysis begins by aggregating the best scientific information into a single set of joint probability distributions, while the Robust Decision Making analysis identifies scenarios where a decision to invest in near-term response to extreme sea-level rise passes a cost-benefit test, and then assembles scientific information of differing levels of confidence to help decision makers judge whether or not these scenarios are sufficiently likely to justify making such investments. Results highlight the highly-localized and context dependent nature of applying Robust Decision Making methods to inform investment decisions. PMID:29414978

A Decision Support System for Optimum Use of Fertilizers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoskinson, Reed Louis; Hess, John Richard; Fink, Raymond Keith

1999-07-01

The Decision Support System for Agriculture (DSS4Ag) is an expert system being developed by the Site-Specific Technologies for Agriculture (SST4Ag) precision farming research project at the INEEL. DSS4Ag uses state-of-the-art artificial intelligence and computer science technologies to make spatially variable, site-specific, economically optimum decisions on fertilizer use. The DSS4Ag has an open architecture that allows for external input and addition of new requirements and integrates its results with existing agricultural systems’ infrastructures. The DSS4Ag reflects a paradigm shift in the information revolution in agriculture that is precision farming. We depict this information revolution in agriculture as an historic trend inmore » the agricultural decision-making process.« less

A Decision Support System for Optimum Use of Fertilizers

DOE Office of Scientific and Technical Information (OSTI.GOV)

R. L. Hoskinson; J. R. Hess; R. K. Fink

1999-07-01

The Decision Support System for Agriculture (DSS4Ag) is an expert system being developed by the Site-Specific Technologies for Agriculture (SST4Ag) precision farming research project at the INEEL. DSS4Ag uses state-of-the-art artificial intelligence and computer science technologies to make spatially variable, site-specific, economically optimum decisions on fertilizer use. The DSS4Ag has an open architecture that allows for external input and addition of new requirements and integrates its results with existing agricultural systems' infrastructures. The DSS4Ag reflects a paradigm shift in the information revolution in agriculture that is precision farming. We depict this information revolution in agriculture as an historic trend inmore » the agricultural decision-making process.« less

An Overview of NASA's IM&S Verification and Validation Process Plan and Specification for Space Exploration

NASA Technical Reports Server (NTRS)

Gravitz, Robert M.; Hale, Joseph

2006-01-01

NASA's Exploration Systems Mission Directorate (ESMD) is implementing a management approach for modeling and simulation (M&S) that will provide decision-makers information on the model's fidelity, credibility, and quality. This information will allow the decision-maker to understand the risks involved in using a model's results in the decision-making process. This presentation will discuss NASA's approach for verification and validation (V&V) of its models or simulations supporting space exploration. This presentation will describe NASA's V&V process and the associated M&S verification and validation (V&V) activities required to support the decision-making process. The M&S V&V Plan and V&V Report templates for ESMD will also be illustrated.

Automatically updating predictive modeling workflows support decision-making in drug design.

PubMed

Muegge, Ingo; Bentzien, Jörg; Mukherjee, Prasenjit; Hughes, Robert O

2016-09-01

Using predictive models for early decision-making in drug discovery has become standard practice. We suggest that model building needs to be automated with minimum input and low technical maintenance requirements. Models perform best when tailored to answering specific compound optimization related questions. If qualitative answers are required, 2-bin classification models are preferred. Integrating predictive modeling results with structural information stimulates better decision making. For in silico models supporting rapid structure-activity relationship cycles the performance deteriorates within weeks. Frequent automated updates of predictive models ensure best predictions. Consensus between multiple modeling approaches increases the prediction confidence. Combining qualified and nonqualified data optimally uses all available information. Dose predictions provide a holistic alternative to multiple individual property predictions for reaching complex decisions.

What can paper-based clinical information systems tell us about the design of computerized clinical information systems (CIS) in the ICU?

PubMed

Miller, A; Pilcher, D; Mercaldo, N; Leong, T; Scheinkestel, C; Schildcrout, J

2010-08-01

Screen designs in computerized clinical information systems (CIS) have been modeled on their paper predecessors. However, limited understanding about how paper forms support clinical work means that we risk repeating old mistakes and creating new opportunities for error and inefficiency as illustrated by problems associated with computerized provider order entry systems. This study was designed to elucidate principles underlying a successful ICU paper-based CIS. The research was guided by two exploratory hypotheses: (1) paper-based artefacts (charts, notes, equipment, order forms) are used differently by nurses, doctors and other healthcare professionals in different (formal and informal) conversation contexts and (2) different artefacts support different decision processes that are distributed across role-based conversations. All conversations undertaken at the bedsides of five patients were recorded with any supporting artefacts for five days per patient. Data was coded according to conversational role-holders, clinical decision process, conversational context and artefacts. 2133 data points were analyzed using Poisson logistic regression analyses. Results show significant interactions between artefacts used during different professional conversations in different contexts (chi(2)((df=16))=55.8, p<0.0001). The interaction between artefacts used during different professional conversations for different clinical decision processes was not statistically significant although all two-way interactions were statistically significant. Paper-based CIS have evolved to support complex interdisciplinary decision processes. The translation of two design principles - support interdisciplinary perspectives and integrate decision processes - from paper to computerized CIS may minimize the risks associated with computerization. 2010 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Balancing obligations: should written information about life-sustaining treatment be neutral?

PubMed Central

Xafis, Vicki; Wilkinson, Dominic; Gillam, Lynn; Sullivan, Jane

2015-01-01

Parents who are facing decisions about life-sustaining treatment for their seriously ill or dying child are supported by their child's doctors and nurses. They also frequently seek other information sources to help them deal with the medical and ethical questions that arise. This might include written or web-based information. As part of a project involving the development of such a resource to support parents facing difficult decisions, some ethical questions emerged. Should this information be presented in a strictly neutral fashion? Is it problematic if narratives, arguments or perspectives appear to favour stopping over continuing life-sustaining treatment? Similar questions might arise with written materials about decisions for adults, or for other ethically contentious decisions. This paper explores the meaning of ‘balance’ in information provision, focusing particularly on written information about life-sustaining treatment for children. We contrast the norm of non-directiveness in genetic counselling with the shared decision-making model often endorsed in end-of-life care. We review evidence that parents do not find neutrality from medical professionals helpful in discussions. We argue that balance in written information must be understood in the light of the aim of the document, the most common situation in which it will be used, and any existing biases. We conclude with four important strategies for ensuring that non-neutral information is nevertheless ethically appropriate. PMID:24763219

Ecosystem Management Decision Support (EMDS) Applied to Watershed Assessment on California's North Coast

Treesearch

Rich Walker; Chris Keithley; Russ Henly; Scott Downie; Steve Cannata

2007-01-01

In 2001, the state of California initiated the North Coast Watershed Assessment Program (2003a) to assemble information on the status of coastal watersheds that have historically supported anadromous fish. The five-agency consortium explored the use of Ecosystem Management Decision Support (EMDS) (Reynolds and others 1996) as a means to help assess overall watershed...

Integrating climatic and fuels information into National Fire Risk Decision Support Tools

Treesearch

W. Cooke; V. Anantharaj; C. Wax; J. Choi; K. Grala; M. Jolly; G.P. Dixon; J. Dyer; D.L. Evans; G.B. Goodrich

2007-01-01

The Wildland Fire Assessment System (WFAS) is a component of the U.S. Department of Agriculture, Forest Service Decision Support Systems (DSS) that support fire potential modeling. Fire potential models for Mississippi and for Eastern fire environments have been developed as part of a National Aeronautic and Space Agency-funded study aimed at demonstrating the utility...

A study on building data warehouse of hospital information system.

PubMed

Li, Ping; Wu, Tao; Chen, Mu; Zhou, Bin; Xu, Wei-guo

2011-08-01

Existing hospital information systems with simple statistical functions cannot meet current management needs. It is well known that hospital resources are distributed with private property rights among hospitals, such as in the case of the regional coordination of medical services. In this study, to integrate and make full use of medical data effectively, we propose a data warehouse modeling method for the hospital information system. The method can also be employed for a distributed-hospital medical service system. To ensure that hospital information supports the diverse needs of health care, the framework of the hospital information system has three layers: datacenter layer, system-function layer, and user-interface layer. This paper discusses the role of a data warehouse management system in handling hospital information from the establishment of the data theme to the design of a data model to the establishment of a data warehouse. Online analytical processing tools assist user-friendly multidimensional analysis from a number of different angles to extract the required data and information. Use of the data warehouse improves online analytical processing and mitigates deficiencies in the decision support system. The hospital information system based on a data warehouse effectively employs statistical analysis and data mining technology to handle massive quantities of historical data, and summarizes from clinical and hospital information for decision making. This paper proposes the use of a data warehouse for a hospital information system, specifically a data warehouse for the theme of hospital information to determine latitude, modeling and so on. The processing of patient information is given as an example that demonstrates the usefulness of this method in the case of hospital information management. Data warehouse technology is an evolving technology, and more and more decision support information extracted by data mining and with decision-making technology is required for further research.

What is the impact of the Internet on decision-making in pregnancy? A global study.

PubMed

Lagan, Briege M; Sinclair, Marlene; Kernohan, W George

2011-12-01

  Women need access to evidence-based information to make informed choices in pregnancy. A search for health information is one of the major reasons that people worldwide access the Internet. Recent years have witnessed an increase in Internet usage by women seeking pregnancy-related information. The aim of this study was to build on previous quantitative studies to explore women's experiences and perceptions of using the Internet for retrieving pregnancy-related information, and its influence on their decision-making processes.   This global study drew on the interpretive qualitative traditions together with a theoretical model on information seeking, adapted to understand Internet use in pregnancy and its role in relation to decision-making. Thirteen asynchronous online focus groups across five countries were conducted with 92 women who had accessed the Internet for pregnancy-related information over a 3-month period. Data were readily transferred and analyzed deductively.   The overall analysis indicates that the Internet is having a visible impact on women's decision making in regards to all aspects of their pregnancy. The key emergent theme was the great need for information. Four broad themes also emerged: "validate information,"empowerment,"share experiences," and "assisted decision-making." Women also reported how the Internet provided support, its negative and positive aspects, and as a source of accurate, timely information.   Health professionals have a responsibility to acknowledge that women access the Internet for support and pregnancy-related information to assist in their decision-making. Health professionals must learn to work in partnership with women to guide them toward evidence-based websites and be prepared to discuss the ensuing information. © 2011, Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.

Impact of a decision-support tool on decision making at the district level in Kenya

PubMed Central

2013-01-01

Background In many countries, the responsibility for planning and delivery of health services is devolved to the subnational level. Health programs, however, often fall short of efficient use of data to inform decisions. As a result, programs are not as effective as they can be at meeting the health needs of the populations they serve. In Kenya, a decision-support tool, the District Health Profile (DHP) tool was developed to integrate data from health programs, primarily HIV, at the district level and to enable district health management teams to review and monitor program progress for specific health issues to make informed service delivery decisions. Methods Thirteen in-depth interviews were conducted with ten tool users and three non-users in six districts to qualitatively assess the process of implementing the tool and its effect on data-informed decision making at the district level. The factors that affected use or non-use of the tool were also investigated. Respondents were selected via convenience sample from among those that had been trained to use the DHP tool except for one user who was self-taught to use the tool. Selection criteria also included respondents from urban districts with significant resources as well as respondents from more remote, under-resourced districts. Results Findings from the in-depth interviews suggest that among those who used it, the DHP tool had a positive effect on data analysis, review, interpretation, and sharing at the district level. The automated function of the tool allowed for faster data sharing and immediate observation of trends that facilitated data-informed decision making. All respondents stated that the DHP tool assisted them to better target existing services in need of improvement and to plan future services, thus positively influencing program improvement. Conclusions This paper stresses the central role that a targeted decision-support tool can play in making data aggregation, analysis, and presentation easier and faster. The visual synthesis of data facilitates the use of information in health decision making at the district level of a health system and promotes program improvement. The experience in Kenya can be applied to other countries that face challenges making district-level, data-informed decisions with data from fragmented information systems. PMID:24011028

A decision support system for delivering optimal quality peach and tomato

NASA Technical Reports Server (NTRS)

Thai, C. N.; Pease, J. N.; Shewfelt, R. L.

1990-01-01

Several studies have indicated that color and firmness are the two quality attributes most important to consumers in making purchasing decisions of fresh peaches and tomatoes. However, at present, retail produce managers do not have the proper information for handling fresh produce so it has the most appealing color and firmness when it reaches the consumer. This information should help them predict the consumer color and firmness perception and preference for produce from various storage conditions. Since 1987, for 'Redglobe' peach and 'Sunny' tomato, we have been generating information about their physical quality attributes (firmness and color) and their corresponding consumer sensory scores. This article reports on our current progress toward the goal of integrating such information into a model-based decision support system for retail level managers in handling fresh peaches and tomatoes.

Climate modeling with decision makers in mind

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jones, Andrew; Calvin, Katherine; Lamarque, Jean -Francois

The need for regional- and local-scale climate information is increasing rapidly as decision makers seek to anticipate and manage a variety of context-specific climate risks over the next several decades. Furthermore, global climate models are not developed with these user needs in mind, and they typically operate at resolutions that are too coarse to provide information that could be used to support regional and local decisions.

Climate modeling with decision makers in mind

DOE PAGES

Jones, Andrew; Calvin, Katherine; Lamarque, Jean -Francois

2016-04-27

The need for regional- and local-scale climate information is increasing rapidly as decision makers seek to anticipate and manage a variety of context-specific climate risks over the next several decades. Furthermore, global climate models are not developed with these user needs in mind, and they typically operate at resolutions that are too coarse to provide information that could be used to support regional and local decisions.

From open source communications to knowledge

NASA Astrophysics Data System (ADS)

Preece, Alun; Roberts, Colin; Rogers, David; Webberley, Will; Innes, Martin; Braines, Dave

2016-05-01

Rapid processing and exploitation of open source information, including social media sources, in order to shorten decision-making cycles, has emerged as an important issue in intelligence analysis in recent years. Through a series of case studies and natural experiments, focussed primarily upon policing and counter-terrorism scenarios, we have developed an approach to information foraging and framing to inform decision making, drawing upon open source intelligence, in particular Twitter, due to its real-time focus and frequent use as a carrier for links to other media. Our work uses a combination of natural language (NL) and controlled natural language (CNL) processing to support information collection from human sensors, linking and schematising of collected information, and the framing of situational pictures. We illustrate the approach through a series of vignettes, highlighting (1) how relatively lightweight and reusable knowledge models (schemas) can rapidly be developed to add context to collected social media data, (2) how information from open sources can be combined with reports from trusted observers, for corroboration or to identify con icting information; and (3) how the approach supports users operating at or near the tactical edge, to rapidly task information collection and inform decision-making. The approach is supported by bespoke software tools for social media analytics and knowledge management.

Watershed forest management using decision support technology

Treesearch

Mark Twery; Robert Northrop

2004-01-01

Using innovative partnerships and a variety of decision support tools, we identified the needs and goals of Baltimore, Maryland, for their reservoir properties containing over 17000 forested acres; developed a management plan; determined the information necessary to evaluate conditions, processes, and context; chose tools to use; collected, organized, and analyzed data...

Using Decision Support to Address Racial Disparities in Mental Health Service Utilization

ERIC Educational Resources Information Center

Rawal, Purva H.; Anderson, Tanya R.; Romansky, Jill R.; Lyons, John S.

2008-01-01

Unfortunately, racial disparities are well documented in the delivery of behavioral health services. This study examines the effects of implementing a decision support process, integrating clinical information into the administration of mental health services, on racial disparities in psychiatric hospital admissions for children in state custody.…

A decision support system for rainfed agricultural areas of Mexico

USDA-ARS?s Scientific Manuscript database

Rural inhabitants of arid lands lack sufficient water to fulfill their agricultural and household needs. They do not have readily available technical information to support decisions regarding the course of action they should follow to handle the agro-climatic risk. In this paper, a computer model (...

Using social network analysis to examine the decision-making process on new vaccine introduction in Nigeria.

PubMed

Wonodi, C B; Privor-Dumm, L; Aina, M; Pate, A M; Reis, R; Gadhoke, P; Levine, O S

2012-05-01

The decision-making process to introduce new vaccines into national immunization programmes is often complex, involving many stakeholders who provide technical information, mobilize finance, implement programmes and garner political support. Stakeholders may have different levels of interest, knowledge and motivations to introduce new vaccines. Lack of consensus on the priority, public health value or feasibility of adding a new vaccine can delay policy decisions. Efforts to support country-level decision-making have largely focused on establishing global policies and equipping policy makers with the information to support decision-making on new vaccine introduction (NVI). Less attention has been given to understanding the interactions of policy actors and how the distribution of influence affects the policy process and decision-making. Social network analysis (SNA) is a social science technique concerned with explaining social phenomena using the structural and relational features of the network of actors involved. This approach can be used to identify how information is exchanged and who is included or excluded from the process. For this SNA of vaccine decision-making in Nigeria, we interviewed federal and state-level government officials, officers of bilateral and multilateral partner organizations, and other stakeholders such as health providers and the media. Using data culled from those interviews, we performed an SNA in order to map formal and informal relationships and the distribution of influence among vaccine decision-makers, as well as to explore linkages and pathways to stakeholders who can influence critical decisions in the policy process. Our findings indicate a relatively robust engagement of key stakeholders in Nigeria. We hypothesized that economic stakeholders and implementers would be important to ensure sustainable financing and strengthen programme implementation, but some economic and implementation stakeholders did not appear centrally on the map; this may suggest a need to strengthen the decision-making processes by engaging these stakeholders more centrally and earlier.

A functional difference in information processing between orbitofrontal cortex and ventral striatum during decision-making behaviour.

PubMed

Stott, Jeffrey J; Redish, A David

2014-11-05

Both orbitofrontal cortex (OFC) and ventral striatum (vStr) have been identified as key structures that represent information about value in decision-making tasks. However, the dynamics of how this information is processed are not yet understood. We recorded ensembles of cells from OFC and vStr in rats engaged in the spatial adjusting delay-discounting task, a decision-making task that involves a trade-off between delay to and magnitude of reward. Ventral striatal neural activity signalled information about reward before the rat's decision, whereas such reward-related signals were absent in OFC until after the animal had committed to its decision. These data support models in which vStr is directly involved in action selection, but OFC processes decision-related information afterwards that can be used to compare the predicted and actual consequences of behaviour. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Supporting Timely Humanitarian Assistance/Disaster Relief (HA/DR) Decisions Through Geospatial Intelligence (GEOINT) and Geographical Information Systems (GIS) Tools

DTIC Science & Technology

2014-05-22

attempted to respond to the advances in technology and the growing power of geographical information system (GIS) tools. However, the doctrine...Geospatial intelligence (GEOINT), Geographical information systems (GIS) tools, Humanitarian Assistance/Disaster Relief (HA/DR), 2010 Haiti Earthquake...Humanitarian Assistance/Disaster Relief (HA/DR) Decisions Through Geospatial Intelligence (GEOINT) and Geographical Information Systems (GIS) Tools

Decision making and cancer.

PubMed

Reyna, Valerie F; Nelson, Wendy L; Han, Paul K; Pignone, Michael P

2015-01-01

We review decision making along the cancer continuum in the contemporary context of informed and shared decision making in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PsycINFO Database Record (c) 2015 APA, all rights reserved.

Cost accounting in health care: fad or fundamental?

PubMed

Kaskiw, E A; Hanlon, P; Wulf, P

1987-11-01

The drastic changes in the environment affecting hospitals have caused management to look toward capturing and reporting cost information to make decisions. These decisions will, in part, shape the way hospitals continue to do business. This article focuses on the data requirements necessary to support product and operational management decisions facing today's hospitals. In addition, the difference in data needed to support product and operational management is explored.

Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis.

PubMed

Veinot, Tiffany C; Senteio, Charles R; Hanauer, David; Lowery, Julie C

2018-06-01

To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research. The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process. The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations. The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians.

DEVELOPMENT PLAN FOR THE CAUSAL ANALYSIS / DIAGNOSIS DECISION INFORMATION SYSTEM (CADDIS) 2001-2004

EPA Science Inventory

The Causal Analysis/Diagnosis Decision Information System (CADDIS) is a web-based system that provides technical support for states, tribes and other users of the Office of Water's Stressor Identification Guidance. The Stressor Identific...

THE CAUSAL ANALYSIS / DIAGNOSIS DECISION INFORMATION SYSTEM (CADDIS) - 2007 UPDATE

EPA Science Inventory

CADDIS is an on-line decision support system that helps investigators in the regions, states and tribes find, access, organize, use and share information to produce causal evaluations in aquatic systems. It is based ...

Evaluating the Effectiveness of Web-based Climate Resilience Decision Support Tools: Insights from Coastal New Jersey

NASA Astrophysics Data System (ADS)

Brady, M.; Lathrop, R.; Auermuller, L. M.; Leichenko, R.

2016-12-01

Despite the recent surge of Web-based decision support tools designed to promote resiliency in U.S. coastal communities, to-date there has been no systematic study of their effectiveness. This study demonstrates a method to evaluate important aspects of effectiveness of four Web map tools designed to promote consideration of climate risk information in local decision-making and planning used in coastal New Jersey. In summer 2015, the research team conducted in-depth phone interviews with users of one regulatory and three non-regulatory Web map tools using a semi-structured questionnaire. The interview and analysis design drew from a combination of effectiveness evaluation approaches developed in software and information usability, program evaluation, and management information system (MIS) research. Effectiveness assessment results were further analyzed and discussed in terms of conceptual hierarchy of system objectives defined by respective tool developer and user organizations represented in the study. Insights from the interviews suggest that users rely on Web tools as a supplement to desktop and analog map sources because they provide relevant and up-to-date information in a highly accessible and mobile format. The users also reported relying on multiple information sources and comparison between digital and analog sources for decision support. However, with respect to this decision support benefit, users were constrained by accessibility factors such as lack of awareness and training with some tools, lack of salient information such as planning time horizons associated with future flood scenarios, and environmental factors such as mandates restricting some users to regulatory tools. Perceptions of Web tool credibility seem favorable overall, but factors including system design imperfections and inconsistencies in data and information across platforms limited trust, highlighting a need for better coordination between tools. Contributions of the study include user feedback on web-tool system designs consistent with collaborative methods for enhancing usability and a systematic look at effectiveness that includes both user perspectives and consideration of developer and organizational objectives.

Information and decision support needs in patients with type 2 diabetes.

PubMed

Weymann, Nina; Härter, Martin; Dirmaier, Jörg

2016-03-01

Diabetes and its sequelae cause a growing burden of morbidity and mortality. For many patients living with diabetes, the Internet is an important source of health information and support. In the course of the development of an Interactive Health Communication Application, combining evidence-based information with behavior change and decision support, we assessed the characteristics, information, and decision support needs of patients with type 2 diabetes.The needs assessment was performed in two steps. First, we conducted semi-structured interviews with 10 patients and seven physicians. In the second step, we developed a self-assessment questionnaire based on the results of the interviews and administered it to a new and larger sample of diabetes patients (N = 178). The questionnaire comprised four main sections: (1) Internet use and Internet experience, (2) diabetes knowledge, (3) relevant decisions and decision preferences, and (4) online health information needs. Descriptive data analyses were performed.In the questionnaire study, the patient sample was heterogeneous in terms of age, time since diagnosis, and glycemic control. (1) Most participants (61.7%) have searched the web for health information at least once. The majority (62%) of those who have used the web use it at least once per month. (2) Diabetes knowledge was scarce: Only a small percentage (1.9%) of the respondents answered all items of the knowledge questionnaire correctly. (3) The most relevant treatment decisions concerned glycemic control, oral medication, and acute complications. The most difficult treatment decision was whether to start insulin treatment. Of the respondents, 69.4 percent thought that medical decisions should be made by them and their doctor together. (4) The most important information needs concerned sequelae of diabetes, blood glucose control, and basic diabetes information.The Internet seems to be a feasible way to reach people with type 2 diabetes. The heterogeneity of the sample, especially with respect to diabetes knowledge, makes it clear that the projected Interactive Health Communication Application should tailor the content to the individual user, taking account of individual characteristics and preferences. A wide range of topics should be covered. Special attention should be paid to the advantages and disadvantages of insulin treatment and the fears and hopes associated with it. These results were taken into account when developing the Interactive Health Communication Application that is currently being evaluated in a randomized controlled trial (International Clinical Trials Registry DRKS00003322). © The Author(s) 2014.

The potential for meta-analysis to support decision analysis in ecology.

PubMed

Mengersen, Kerrie; MacNeil, M Aaron; Caley, M Julian

2015-06-01

Meta-analysis and decision analysis are underpinned by well-developed methods that are commonly applied to a variety of problems and disciplines. While these two fields have been closely linked in some disciplines such as medicine, comparatively little attention has been paid to the potential benefits of linking them in ecology, despite reasonable expectations that benefits would be derived from doing so. Meta-analysis combines information from multiple studies to provide more accurate parameter estimates and to reduce the uncertainty surrounding them. Decision analysis involves selecting among alternative choices using statistical information that helps to shed light on the uncertainties involved. By linking meta-analysis to decision analysis, improved decisions can be made, with quantification of the costs and benefits of alternate decisions supported by a greater density of information. Here, we briefly review concepts of both meta-analysis and decision analysis, illustrating the natural linkage between them and the benefits from explicitly linking one to the other. We discuss some examples in which this linkage has been exploited in the medical arena and how improvements in precision and reduction of structural uncertainty inherent in a meta-analysis can provide substantive improvements to decision analysis outcomes by reducing uncertainty in expected loss and maximising information from across studies. We then argue that these significant benefits could be translated to ecology, in particular to the problem of making optimal ecological decisions in the face of uncertainty. Copyright © 2013 John Wiley & Sons, Ltd.

Advancements in Risk-Informed Performance-Based Asset Management for Commercial Nuclear Power Plants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liming, James K.; Ravindra, Mayasandra K.

2006-07-01

Over the past several years, ABSG Consulting Inc. (ABS Consulting) and the South Texas Project Nuclear Operating Company (STPNOC) have developed a decision support process and associated software for risk-informed, performance-based asset management (RIPBAM) of nuclear power plant facilities. RIPBAM applies probabilistic risk assessment (PRA) tools and techniques in the realm of plant physical and financial asset management. The RIPBAM process applies a tiered set of models and supporting performance measures (or metrics) that can ultimately be applied to support decisions affecting the allocation and management of plant resources (e.g., funding, staffing, scheduling, etc.). In general, the ultimate goal ofmore » the RIPBAM process is to continually support decision-making to maximize a facility's net present value (NPV) and long-term profitability for its owners. While the initial applications of RIPBAM have been for nuclear power stations, the methodology can easily be adapted to other types of power station or complex facility decision-making support. RIPBAM can also be designed to focus on performance metrics other than NPV and profitability (e.g., mission reliability, operational availability, probability of mission success per dollar invested, etc.). Recent advancements in the RIPBAM process focus on expanding the scope of previous RIPBAM applications to include not only operations, maintenance, and safety issues, but also broader risk perception components affecting plant owner (stockholder), operator, and regulator biases. Conceptually, RIPBAM is a comprehensive risk-informed cash flow model for decision support. It originated as a tool to help manage plant refueling outage scheduling, and was later expanded to include the full spectrum of operations and maintenance decision support. However, it differs from conventional business modeling tools in that it employs a systems engineering approach with broadly based probabilistic analysis of organizational 'value streams'. The scope of value stream inclusion in the process can be established by the user, but in its broadest applications, RIPBAM can be used to address how risk perceptions of plant owners and regulators are impacted by plant performance. Plant staffs can expand and refine RIPBAM models scope via a phased program of activities over time. This paper shows how the multi-metric uncertainty analysis feature of RIPBAM can apply a wide spectrum of decision-influencing factors to support decisions designed to maximize the probability of achieving, maintaining, and improving upon plant goals and objectives. In this paper, the authors show how this approach can be extremely valuable to plant owners and operators in supporting plant value-impacting decision-making processes. (authors)« less

Theory-based design and field-testing of an intervention to support women choosing surgery for breast cancer: BresDex.

PubMed

Sivell, Stephanie; Marsh, William; Edwards, Adrian; Manstead, Antony S R; Clements, Alison; Elwyn, Glyn

2012-02-01

Design and undertake usability and field-testing evaluation of a theory-guided decision aid (BresDex) in supporting women choosing surgery for early breast cancer. An extended Theory of Planned Behavior (TPB) and the Common Sense Model of Illness Representations (CSM) guided the design of BresDex. BresDex was evaluated and refined across 3 cycles by interviewing 6 women without personal history of breast cancer, 8 women with personal history of breast cancer who had completed treatment and 11 women newly diagnosed with breast cancer. Participants were interviewed for views on content, presentation (usability) and perceived usefulness towards deciding on treatment (utility). Framework analysis was used, guided by the extended TPB and the CSM. BresDex was positively received in content and presentation (usability). It appeared an effective support to decision-making and useful source for further information, particularly in clarifying attitudes, social norms and perceived behavioral control, and presenting consequences of decisions (utility). This study illustrates the potential benefit of the extended TPB and CSM in designing a decision aid to support women choosing breast cancer surgery. BresDex could provide decision-making support and serve as an additional source of information, to complement the care received from the clinical team. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed Central

Gadd, C. S.; Baskaran, P.; Lobach, D. F.

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings. Images Figure 1 PMID:9929188

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

PubMed Central

Okelo, Sande O.; Butz, Arlene M.; Sharma, Ritu; Diette, Gregory B.; Pitts, Samantha I.; King, Tracy M.; Linn, Shauna T.; Reuben, Manisha; Chelladurai, Yohalakshmi

2013-01-01

BACKGROUND AND OBJECTIVE: Health care provider adherence to asthma guidelines is poor. The objective of this study was to assess the effect of interventions to improve health care providers’ adherence to asthma guidelines on health care process and clinical outcomes. METHODS: Data sources included Medline, Embase, Cochrane CENTRAL Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Center, PsycINFO, and Research and Development Resource Base in Continuing Medical Education up to July 2012. Paired investigators independently assessed study eligibility. Investigators abstracted data sequentially and independently graded the evidence. RESULTS: Sixty-eight eligible studies were classified by intervention: decision support, organizational change, feedback and audit, clinical pharmacy support, education only, quality improvement/pay-for-performance, multicomponent, and information only. Half were randomized trials (n = 35). There was moderate evidence for increased prescriptions of controller medications for decision support, feedback and audit, and clinical pharmacy support and low-grade evidence for organizational change and multicomponent interventions. Moderate evidence supports the use of decision support and clinical pharmacy interventions to increase provision of patient self-education/asthma action plans. Moderate evidence supports use of decision support tools to reduce emergency department visits, and low-grade evidence suggests there is no benefit for this outcome with organizational change, education only, and quality improvement/pay-for-performance. CONCLUSIONS: Decision support tools, feedback and audit, and clinical pharmacy support were most likely to improve provider adherence to asthma guidelines, as measured through health care process outcomes. There is a need to evaluate health care provider-targeted interventions with standardized outcomes. PMID:23979092

15 CFR 930.130 - Closure of the decision record and issuance of decision.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., when the information in the decision record supports this conclusion. (e)(1) If the Secretary finds... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Closure of the decision record and issuance of decision. 930.130 Section 930.130 Commerce and Foreign Trade Regulations Relating to Commerce...

Automated Modular Magnetic Resonance Imaging Clinical Decision Support System (MIROR): An Application in Pediatric Cancer Diagnosis.

PubMed

Zarinabad, Niloufar; Meeus, Emma M; Manias, Karen; Foster, Katharine; Peet, Andrew

2018-05-02

Advances in magnetic resonance imaging and the introduction of clinical decision support systems has underlined the need for an analysis tool to extract and analyze relevant information from magnetic resonance imaging data to aid decision making, prevent errors, and enhance health care. The aim of this study was to design and develop a modular medical image region of interest analysis tool and repository (MIROR) for automatic processing, classification, evaluation, and representation of advanced magnetic resonance imaging data. The clinical decision support system was developed and evaluated for diffusion-weighted imaging of body tumors in children (cohort of 48 children, with 37 malignant and 11 benign tumors). Mevislab software and Python have been used for the development of MIROR. Regions of interests were drawn around benign and malignant body tumors on different diffusion parametric maps, and extracted information was used to discriminate the malignant tumors from benign tumors. Using MIROR, the various histogram parameters derived for each tumor case when compared with the information in the repository provided additional information for tumor characterization and facilitated the discrimination between benign and malignant tumors. Clinical decision support system cross-validation showed high sensitivity and specificity in discriminating between these tumor groups using histogram parameters. MIROR, as a diagnostic tool and repository, allowed the interpretation and analysis of magnetic resonance imaging images to be more accessible and comprehensive for clinicians. It aims to increase clinicians' skillset by introducing newer techniques and up-to-date findings to their repertoire and make information from previous cases available to aid decision making. The modular-based format of the tool allows integration of analyses that are not readily available clinically and streamlines the future developments. ©Niloufar Zarinabad, Emma M Meeus, Karen Manias, Katharine Foster, Andrew Peet. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 02.05.2018.

Clinical decision support systems for addressing information needs of physicians.

PubMed

Denekamp, Yaron

2007-11-01

Clinicians routinely practice in a state of incomplete information--about the patient, and about medical knowledge pertaining to patients' care. Consequently, there is now growing interest in the use of CDSS to bring decision support to the point of care. CDSS can impact physician behavior in routine practice. Nonetheless, CDSSs are meant to support humans who are ultimately responsible for the clinical decisions, rather than replace them. Although the adoption of CDSS has proceeded at a slow pace, there is a widespread recognition that CDSSs are expected to play a crucial role in reducing medical errors and improving the quality and efficacy of health care. This will be facilitated by the gradual maturation of electronic health record systems and the emergence of standard terminologies and messaging standards for the exchange of clinical data.

Web-based Traffic Noise Control Support System for Sustainable Transportation

NASA Astrophysics Data System (ADS)

Fan, Lisa; Dai, Liming; Li, Anson

Traffic noise is considered as one of the major pollutions that will affect our communities in the future. This paper presents a framework of web-based traffic noise control support system (WTNCSS) for a sustainable transportation. WTNCSS is to provide the decision makers, engineers and publics a platform to efficiently access the information, and effectively making decisions related to traffic control. The system is based on a Service Oriented Architecture (SOA) which takes the advantages of the convenience of World Wide Web system with the data format of XML. The whole system is divided into different modules such as the prediction module, ontology-based expert module and dynamic online survey module. Each module of the system provides a distinct information service to the decision support center through the HTTP protocol.

What can Natural Language Processing do for Clinical Decision Support?

PubMed Central

Demner-Fushman, Dina; Chapman, Wendy W.; McDonald, Clement J.

2009-01-01

Computerized Clinical Decision Support (CDS) aims to aid decision making of health care providers and the public by providing easily accessible health-related information at the point and time it is needed. Natural Language Processing (NLP) is instrumental in using free-text information to drive CDS, representing clinical knowledge and CDS interventions in standardized formats, and leveraging clinical narrative. The early innovative NLP research of clinical narrative was followed by a period of stable research conducted at the major clinical centers and a shift of mainstream interest to biomedical NLP. This review primarily focuses on the recently renewed interest in development of fundamental NLP methods and advances in the NLP systems for CDS. The current solutions to challenges posed by distinct sublanguages, intended user groups, and support goals are discussed. PMID:19683066

When Informationists Get Involved: the CHICA-GIS Project.

PubMed

Whipple, Elizabeth C; Odell, Jere D; Ralston, Rick K; Liu, Gilbert C

2013-01-01

Child Health Improvement through Computer Automation (CHICA) is a computer decision support system (CDSS) that interfaces with existing electronic medical record systems (EMRS) and delivers "just-in-time" patient-relevant guidelines to physicians during the clinical encounter and accurately captures structured data from all who interact with the system. "Delivering Geospatial Intelligence to Health Care Professionals (CHICA-GIS)" (1R01LM010923-01) expands the medical application of Geographic Information Systems (GIS) by integrating a geographic information system with CHICA. To provide knowledge management support for CHICA-GIS, three informationists at the Indiana University School of Medicine were awarded a supplement from the National Library Medicine. The informationists will enhance CHICA-GIS by: improving the accuracy and accessibility of information, managing and mapping the knowledge which undergirds the CHICA-GIS decision support tool, supporting community engagement and consumer health information outreach, and facilitating the dissemination of new CHICA-GIS research results and services.

It's Not Just About More Data: Translation of Science and Decision Support Evaluation for Climate Impact Indicators

NASA Astrophysics Data System (ADS)

Kenney, M. A.

2014-12-01

The U.S. Global Change Research Program is currently considering establishing a National Climate Indicators System, which would be a set of physical, ecological, and societal indicators that would communicate key aspects of climate changes, impacts, vulnerabilities, and preparedness to inform mitigation and adaptation decisions. Thus, over the past several years 150+ scientists and practitioners representing a range of expertise from the climate system to natural systems to human sectors have developed a set of indicator recommendations that could be used as a first step to establishing such an indicator system. These recommendations have been implemented into a pilot system, with the goal of working with stakeholder communities to evaluate the understandability of individual indicators and learn how users are combining indicators for their own understanding or decision needs through this multiple Federal agency decision support platform. This prototype system provides the perfect test bed for evaluating the translation of scientific data - observations, remote sensing, and citizen science data -- and data products, such as indicators, for decision-making audiences. Often translation of scientific information into decision support products is developed and improved given intuition and feedback. Though this can be useful in many cases, more rigorous testing using social science methodologies would provide greater assurance that the data products are useful for the intended audiences. I will present some initial research using surveys to assess the understandability of indicators and whether that understanding is influenced by one's attitude toward climate change. Such information is critical to assess whether products developed for scientists by scientists have been appropriately translated for non-scientists, thus assuring that the data will have some value for the intended audience. Such survey information will provide a data driven approach to further develop and improve the National Climate Indicators System and could be applied to improve other decision support systems.

What perceptions do patients have of decision making (DM)? Toward an integrative patient-centered care model. A qualitative study using focus-group interviews.

PubMed

Moreau, Alain; Carol, Laurent; Dedianne, Marie Cécile; Dupraz, Christian; Perdrix, Corinne; Lainé, Xavier; Souweine, Gilbert

2012-05-01

To understand patients' perceptions of decision making and identify relationships among decision-making models. This qualitative study was made up of four focus group interviews (elderly persons, users of health support groups, students, and rural inhabitants). Participants were asked to report their perceptions of decision making in three written clinical scenarios (hypertension, breast cancer, prostate cancer). The analysis was based on the principles of grounded theory. Most patients perceived decision making as shared decision making, a deliberative question-response interaction with the physician that allowed patients to be experts in obtaining clearer information, participating in the care process, and negotiating compromises with physician preferences. Requesting second opinions allowed patients to maintain control, even within the paternalistic model preferred by elderly persons. Facilitating factors (trust, qualitative non-verbal communication, time to think) and obstacles (serious/emergency situations, perceived inadequate scientific competence, problems making requests, fear of knowing) were also part of shared decision making. In the global concept of patient-centered care, shared decision making can be flexible and can integrate paternalistic and informative models. Physicians' expertise should be associated with biomedical and relational skills through listening to, informing, and advising patients, and by supporting patients' choices. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

[Shared decision making in breast cancer. Womens' attitudes].

PubMed

Martín-Fernández, Roberto; Abt-Sacks, Analía; Perestelo-Perez, Lilisbeth; Serrano-Aguilar, Pedro

2013-01-01

The patient autonomy and the greater role for women with breast cancer in the decisions about their health are recent issues in healthcare. The objective of this work is to identify and characterize the elements that influence them in treatment decisions. A phenomenological type qualitative study. Theoretical Sampling included 70 women diagnosed with breast cancer. 45 semi structured interviews and 3 focus groups were performed between October 2009 and July 2010 in 15 regions of Spain. The analysis was based on the principles of grounded theory with the support of Atlas.ti v6.1. Patients are likely to take an active or passive role regarding decision-making depending on different variables such as their age, the information available, their self-assessment as capable agents to make decisions and the relative importance given to physical appearance. As the disease progresses, it can cause a change in women attitude, from an initially passive attitude to a more active role. The attitude of health professionals concerning shared decision-making and the information they offer determines patient participation while the family plays an essential role as a support or reinforcement of decisions made by patients. The patients' attitude regarding the decision-making of patients is very variable, becoming increasingly important the emotional status, the level of information available and the influence of the context.

Computerized Adaptive Test vs. decision trees: Development of a support decision system to identify suicidal behavior.

PubMed

Delgado-Gomez, D; Baca-Garcia, E; Aguado, D; Courtet, P; Lopez-Castroman, J

2016-12-01

Several Computerized Adaptive Tests (CATs) have been proposed to facilitate assessments in mental health. These tests are built in a standard way, disregarding useful and usually available information not included in the assessment scales that could increase the precision and utility of CATs, such as the history of suicide attempts. Using the items of a previously developed scale for suicidal risk, we compared the performance of a standard CAT and a decision tree in a support decision system to identify suicidal behavior. We included the history of past suicide attempts as a class for the separation of patients in the decision tree. The decision tree needed an average of four items to achieve a similar accuracy than a standard CAT with nine items. The accuracy of the decision tree, obtained after 25 cross-validations, was 81.4%. A shortened test adapted for the separation of suicidal and non-suicidal patients was developed. CATs can be very useful tools for the assessment of suicidal risk. However, standard CATs do not use all the information that is available. A decision tree can improve the precision of the assessment since they are constructed using a priori information. Copyright © 2016 Elsevier B.V. All rights reserved.

Exploring Scientific Information for Policy Making under Deep Uncertainty

NASA Astrophysics Data System (ADS)

Forni, L.; Galaitsi, S.; Mehta, V. K.; Escobar, M.; Purkey, D. R.; Depsky, N. J.; Lima, N. A.

2016-12-01

Each actor evaluating potential management strategies brings her/his own distinct set of objectives to a complex decision space of system uncertainties. The diversity of these objectives require detailed and rigorous analyses that responds to multifaceted challenges. However, the utility of this information depends on the accessibility of scientific information to decision makers. This paper demonstrates data visualization tools for presenting scientific results to decision makers in two case studies, La Paz/ El Alto, Bolivia, and Yuba County,California. Visualization output from the case studies combines spatiotemporal, multivariate and multirun/multiscenario information to produce information corresponding to the objectives defined by key actors and stakeholders. These tools can manage complex data and distill scientific information into accessible formats. Using the visualizations, scientists and decision makers can navigate the decision space and potential objective trade-offs to facilitate discussion and consensus building. These efforts can support identifying stable negotiatedagreements between different stakeholders.

Changing hospitals, choosing chemotherapy and deciding you've made the right choice: Understanding the role of online support groups in different health decision-making activities.

PubMed

Sillence, Elizabeth; Bussey, Lauren

2017-05-01

To investigate the ways in which people use online support groups (OSGs) in relation to their health decision-making and to identify the key features of the resource that support those activities. Eighteen participants who used OSGs for a range of health conditions participated in qualitative study in which they were interviewed about their experiences of using OSGs in relation to decision-making. Exploration of their experiences was supported by discussion of illustrative quotes. Across the health conditions OSGs supported two main decision-making activities: (i) prompting decision making and (ii) evaluating and confirming decisions already made. Depending on the activity, participants valued information about the process, the experience and the outcome of patient narratives. The importance of forum interactivity was highlighted in relation to advice-seeking and the selection of relevant personal experiences. People use OSGs in different ways to support their health related decision-making valuing the different content types of the narratives and the interactivity provided by the resource. Engaging with OSGs helps people in a number of different ways in relation to decision-making. However, it only forms one part of people's decision-making strategies and appropriate resources should be signposted where possible. Copyright © 2017 Elsevier B.V. All rights reserved.

The use of syndromic surveillance for decision-making during the H1N1 pandemic: a qualitative study.

PubMed

Chu, Anna; Savage, Rachel; Willison, Don; Crowcroft, Natasha S; Rosella, Laura C; Sider, Doug; Garay, Jason; Gemmill, Ian; Winter, Anne-Luise; Davies, Richard F; Johnson, Ian

2012-10-30

Although an increasing number of studies are documenting uses of syndromic surveillance by front line public health, few detail the value added from linking syndromic data to public health decision-making. This study seeks to understand how syndromic data informed specific public health actions during the 2009 H1N1 pandemic. Semi-structured telephone interviews were conducted with participants from Ontario's public health departments, the provincial ministry of health and federal public health agency to gather information about syndromic surveillance systems used and the role of syndromic data in informing specific public health actions taken during the pandemic. Responses were compared with how the same decisions were made by non-syndromic surveillance users. Findings from 56 interviews (82% response) show that syndromic data were most used for monitoring virus activity, measuring impact on the health care system and informing the opening of influenza assessment centres in several jurisdictions, and supporting communications and messaging, rather than its intended purpose of early outbreak detection. Syndromic data had limited impact on decisions that involved the operation of immunization clinics, school closures, sending information letters home with school children or providing recommendations to health care providers. Both syndromic surveillance users and non-users reported that guidance from the provincial ministry of health, communications with stakeholders and vaccine availability were driving factors in these public health decisions. Syndromic surveillance had limited use in decision-making during the 2009 H1N1 pandemic in Ontario. This study provides insights into the reasons why this occurred. Despite this, syndromic data were valued for providing situational awareness and confidence to support public communications and recommendations. Developing an understanding of how syndromic data are utilized during public health events provides valuable evidence to support future investments in public health surveillance.

77 FR 48969 - Record of Decision for the U.S. Marine Corps Basing of MV-22 and H-1 Aircraft in Support of III...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-15

... DEPARTMENT OF DEFENSE Department of the Navy Record of Decision for the U.S. Marine Corps Basing of MV-22 and H-1 Aircraft in Support of III Marine Expeditionary Force Elements in Hawaii AGENCY... aircraft) in support of III Marine Expeditionary Force elements in Hawaii. SUPPLEMENTARY INFORMATION: The...

The use of the Dutch Self-Sufficiency Matrix (SSM-D) to inform allocation decisions to public mental health care for homeless people.

PubMed

Lauriks, Steve; de Wit, Matty A S; Buster, Marcel C A; Fassaert, Thijs J L; van Wifferen, Ron; Klazinga, Niek S

2014-10-01

The current study set out to develop a decision support tool based on the Self-Sufficiency Matrix (Dutch version; SSM-D) for the clinical decision to allocate homeless people to the public mental health care system at the central access point of public mental health care in Amsterdam, The Netherlands. Logistic regression and receiver operating characteristic-curve analyses were used to model professional decisions and establish four decision categories based on SSM-D scores from half of the research population (Total n = 612). The model and decision categories were found to be accurate and reliable in predicting professional decisions in the second half of the population. Results indicate that the decision support tool based on the SSM-D is useful and feasible. The method to develop the SSM-D as a decision support tool could be applied to decision-making processes in other systems and services where the SSM-D has been implemented, to further increase the utility of the instrument.

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

PubMed Central

2013-01-01

Background 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. Methods 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. Results 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. Conclusions 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 strategies to meaningfully involve clinicians, patients and their relatives in an iterative design process; include evidence-based methods to augment interpretability of textual and probabilistic information (e.g. graphical displays showing natural frequencies) on the full range of outcome states associated with available options; and address patients with different levels of health literacy. Implementation of tools will be enhanced when mechanisms are in place to periodically assess the relevance of tools and where necessary, update the mode of delivery, form and information content. PMID:23777368

Interventions for supporting pregnant women's decision-making about mode of birth after a caesarean.

PubMed

Horey, Dell; Kealy, Michelle; Davey, Mary-Ann; Small, Rhonda; Crowther, Caroline A

2013-07-30

Pregnant women who have previously had a caesarean birth and who have no contraindication for vaginal birth after caesarean (VBAC) may need to decide whether to choose between a repeat caesarean birth or to commence labour with the intention of achieving a VBAC. Women need information about their options and interventions designed to support decision-making may be helpful. Decision support interventions can be implemented independently, or shared with health professionals during clinical encounters or used in mediated social encounters with others, such as telephone decision coaching services. Decision support interventions can include decision aids, one-on-one counselling, group information or support sessions and decision protocols or algorithms. This review considers any decision support intervention for pregnant women making birth choices after a previous caesarean birth. To examine the effectiveness of interventions to support decision-making about vaginal birth after a caesarean birth.Secondary objectives are to identify issues related to the acceptability of any interventions to parents and the feasibility of their implementation. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2013), Current Controlled Trials (22 July 2013), the WHO International Clinical Trials Registry Platform Search Portal (ICTRP) (22 July 2013) and reference lists of retrieved articles. We also conducted citation searches of included studies to identify possible concurrent qualitative studies. All published, unpublished, and ongoing randomised controlled trials (RCTs) and quasi-randomised trials with reported data of any intervention designed to support pregnant women who have previously had a caesarean birth make decisions about their options for birth. Studies using a cluster-randomised design were eligible for inclusion but none were identified. Studies using a cross-over design were not eligible for inclusion. Studies published in abstract form only would have been eligible for inclusion if data were able to be extracted. Two review authors independently applied the selection criteria and carried out data extraction and quality assessment of studies. Data were checked for accuracy. We contacted authors of included trials for additional information. All included interventions were classified as independent, shared or mediated decision supports. Consensus was obtained for classifications. Verification of the final list of included studies was undertaken by three review authors. Three randomised controlled trials involving 2270 women from high-income countries were eligible for inclusion in the review. Outcomes were reported for 1280 infants in one study. The interventions assessed in the trials were designed to be used either independently by women or mediated through the involvement of independent support. No studies looked at shared decision supports, that is, interventions designed to facilitate shared decision-making with health professionals during clinical encounters.We found no difference in planned mode of birth: VBAC (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.97 to 1.10; I² = 0%) or caesarean birth (RR 0.96, 95% CI 0.84 to 1.10; I² = 0%). The proportion of women unsure about preference did not change (RR 0.87, 95% CI 0.62 to 1.20; I² = 0%).There was no difference in adverse outcomes reported between intervention and control groups (one trial, 1275 women/1280 babies): permanent (RR 0.66, 95% CI 0.32 to 1.36); severe (RR 1.02, 95% CI 0.77 to 1.36); unclear (0.66, 95% CI 0.27, 1.61). Overall, 64.8% of those indicating preference for VBAC achieved it, while 97.1% of those planning caesarean birth achieved this mode of birth. We found no difference in the proportion of women achieving congruence between preferred and actual mode of birth (RR 1.02, 95% CI 0.96 to 1.07) (three trials, 1921 women).More women had caesarean births (57.3%), including 535 women where it was unplanned (42.6% all caesarean deliveries and 24.4% all births). We found no difference in actual mode of birth between groups, (average RR 0.97, 95% CI 0.89 to 1.06) (three trials, 2190 women).Decisional conflict about preferred mode of birth was lower (less uncertainty) for women with decisional support (standardised mean difference (SMD) -0.25, 95% CI -0.47 to -0.02; two trials, 787 women; I² = 48%). There was also a significant increase in knowledge among women with decision support compared with those in the control group (SMD 0.74, 95% CI 0.46 to 1.03; two trials, 787 women; I² = 65%). However, there was considerable heterogeneity between the two studies contributing to this outcome ( I² = 65%) and attrition was greater than 15 per cent and the evidence for this outcome is considered to be moderate quality only. There was no difference in satisfaction between women with decision support and those without it (SMD 0.06, 95% CI -0.09 to 0.20; two trials, 797 women; I² = 0%). No study assessed decisional regret or whether women's information needs were met.Qualitative data gathered in interviews with women and health professionals provided information about acceptability of the decision support and its feasibility of implementation. While women liked the decision support there was concern among health professionals about their impact on their time and workload. Evidence is limited to independent and mediated decision supports. Research is needed on shared decision support interventions for women considering mode of birth in a pregnancy after a caesarean birth to use with their care providers.

New Interoperable Tools to Facilitate Decision-Making to Support Community Sustainability

EPA Science Inventory

Communities, regional planning authorities, regulatory agencies, and other decision-making bodies do not currently have adequate access to spatially explicit information crucial to making decisions that allow them to consider a full accounting of the costs, benefits, and trade-of...

Supporting Informed Decision Making - Center for Research Strategy

Cancer.gov

CRS conducts portfolio analyses and collects data on scientific topics, funding mechanisms, and investigator characteristics to help NCI leadership make data-driven decisions about the scientific research enterprise.

Impact of discharge planning decision support on time to readmission among older adult medical patients.

PubMed

Bowles, Kathryn H; Hanlon, Alexandra; Holland, Diane; Potashnik, Sheryl L; Topaz, Maxim

2014-01-01

Hospital clinicians are overwhelmed with the volume of patients churning through the health care systems. The study purpose was to determine whether alerting case managers about high-risk patients by supplying decision support results in better discharge plans as evidenced by time to first hospital readmission. Four medical units at one urban, university medical center. A quasi-experimental study including a usual care and experimental phase with hospitalized English-speaking patients aged 55 years and older. The intervention included using an evidence-based screening tool, the Discharge Decision Support System (D2S2), that supports clinicians' discharge referral decision making by identifying high-risk patients upon admission who need a referral for post-acute care. The usual care phase included collection of the D2S2 information, but not sharing the information with case managers. The experimental phase included data collection and then sharing the results with the case managers. The study compared time to readmission between index discharge date and 30 and 60 days in patients in both groups (usual care vs. experimental). After sharing the D2S2 results, the percentage of referral or high-risk patients readmitted by 30 and 60 days decreased by 6% and 9%, respectively, representing a 26% relative reduction in readmissions for both periods. Supplying decision support to identify high-risk patients recommended for postacute referral is associated with better discharge plans as evidenced by an increase in time to first hospital readmission. The tool supplies standardized information upon admission allowing more time to work with high-risk admissions.

An Integrated Decision-Making Model for Categorizing Weather Products and Decision Aids

NASA Technical Reports Server (NTRS)

Elgin, Peter D.; Thomas, Rickey P.

2004-01-01

The National Airspace System s capacity will experience considerable growth in the next few decades. Weather adversely affects safe air travel. The FAA and NASA are working to develop new technologies that display weather information to support situation awareness and optimize pilot decision-making in avoiding hazardous weather. Understanding situation awareness and naturalistic decision-making is an important step in achieving this goal. Information representation and situation time stress greatly influence attentional resource allocation and working memory capacity, potentially obstructing accurate situation awareness assessments. Three naturalistic decision-making theories were integrated to provide an understanding of the levels of decision making incorporated in three operational situations and two conditions. The task characteristics associated with each phase of flight govern the level of situation awareness attained and the decision making processes utilized. Weather product s attributes and situation task characteristics combine to classify weather products according to the decision-making processes best supported. In addition, a graphical interface is described that affords intuitive selection of the appropriate weather product relative to the pilot s current flight situation.

78 FR 48198 - Comment Request for Information Collection for Workforce Information Grants to States, Extension...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-07

..., inform training and employment program design and investment decision- making, support consultations with strategic partners, and leverage limited labor market information-workforce information (LMI-WI) program...

The Politics of Information: Building a Relational Database To Support Decision-Making at a Public University.

ERIC Educational Resources Information Center

Friedman, Debra; Hoffman, Phillip

2001-01-01

Describes creation of a relational database at the University of Washington supporting ongoing academic planning at several levels and affecting the culture of decision making. Addresses getting started; sharing the database; questions, worries, and issues; improving access to high-demand courses; the advising function; management of instructional…

A GIS BASED DECISION SUPPORT SYSTEM AND RESOURCE TOOL FOR USE ON STUDIES OF THE LAKE TEXOMA ECOSYSTEM

EPA Science Inventory

Investigations are underway at Lake Texoma, to develop decision support tools and information to evaluate the transport and attenuation of contaminants and stressors in a lake ecosystem, and link them to observable ecological effects. The U.S. EPA, USGS, U. S. Army Corps of Eng...

Trends in Facility Management Technology: The Emergence of the Internet, GIS, and Facility Assessment Decision Support.

ERIC Educational Resources Information Center

Teicholz, Eric

1997-01-01

Reports research on trends in computer-aided facilities management using the Internet and geographic information system (GIS) technology for space utilization research. Proposes that facility assessment software holds promise for supporting facility management decision making, and outlines four areas for its use: inventory; evaluation; reporting;…

Multicriteria decision model for retrofitting existing buildings

NASA Astrophysics Data System (ADS)

Bostenaru Dan, B.

2003-04-01

In this paper a model to decide which buildings from an urban area should be retrofitted is presented. The model has been cast into existing ones by choosing the decision rule, criterion weighting and decision support system types most suitable for the spatial problem of reducing earthquake risk in urban areas, considering existing spatial multiatributive and multiobjective decision methods and especially collaborative issues. Due to the participative character of the group decision problem "retrofitting existing buildings" the decision making model is based on interactivity. Buildings have been modeled following the criteria of spatial decision support systems. This includes identifying the corresponding spatial elements of buildings according to the information needs of actors from different sphaeres like architects, construction engineers and economists. The decision model aims to facilitate collaboration between this actors. The way of setting priorities interactivelly will be shown, by detailing the two phases: judgemental and computational, in this case site analysis, collection and evaluation of the unmodified data and converting survey data to information with computational methods using additional expert support. Buildings have been divided into spatial elements which are characteristic for the survey, present typical damages in case of an earthquake and are decisive for a better seismic behaviour in case of retrofitting. The paper describes the architectural and engineering characteristics as well as the structural damage for constuctions of different building ages on the example of building types in Bucharest, Romania in compressible and interdependent charts, based on field observation, reports from the 1977 earthquake and detailed studies made by the author together with a local engineer for the EERI Web Housing Encyclopedia. On this base criteria for setting priorities flow into the expert information contained in the system.

Evidence and Options for Informed Decision-Making to Achive Arctic Sustainability

NASA Astrophysics Data System (ADS)

Berkman, P. A.

2017-12-01

This presentation will consider the development of evidence and options for informed decision-making that will need to operate across generations to achieve Arctic sustainability (Figure). Context of these Arctic decisions is global, recognizing that we live in an interconnected civilization on a planetary scale, as revealed unambiguously with evidence from the `world' wars in the first half of the 20thcentury. First, for clarification, data and evidence are not the same. Data is generated from information and observations to answer specific questions, posed with methods from the natural and social sciences as well as indigenous knowledge. These data reveal patterns and trends in our societies and natural world, underscoring the evidence for decisions to address impacts, issues and resources within, across and beyond the boundaries of nations - recognizing that nations still are the principal jurisdictional unit. However, for this decision-support process to be effective, options (without advocacy) - which can be used or ignored explicitly - must be generated from the evidence, taking into consideration stakeholder perspectives and governance records in a manner that will contribute to informed decision-making. The resulting decisions will involve built elements that require capitalization and technology as well as governance mechanisms coming from diverse jurisdictional authorities. The innovation required is to balance economic prosperity, environmental protection and societal well-being. These three pillars of sustainability further involve stability, balancing urgencies of the moment and of future generations, recognizing that children born today will be alive in the 22nd century. Consequently, options for informed decisions must operate across a continuum of urgencies from security time scales to sustainability time scales. This decision-support process is holistic (international, interdisciplinary and inclusive), reflecting the applications of science diplomacy to balance national interests and common interests for the benefit of all on Earth.

Hidden profiles and concealed information: strategic information sharing and use in group decision making.

PubMed

Toma, Claudia; Butera, Fabrizio

2009-06-01

Two experiments investigated the differential impact of cooperation and competition on strategic information sharing and use in a three-person group decision-making task. Information was distributed in order to create a hidden profile so that disconfirmation of group members' initial preferences was required to solve the task. Experiment 1 revealed that competition, compared to cooperation, led group members to withhold unshared information, a difference that was not significant for shared information. In competition, compared to cooperation, group members were also more reluctant to disconfirm their initial preferences. Decision quality was lower in competition than in cooperation, this effect being mediated by disconfirmation use and not by information sharing. Experiment 2 replicated these findings and revealed the role of mistrust in predicting strategic information sharing and use in competition. These results support a motivated information processing approach of group decision making.

Rationality versus reality: the challenges of evidence-based decision making for health policy makers

PubMed Central

2010-01-01

Background Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. Summary In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be improved. PMID:20504357

Rationality versus reality: the challenges of evidence-based decision making for health policy makers.

PubMed

McCaughey, Deirdre; Bruning, Nealia S

2010-05-26

Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be improved.

Bayesian Decision Support

NASA Astrophysics Data System (ADS)

Berliner, M.

2017-12-01

Bayesian statistical decision theory offers a natural framework for decision-policy making in the presence of uncertainty. Key advantages of the approach include efficient incorporation of information and observations. However, in complicated settings it is very difficult, perhaps essentially impossible, to formalize the mathematical inputs needed in the approach. Nevertheless, using the approach as a template is useful for decision support; that is, organizing and communicating our analyses. Bayesian hierarchical modeling is valuable in quantifying and managing uncertainty such cases. I review some aspects of the idea emphasizing statistical model development and use in the context of sea-level rise.

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise.

PubMed

Militello, Laura G; Saleem, Jason J; Borders, Morgan R; Sushereba, Christen E; Haverkamp, Donald; Wolf, Steven P; Doebbeling, Bradley N

2016-03-01

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration's EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability.

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise

PubMed Central

Militello, Laura G.; Saleem, Jason J.; Borders, Morgan R.; Sushereba, Christen E.; Haverkamp, Donald; Wolf, Steven P.; Doebbeling, Bradley N.

2016-01-01

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration’s EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability. PMID:26973441

Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: a sociotechnical analysis.

PubMed

Sheehan, Barbara; Nigrovic, Lise E; Dayan, Peter S; Kuppermann, Nathan; Ballard, Dustin W; Alessandrini, Evaline; Bajaj, Lalit; Goldberg, Howard; Hoffman, Jeffrey; Offerman, Steven R; Mark, Dustin G; Swietlik, Marguerite; Tham, Eric; Tzimenatos, Leah; Vinson, David R; Jones, Grant S; Bakken, Suzanne

2013-10-01

Integration of clinical decision support services (CDSS) into electronic health records (EHRs) may be integral to widespread dissemination and use of clinical prediction rules in the emergency department (ED). However, the best way to design such services to maximize their usefulness in such a complex setting is poorly understood. We conducted a multi-site cross-sectional qualitative study whose aim was to describe the sociotechnical environment in the ED to inform the design of a CDSS intervention to implement the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules for children with minor blunt head trauma. Informed by a sociotechnical model consisting of eight dimensions, we conducted focus groups, individual interviews and workflow observations in 11 EDs, of which 5 were located in academic medical centers and 6 were in community hospitals. A total of 126 ED clinicians, information technology specialists, and administrators participated. We clustered data into 19 categories of sociotechnical factors through a process of thematic analysis and subsequently organized the categories into a sociotechnical matrix consisting of three high-level sociotechnical dimensions (workflow and communication, organizational factors, human factors) and three themes (interdisciplinary assessment processes, clinical practices related to prediction rules, EHR as a decision support tool). Design challenges that emerged from the analysis included the need to use structured data fields to support data capture and re-use while maintaining efficient care processes, supporting interdisciplinary communication, and facilitating family-clinician interaction for decision-making. Copyright © 2013 Elsevier Inc. All rights reserved.

Group Health's participation in a shared decision-making demonstration yielded lessons, such as role of culture change.

PubMed

King, Jaime; Moulton, Benjamin

2013-02-01

In 2007 Washington State became the first state to enact legislation encouraging the use of shared decision making and decision aids to address deficiencies in the informed-consent process. Group Health volunteered to fulfill a legislated mandate to study the costs and benefits of integrating these shared decision-making processes into clinical practice across a range of conditions for which multiple treatment options are available. The Group Health Demonstration Project, conducted during 2009-11, yielded five key lessons for successful implementation, including the synergy between efforts to reduce practice variation and increase shared decision making; the need to support modifications in practice with changes in physician training and culture; and the value of identifying best implementation methods through constant evaluation and iterative improvement. These lessons, and the legislated provisions that supported successful implementation, can guide other states and health care institutions moving toward informed patient choice as the standard of care for medical decision making.

A Synthesis Of Knowledge About Caregiver Decision Making Finds Gaps In Support For Those Who Care For Aging Loved Ones.

PubMed

Garvelink, Mirjam M; Ngangue, Patrice A G; Adekpedjou, Rheda; Diouf, Ndeye T; Goh, Larissa; Blair, Louisa; Légaré, France

2016-04-01

We conducted a mixed-methods knowledge synthesis to assess the effectiveness of interventions to improve caregivers' involvement in decision making with seniors, and to describe caregivers' experiences of decision making in the absence of interventions. We analyzed forty-nine qualitative, fourteen quantitative, and three mixed-methods studies. The qualitative studies indicated that caregivers had unmet needs for information, discussions of values and needs, and decision support, which led to negative sentiments after decision making. Our results indicate that there have been insufficient quantitative evaluations of interventions to involve caregivers in decision making with seniors and that the evaluations that do exist found few clinically significant effects. Elements of usual care that received positive evaluations were the availability of a decision coach and a supportive decision-making environment. Additional rigorously evaluated interventions are needed to help caregivers be more involved in decision making with seniors. Project HOPE—The People-to-People Health Foundation, Inc.

Recognition Decisions From Visual Working Memory Are Mediated by Continuous Latent Strengths.

PubMed

Ricker, Timothy J; Thiele, Jonathan E; Swagman, April R; Rouder, Jeffrey N

2017-08-01

Making recognition decisions often requires us to reference the contents of working memory, the information available for ongoing cognitive processing. As such, understanding how recognition decisions are made when based on the contents of working memory is of critical importance. In this work we examine whether recognition decisions based on the contents of visual working memory follow a continuous decision process of graded information about the correct choice or a discrete decision process reflecting only knowing and guessing. We find a clear pattern in favor of a continuous latent strength model of visual working memory-based decision making, supporting the notion that visual recognition decision processes are impacted by the degree of matching between the contents of working memory and the choices given. Relation to relevant findings and the implications for human information processing more generally are discussed. Copyright © 2016 Cognitive Science Society, Inc.

A framework for ecological decision support systems: Building the right systems and building the systems right

USGS Publications Warehouse

D'Erchia, Frank; Korschgen, Carl E.; Nyquist, M.; Root, Ralph; Sojda, Richard S.; Stine, Peter

2001-01-01

Workshops in the late 1990's launched the commitment of the U.S. Geological Survey's Biological Resources Division (BRD) to develop and implement decision support systems (DSS) applications. One of the primary goals of this framework document is to provide sufficient background and information for Department of the Interior (DOI) bureau stakeholders and other clients to determine the potential for DSS development. Such an understanding can assist them in carrying out effective land planning and management practices. This document provides a definition of DSS and its characteristics and capabilities. It proceeds to describe issues related to meeting resource managers needs, such as the needs for specific applications, customer requirements, information and technology transfer, user support, and institutionalization. Using the decision process as a means to guide DSS development and determine users needs is also discussed. We conclude with information on method to evaluate DSS development efforts and recommended procedures for verification and validation. 

Decision making by urgency gating: theory and experimental support.

PubMed

Thura, David; Beauregard-Racine, Julie; Fradet, Charles-William; Cisek, Paul

2012-12-01

It is often suggested that decisions are made when accumulated sensory information reaches a fixed accuracy criterion. This is supported by many studies showing a gradual build up of neural activity to a threshold. However, the proposal that this build up is caused by sensory accumulation is challenged by findings that decisions are based on information from a time window much shorter than the build-up process. Here, we propose that in natural conditions where the environment can suddenly change, the policy that maximizes reward rate is to estimate evidence by accumulating only novel information and then compare the result to a decreasing accuracy criterion. We suggest that the brain approximates this policy by multiplying an estimate of sensory evidence with a motor-related urgency signal and that the latter is primarily responsible for neural activity build up. We support this hypothesis using human behavioral data from a modified random-dot motion task in which motion coherence changes during each trial.

Evaluation of a Potential for Enhancing the Decision Support System of the Interagency Modeling and Atmospheric Assessment Center with NASA Earth Science Research Results

NASA Technical Reports Server (NTRS)

Blonski, Slawomir; Berglund, Judith; Spruce, Joseph P.; McKellip, Rodney; Jasinski, Michael; Borak, Jordan; Lundquist, Julie

2007-01-01

NASA's objective for the Applied Sciences Program of the Science Mission Directorate is to expand and accelerate the realization of economic and societal benefits from Earth science, information, and technology. This objective is accomplished by using a systems approach to facilitate the incorporation of Earth observations and predictions into the decision-support tools used by partner organizations to provide essential services to society. The services include management of forest fires, coastal zones, agriculture, weather prediction, hazard mitigation, aviation safety, and homeland security. In this way, NASA's long-term research programs yield near-term, practical benefits to society. The Applied Sciences Program relies heavily on forging partnerships with other Federal agencies to accomplish its objectives. NASA chooses to partner with agencies that have existing connections with end-users, information infrastructure already in place, and decision support systems that can be enhanced by the Earth science information that NASA is uniquely poised to provide (NASA, 2004).

Direct and Electronic Health Record Access to the Clinical Decision Support for Immunizations in the Minnesota Immunization Information System.

PubMed

Rajamani, Sripriya; Bieringer, Aaron; Wallerius, Stephanie; Jensen, Daniel; Winden, Tamara; Muscoplat, Miriam Halstead

2016-01-01

Immunization information systems (IIS) are population-based and confidential computerized systems maintained by public health agencies containing individual data on immunizations from participating health care providers. IIS hold comprehensive vaccination histories given across providers and over time. An important aspect to IIS is the clinical decision support for immunizations (CDSi), consisting of vaccine forecasting algorithms to determine needed immunizations. The study objective was to analyze the CDSi presentation by IIS in Minnesota (Minnesota Immunization Information Connection [MIIC]) through direct access by IIS interface and by access through electronic health records (EHRs) to outline similarities and differences. The immunization data presented were similar across the three systems examined, but with varying ability to integrate data across MIIC and EHR, which impacts immunization data reconciliation. Study findings will lead to better understanding of immunization data display, clinical decision support, and user functionalities with the ultimate goal of promoting IIS CDSi to improve vaccination rates.

Women's health nursing in the context of the National Health Information Infrastructure.

PubMed

Jenkins, Melinda L; Hewitt, Caroline; Bakken, Suzanne

2006-01-01

Nurses must be prepared to participate in the evolving National Health Information Infrastructure and the changes that will consequently occur in health care practice and documentation. Informatics technologies will be used to develop electronic health records with integrated decision support features that will likely lead to enhanced health care quality and safety. This paper provides a summary of the National Health Information Infrastructure and highlights electronic health records and decision support systems within the context of evidence-based practice. Activities at the Columbia University School of Nursing designed to prepare nurses with the necessary informatics competencies to practice in a National Health Information Infrastructure-enabled health care system are described. Data are presented from electronic (personal digital assistant) encounter logs used in our Women's Health Nurse Practitioner program to support evidence-based advanced practice nursing care. Implications for nursing practice, education, and research in the evolving National Health Information Infrastructure are discussed.

RF-CLASS: A Remote-sensing-based Interoperable Web service system for Flood Crop Loss Assessment

NASA Astrophysics Data System (ADS)

Di, L.; Yu, G.; Kang, L.

2014-12-01

Flood is one of the worst natural disasters in the world. Flooding often causes significant crop loss over large agricultural areas in the United States. Two USDA agencies, the National Agricultural Statistics Service (NASS) and Risk Management Agency (RMA), make decisions on flood statistics, crop insurance policy, and recovery management by collecting, analyzing, reporting, and utilizing flooded crop acreage and crop loss information. NASS has the mandate to report crop loss after all flood events. RMA manages crop insurance policy and uses crop loss information to guide the creation of the crop insurance policy and the aftermath compensation. Many studies have been conducted in the recent years on monitoring floods and assessing the crop loss due to floods with remote sensing and geographic information technologies. The Remote-sensing-based Flood Crop Loss Assessment Service System (RF-CLASS), being developed with NASA and USDA support, aims to significantly improve the post-flood agricultural decision-making supports in USDA by integrating and advancing the recently developed technologies. RF-CLASS will operationally provide information to support USDA decision making activities on collecting and archiving flood acreage and duration, recording annual crop loss due to flood, assessing the crop insurance rating areas, investigating crop policy compliance, and spot checking of crop loss claims. This presentation will discuss the remote sensing and GIS based methods for deriving the needed information to support the decision making, the RF-CLASS cybersystem architecture, the standards and interoperability arrangements in the system, and the current and planned capabilities of the system.

Simultaneous Visualization of Different Utility Networks for Disaster Management

NASA Astrophysics Data System (ADS)

Semm, S.; Becker, T.; Kolbe, T. H.

2012-07-01

Cartographic visualizations of crises are used to create a Common Operational Picture (COP) and enforce Situational Awareness by presenting and representing relevant information. As nearly all crises affect geospatial entities, geo-data representations have to support location-specific decision-making throughout the crises. Since, Operator's attention span and their working memory are limiting factors for the process of getting and interpreting information; the cartographic presentation has to support individuals in coordinating their activities and with handling highly dynamic situations. The Situational Awareness of operators in conjunction with a COP are key aspects of the decision making process and essential for coming to appropriate decisions. Utility networks are one of the most complex and most needed systems within a city. The visualization of utility infrastructure in crisis situations is addressed in this paper. The paper will provide a conceptual approach on how to simplify, aggregate, and visualize multiple utility networks and their components to meet the requirements of the decision-making process and to support Situational Awareness.

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context.

PubMed

Ng, Chirk-Jenn; Lee, Ping-Yein; Lee, Yew-Kong; Chew, Boon-How; Engkasan, Julia P; Irmi, Zarina-Ismail; Hanafi, Nik-Sherina; Tong, Seng-Fah

2013-10-11

Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients' desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient' programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia.

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context

PubMed Central

2013-01-01

Background Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. Methods In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. Results There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient’ programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. Conclusion In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia. PMID:24119237

An Integrated Decision Support System for Planning and Measuring Institutional Efficiency. AIR 1992 Annual Forum Paper.

ERIC Educational Resources Information Center

Minnaar, Phil C.

This paper presents a model for obtaining and organizing managment information for decision making in university planning, developed by the Bureau for Management Information of the University of South Africa. The model identifies the fundamental entities of the university as environment, finance, physical facilities, assets, personnel, and…

77 FR 71871 - Information Collection Available for Public Comments and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-04

... availability, location, and specifications of U.S.-flag vessels for the purpose of making vessel availability... Administrator to make a timely and informed decision on the availability of coastwise qualified vessels in support of a request from the Department of Homeland Security prior to the final decision on granting a...

In the patient's best interest: appraising social network site information for surrogate decision making.

PubMed

Siddiqui, Shahla; Chuan, Voo Teck

2018-06-28

This paper will discuss why and how social network sites ought to be used in surrogate decision making (SDM), with focus on a context like Singapore in which substituted judgment is incorporated as part of best interest assessment for SDM, as guided by the Code of Practice for making decisions for those lacking mental capacity under the Mental Capacity Act (2008). Specifically, the paper will argue that the Code of Practice already supports an ethical obligation, as part of a patient-centred care approach, to look for and appraise social network site (SNS) as a source of information for best interest decision making. As an important preliminary, the paper will draw on Berg's arguments to support the use of SNS information as a resource for SDM. It will also supplement her account for how SNS information ought to be weighed against or considered alongside other evidence of patient preference or wishes, such as advance directives and anecdotal accounts by relatives. © Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.

Combining the Generic Entity-Attribute-Value Model and Terminological Models into a Common Ontology to Enable Data Integration and Decision Support.

PubMed

Bouaud, Jacques; Guézennec, Gilles; Séroussi, Brigitte

2018-01-01

The integration of clinical information models and termino-ontological models into a unique ontological framework is highly desirable for it facilitates data integration and management using the same formal mechanisms for both data concepts and information model components. This is particularly true for knowledge-based decision support tools that aim to take advantage of all facets of semantic web technologies in merging ontological reasoning, concept classification, and rule-based inferences. We present an ontology template that combines generic data model components with (parts of) existing termino-ontological resources. The approach is developed for the guideline-based decision support module on breast cancer management within the DESIREE European project. The approach is based on the entity attribute value model and could be extended to other domains.

An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support.

PubMed

Wong, C M; Wu, S Y; Ting, W H; Ho, K H; Tong, L H; Cheung, N T

2015-01-01

Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.

Development and utilization of complementary communication channels for treatment decision making and survivorship issues among cancer patients: The CIS Research Consortium Experience.

PubMed

Fleisher, Linda; Wen, Kuang Yi; Miller, Suzanne M; Diefenbach, Michael; Stanton, Annette L; Ropka, Mary; Morra, Marion; Raich, Peter C

2015-11-01

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 examine the actual use of and perceived benefits of two complementary communication channels -- print and eHealth interventions. The three Virtual Cancer Information Service (V-CIS) interventions were developed through a rigorous developmental process, guided by self-regulatory theory, informed decision-making frameworks, and health communications best practices. Control arm participants received NCI print materials; experimental arm participants received the additional V-CIS patient support tool. Actual usage data from the web-based V-CIS was also obtained and reported. Print materials were highly used by all groups. About 60% of the experimental group reported using the V-CIS. Those who did use the V-CIS rated it highly on improvements in knowledge, patient-provider communication and decision-making. The findings show that how patients actually use eHealth interventions either singularly or within the context of other communication channels is complex. Integrating rigorous best practices and theoretical foundations is essential and multiple communication approaches should be considered to support patient preferences.

Collaborating with Youth to Inform and Develop Tools for Psychotropic Decision Making

PubMed Central

Murphy, Andrea; Gardner, David; Kutcher, Stan; Davidson, Simon; Manion, Ian

2010-01-01

Introduction: Youth oriented and informed resources designed to support psychopharmacotherapeutic decision-making are essentially unavailable. This article outlines the approach taken to design such resources, the product that resulted from the approach taken, and the lessons learned from the process. Methods: A project team with psychopharmacology expertise was assembled. The project team reviewed best practices regarding medication educational materials and related tools to support decisions. Collaboration with key stakeholders who were thought of as primary end-users and target groups occurred. A graphic designer and a plain language consultant were also retained. Results: Through an iterative and collaborative process over approximately 6 months, Med Ed and Med Ed Passport were developed. Literature and input from key stakeholders, in particular youth, was instrumental to the development of the tools and materials within Med Ed. A training program utilizing a train-the-trainer model was developed to facilitate the implementation of Med Ed in Ontario, which is currently ongoing. Conclusion: An evidence-informed process that includes youth and key stakeholder engagement is required for developing tools to support in psychopharmacotherapeutic decision-making. The development process fostered an environment of reciprocity between the project team and key stakeholders. PMID:21037916

Physician Information Needs in Managing Delirium

PubMed Central

Taft, Teresa; Nelsen, Scott D; Slager, Stacey; Weir, Charlene

2017-01-01

Delirium has the highest occurrence rate of any complication in hospitalized adults over the age of 65. The study objective was to determine physician information needs for use in the development of electronic clinical decision support for physicians managing the care of patients with delirium. Critical incident interviews were conducted with 8 experienced internal medicine physicians and 1 cardiologist. Thematic analysis revealed the following 6 themes: 1) Clinician’s experience an impoverished information field for mental status, 2) Uncertainty is pervasive, 3) Extensive information foraging effort is required for cohesive story building, 4) Goal Conflict leads to missed diagnosis and early closure, 5) Diffusion of Responsibility for treating delirium is common, and 6) Use of structured delirium resources is minimal. Elicited information needs were identified and physician recommendations for improving access to information needed in managing the care of patient’s with delirium are reported. Information elicited in this study is useful for designing delirium clinical decision support that supports physician cognition.

Impact of a goal setting and decision support telephone coaching intervention on diet, psychosocial, and decision outcomes among people with type 2 diabetes.

PubMed

Swoboda, Christine M; Miller, Carla K; Wills, Celia E

2017-07-01

Evaluate a 16-week decision support and goal-setting intervention to compare diet quality, decision, and diabetes-related outcomes to a control group. Adults with type 2 diabetes (n=54) were randomly assigned to an intervention or control group. Intervention group participants completed one in-person motivational interviewing and decision support session followed by seven biweekly telephone coaching calls. Participants reported previous goal attempts and set diet- and/or physical activity-related goals during coaching calls. Control group participants received information about local health care resources on the same contact schedule. There was a significant difference between groups for diabetes empowerment (p=0.045). A significant increase in diet quality, diabetes self-efficacy, and diabetes empowerment, and a significant decrease in diabetes distress and depressive symptoms (all p≤0.05) occurred in the intervention group. Decision confidence to achieve diet-related goals significantly improved from baseline to week 8 but then declined at study end (both p≤0.05). Setting specific diet-related goals may promote dietary change, and telephone coaching can improve psychosocial outcomes related to diabetes self-management. Informed shared decision making can facilitate progressively challenging yet attainable goals tailored to individuals' lifestyle. Decision coaching may empower patients to improve self-management practices and reduce distress. Copyright © 2017 Elsevier B.V. All rights reserved.

Creating Shareable Clinical Decision Support Rules for a Pharmacogenomics Clinical Guideline Using Structured Knowledge Representation.

PubMed

Linan, Margaret K; Sottara, Davide; Freimuth, Robert R

2015-01-01

Pharmacogenomics (PGx) guidelines contain drug-gene relationships, therapeutic and clinical recommendations from which clinical decision support (CDS) rules can be extracted, rendered and then delivered through clinical decision support systems (CDSS) to provide clinicians with just-in-time information at the point of care. Several tools exist that can be used to generate CDS rules that are based on computer interpretable guidelines (CIG), but none have been previously applied to the PGx domain. We utilized the Unified Modeling Language (UML), the Health Level 7 virtual medical record (HL7 vMR) model, and standard terminologies to represent the semantics and decision logic derived from a PGx guideline, which were then mapped to the Health eDecisions (HeD) schema. The modeling and extraction processes developed here demonstrate how structured knowledge representations can be used to support the creation of shareable CDS rules from PGx guidelines.

Utilization of Live Localized Weather Information for Sustainable Agriculture

NASA Astrophysics Data System (ADS)

Anderson, J.; Usher, J.

2010-09-01

Authors: Jim Anderson VP, Global Network and Business Development WeatherBug® Professional Jeremy Usher Managing Director, Europe WeatherBug® Professional Localized, real-time weather information is vital for day-to-day agronomic management of all crops. The challenge for agriculture is twofold in that local and timely weather data is not often available for producers and farmers, and it is not integrated into decision-support tools they require. Many of the traditional sources of weather information are not sufficient for agricultural applications because of the long distances between weather stations, meaning the data is not always applicable for on-farm decision making processes. The second constraint with traditional weather information is the timeliness of the data. Most delivery systems are designed on a one-hour time step, whereas many decisions in agriculture are based on minute-by-minute weather conditions. This is especially true for decisions surrounding chemical and fertilizer application and frost events. This presentation will outline how the creation of an agricultural mesonet (weather network) can enable producers and farmers with live, local weather information from weather stations installed in farm/field locations. The live weather information collected from each weather station is integrated into a web-enabled decision support tool, supporting numerous on-farm agronomic activities such as pest management, or dealing with heavy rainfall and frost events. Agronomic models can be used to assess the potential of disease pressure, enhance the farmer's abilities to time pesticide applications, or assess conditions contributing to yield and quality fluctuations. Farmers and industry stakeholders may also view quality-assured historical weather variables at any location. This serves as a record-management tool for viewing previously uncharted agronomic weather events in graph or table form. This set of weather tools is unique and provides a significant enhancement to the agronomic decision-support process. Direct benefits to growers can take the form of increased yield and grade potential, as well as savings in money and time. Pest management strategies become more efficient due to timely and localized disease and pest modelling, and increased efficacy of pest and weed control. Examples from the Canadian Wheat Board (CWB) WeatherFarm weather network will be utilized to illustrate the processes, decision tools and benefits to producers and farmers.

Coping with Inflammatory Bowel Disease: Engaging with Information to Inform Health-Related Decision Making in Daily Life.

PubMed

Restall, Gayle J; Simms, Alexandria M; Walker, John R; Haviva, Clove; Graff, Lesley A; Sexton, Kathryn A; Miller, Norine; Targownik, Laura E; Bernstein, Charles N

2017-08-01

People with inflammatory bowel disease (IBD) require disease and lifestyle information to make health-related decisions in their daily lives. Derived from a larger qualitative study of the lived experiences of people with IBD, we report on findings that explored how people with IBD engage with health-related information in their daily lives. Participants were recruited primarily from the Manitoba IBD Cohort Study. We used purposive sampling to select people with a breadth of characteristics and experiences. Individual interviews were audio-recorded and transcribed verbatim. Data were analyzed using inductive qualitative methods consistent with a phenomenological approach. Forty-five people with IBD participated; 51% were women. Findings highlighted the temporal and contextual influences on engagement with health-related information. Temporal influences were described as the changing need for health-related information over time. Participants identified 6 contextual factors influencing engagement with information to make health decisions: (1) emotional and attitudinal responses, (2) perceived benefits and risks, (3) trust in the source of the information, (4) knowledge and skills to access and use information, (5) availability of evidence to support decisions, and (6) social and economic environments. Findings illustrate the changing needs for health-related information over the course of IBD, and with evolving health and life circumstances. Practitioners can be responsive to information needs of people with IBD by having high-quality information available at the right time in a variety of formats and by supporting the incorporation of information in daily life.

Organisational capacity and chronic disease care: an Australian general practice perspective.

PubMed

Proudfoot, Judith; Infante, Fernando; Holton, Christine; Powell-Davies, Gawaine; Bubner, Tanya; Beilby, Justin; Harris, Mark

2007-04-01

Although we are rapidly improving our understanding of how to manage patients with chronic illness in Australian general practice, many patients are still receiving suboptimal care. General practices have limited organisational capacity to provide the structured care that is required for managing chronic conditions: regular monitoring, decision support, patient recall, supporting patient self management, team work, and information management. This requires a shift away from episodic, acute models. Overseas research has shown that areas such as team work, clinical information systems, decision support, linkages and leadership are also important in managing chronic illness, but we do not know which of these are most important in Australia.

Evaluating the Effectiveness of Nurse-Focused Computerized Clinical Decision Support on Urinary Catheter Practice Guidelines

ERIC Educational Resources Information Center

Lang, Robin Lynn Neal

2012-01-01

A growing national emphasis has been placed on health information technology (HIT) with robust computerized clinical decision support (CCDS) integration into health care delivery. Catheter-associated urinary tract infection is the most frequent health care-associated infection in the United States and is associated with high cost, high volumes and…

An agent architecture for an integrated forest ecosystem management decision support system

Treesearch

Donald Nute; Walter D. Potter; Mayukh Dass; Astrid Glende; Frederick Maier; Hajime Uchiyama; Jin Wang; Mark Twery; Peter Knopp; Scott Thomasma; H. Michael Rauscher

2003-01-01

A wide variety of software tools are available to support decision in the management of forest ecosystems. These tools include databases, growth and yield models, wildlife models, silvicultural expert systems, financial models, geographical informations systems, and visualization tools. Typically, each of these tools has its own complex interface and data format. To...

Computer Decision Support to Improve Autism Screening and Care in Community Pediatric Clinics

ERIC Educational Resources Information Center

Bauer, Nerissa S.; Sturm, Lynne A.; Carroll, Aaron E.; Downs, Stephen M.

2013-01-01

An autism module was added to an existing computer decision support system (CDSS) to facilitate adherence to recommended guidelines for screening for autism spectrum disorders in primary care pediatric clinics. User satisfaction was assessed by survey and informal feedback at monthly meetings between clinical staff and the software team. To assess…

Environmental impact assessment of transportation projects: An analysis using an integrated GIS, remote sensing, and spatial modeling approach

NASA Astrophysics Data System (ADS)

El-Gafy, Mohamed Anwar

Transportation projects will have impact on the environment. The general environmental pollution and damage caused by roads is closely associated with the level of economic activity. Although Environmental Impact Assessments (EIAs) are dependent on geo-spatial information in order to make an assessment, there are no rules per se how to conduct an environmental assessment. Also, the particular objective of each assessment is dictated case-by-case, based on what information and analyses are required. The conventional way of Environmental Impact Assessment (EIA) study is a time consuming process because it has large number of dependent and independent variables which have to be taken into account, which also have different consequences. With the emergence of satellite remote sensing technology and Geographic Information Systems (GIS), this research presents a new framework for the analysis phase of the Environmental Impact Assessment (EIA) for transportation projects based on the integration between remote sensing technology, geographic information systems, and spatial modeling. By integrating the merits of the map overlay method and the matrix method, the framework analyzes comprehensively the environmental vulnerability around the road and its impact on the environment. This framework is expected to: (1) improve the quality of the decision making process, (2) be applied both to urban and inter-urban projects, regardless of transport mode, and (3) present the data and make the appropriate analysis to support the decision of the decision-makers and allow them to present these data to the public hearings in a simple manner. Case studies, transportation projects in the State of Florida, were analyzed to illustrate the use of the decision support framework and demonstrate its capabilities. This cohesive and integrated system will facilitate rational decisions through cost effective coordination of environmental information and data management that can be tailored to specific projects. The framework would facilitate collecting, organizing, analyzing, archiving, and coordinating the information and data necessary to support technical and policy transportation decisions.

Systematic review of the empirical investigation of resources to support decision-making regarding BRCA1 and BRCA2 genetic testing in women with breast cancer.

PubMed

Grimmett, Chloe; Pickett, Karen; Shepherd, Jonathan; Welch, Karen; Recio-Saucedo, Alejandra; Streit, Elke; Seers, Helen; Armstrong, Anne; Cutress, Ramsey I; Evans, D Gareth; Copson, Ellen; Meiser, Bettina; Eccles, Diana; Foster, Claire

2018-05-01

Identify existing resources developed and/or evaluated empirically in the published literature designed to support women with breast cancer making decisions regarding genetic testing for BRCA1/2 mutations. Systematic review of seven electronic databases. Studies were included if they described or evaluated resources that were designed to support women with breast cancer in making a decision to have genetic counselling or testing for familial breast cancer. Outcome and process evaluations, using any type of study design, as well as articles reporting the development of decision aids, were eligible for inclusion. Total of 9 publications, describing 6 resources were identified. Resources were effective at increasing knowledge or understanding of hereditary breast cancer. Satisfaction with resources was high. There was no evidence that any resource increased distress, worry or decisional conflict. Few resources included active functionalities for example, values-based exercises, to support decision-making. Tailored resources supporting decision-making may be helpful and valued by patients and increase knowledge of hereditary breast cancer, without causing additional distress. Clinicians should provide supportive written information to patients where it is available. However, there is a need for robustly developed decision tools to support decision-making around genetic testing in women with breast cancer. Copyright © 2017 Elsevier B.V. All rights reserved.

Personalized health care and health information technology policy: an exploratory analysis.

PubMed

Wald, Jonathan S; Shapiro, Michael

2013-01-01

Personalized healthcare (PHC) is envisioned to enhance clinical practice decision-making using new genome-driven knowledge that tailors diagnosis, treatment, and prevention to the individual patient. In 2012, we conducted a focused environmental scan and informal interviews with fifteen experts to anticipate how PHC might impact health Information Technology (IT) policy in the United States. Findings indicatedthat PHC has a variable impact on current clinical practice, creates complex questions for providers, patients, and policy-makers, and will require a robust health IT infrastructure with advanced data architecture, clinical decision support, provider workflow tools, and re-use of clinical data for research. A number of health IT challenge areas were identified, along with five policy areas including: interoperable clinical decision support, standards for patient values and preferences, patient engagement, data transparency, and robust privacy and security.

Ecological support for rural land-use planning.

Treesearch

David M. Theobald; Thomas Spies; Jeff Kline; Bruce Maxwell; N. T. Hobbs; Virginia H. Dale

2005-01-01

How can ecologists be more effective in supporting ecologically informed rural land-use planning and policy? Improved decision making about rural lands requires careful consideration of how ecological information and analyses can inform specific planning and policy needs. We provide a brief overview of rural land-use planning, including recently developed approaches to...

Involved, inputting or informing: "Shared" decision making in adult mental health care.

PubMed

Bradley, Eleanor; Green, Debra

2018-02-01

A diagnosis of serious mental illness can impact on the whole family. Families informally provide significant amounts of care but are disproportionately at risk of carer burden when compared to those supporting people with other long-term conditions. Shared decision making (SDM) is an ethical model of health communication associated with positive health outcomes; however, there has been little research to evaluate how routinely family is invited to participate in SDM, or what this looks like in practice. This UK study aimed to better understand how the family caregivers of those diagnosed with SMI are currently involved in decision making, particularly decisions about treatment options including prescribed medication. Objectives were to Explore the extent to which family members wish to be involved in decisions about prescribed medication Determine how and when professionals engage family in these decisions Identify barriers and facilitators associated with the engagement of family in decisions about treatment. Open-ended questions were sent to professionals and family members to elicit written responses. Qualitative responses were analysed thematically. Themes included the definition of involvement and "rules of engagement." Staff members are gatekeepers for family involvement, and the process is not democratic. Family and staff ascribe practical, rather than recovery-oriented roles to family, with pre-occupation around notions of adherence. Staff members need support, training and education to apply SDM. Time to exchange information is vital but practically difficult. Negotiated teams, comprising of staff, service users, family, peers as applicable, with ascribed roles and responsibilities could support SDM. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

E-Health towards ecumenical framework for personalized medicine via Decision Support System.

PubMed

Kouris, Ioannis; Tsirmpas, Charalampos; Mougiakakou, Stavroula G; Iliopoulou, Dimitra; Koutsouris, Dimitris

2010-01-01

The purpose of the present manuscript is to present the advances performed in medicine using a Personalized Decision Support System (PDSS). The models used in Decision Support Systems (DSS) are examined in combination with Genome Information and Biomarkers to produce personalized result for each individual. The concept of personalize medicine is described in depth and application of PDSS for Cardiovascular Diseases (CVD) and Type-1 Diabetes Mellitus (T1DM) are analyzed. Parameters extracted from genes, biomarkers, nutrition habits, lifestyle and biological measurements feed DSSs, incorporating Artificial Intelligence Modules (AIM), to provide personalized advice, medication and treatment.

E-DECIDER: Using Earth Science Data and Modeling Tools to Develop Decision Support for Earthquake Disaster Response

NASA Astrophysics Data System (ADS)

Glasscoe, Margaret T.; Wang, Jun; Pierce, Marlon E.; Yoder, Mark R.; Parker, Jay W.; Burl, Michael C.; Stough, Timothy M.; Granat, Robert A.; Donnellan, Andrea; Rundle, John B.; Ma, Yu; Bawden, Gerald W.; Yuen, Karen

2015-08-01

Earthquake Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response (E-DECIDER) is a NASA-funded project developing new capabilities for decision making utilizing remote sensing data and modeling software to provide decision support for earthquake disaster management and response. E-DECIDER incorporates the earthquake forecasting methodology and geophysical modeling tools developed through NASA's QuakeSim project. Remote sensing and geodetic data, in conjunction with modeling and forecasting tools allows us to provide both long-term planning information for disaster management decision makers as well as short-term information following earthquake events (i.e. identifying areas where the greatest deformation and damage has occurred and emergency services may need to be focused). This in turn is delivered through standards-compliant web services for desktop and hand-held devices.

Next generation terminology infrastructure to support interprofessional care planning.

PubMed

Collins, Sarah; Klinkenberg-Ramirez, Stephanie; Tsivkin, Kira; Mar, Perry L; Iskhakova, Dina; Nandigam, Hari; Samal, Lipika; Rocha, Roberto A

2017-11-01

Develop a prototype of an interprofessional terminology and information model infrastructure that can enable care planning applications to facilitate patient-centered care, learn care plan linkages and associations, provide decision support, and enable automated, prospective analytics. The study steps included a 3 step approach: (1) Process model and clinical scenario development, and (2) Requirements analysis, and (3) Development and validation of information and terminology models. Components of the terminology model include: Health Concerns, Goals, Decisions, Interventions, Assessments, and Evaluations. A terminology infrastructure should: (A) Include discrete care plan concepts; (B) Include sets of profession-specific concerns, decisions, and interventions; (C) Communicate rationales, anticipatory guidance, and guidelines that inform decisions among the care team; (D) Define semantic linkages across clinical events and professions; (E) Define sets of shared patient goals and sub-goals, including patient stated goals; (F) Capture evaluation toward achievement of goals. These requirements were mapped to AHRQ Care Coordination Measures Framework. This study used a constrained set of clinician-validated clinical scenarios. Terminology models for goals and decisions are unavailable in SNOMED CT, limiting the ability to evaluate these aspects of the proposed infrastructure. Defining and linking subsets of care planning concepts appears to be feasible, but also essential to model interprofessional care planning for common co-occurring conditions and chronic diseases. We recommend the creation of goal dynamics and decision concepts in SNOMED CT to further enable the necessary models. Systems with flexible terminology management infrastructure may enable intelligent decision support to identify conflicting and aligned concerns, goals, decisions, and interventions in shared care plans, ultimately decreasing documentation effort and cognitive burden for clinicians and patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Towards generic online multicriteria decision support in patient-centred health care.

PubMed

Dowie, Jack; Kjer Kaltoft, Mette; Salkeld, Glenn; Cunich, Michelle

2015-10-01

To introduce a new online generic decision support system based on multicriteria decision analysis (MCDA), implemented in practical and user-friendly software (Annalisa©). All parties in health care lack a simple and generic way to picture and process the decisions to be made in pursuit of improved decision making and more informed choice within an overall philosophy of person- and patient-centred care. The MCDA-based system generates patient-specific clinical guidance in the form of an opinion as to the merits of the alternative options in a decision, which are all scored and ranked. The scores for each option combine, in a simple expected value calculation, the best estimates available now for the performance of those options on patient-determined criteria, with the individual patient's preferences, expressed as importance weightings for those criteria. The survey software within which the Annalisa file is embedded (Elicia©) customizes and personalizes the presentation and inputs. Principles relevant to the development of such decision-specific MCDA-based aids are noted and comparisons with alternative implementations presented. The necessity to trade-off practicality (including resource constraints) with normative rigour and empirical complexity, in both their development and delivery, is emphasized. The MCDA-/Annalisa-based decision support system represents a prescriptive addition to the portfolio of decision-aiding tools available online to individuals and clinicians interested in pursuing shared decision making and informed choice within a commitment to transparency in relation to both the evidence and preference bases of decisions. Some empirical data establishing its usability are provided. © 2013 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Aiding Lay Decision Making Using a Cognitive Competencies Approach.

PubMed

Maule, A J; Maule, Simon

2015-01-01

Two prescriptive approaches have evolved to aid human decision making: just in time interventions that provide support as a decision is being made; and just in case interventions that educate people about future events that they may encounter so that they are better prepared to make an informed decision when these events occur. We review research on these two approaches developed in the context of supporting everyday decisions such as choosing an apartment, a financial product or a medical procedure. We argue that the lack of an underlying prescriptive theory has limited the development and evaluation of these interventions. We draw on recent descriptive research on the cognitive competencies that underpin human decision making to suggest new ways of interpreting how and why existing decision aids may be effective and suggest a different way of evaluating their effectiveness. We also briefly outline how our approach has the potential to develop new interventions to support everyday decision making and highlight the benefits of drawing on descriptive research when developing and evaluating interventions.

Aiding Lay Decision Making Using a Cognitive Competencies Approach

PubMed Central

Maule, A. J.; Maule, Simon

2016-01-01

Two prescriptive approaches have evolved to aid human decision making: just in time interventions that provide support as a decision is being made; and just in case interventions that educate people about future events that they may encounter so that they are better prepared to make an informed decision when these events occur. We review research on these two approaches developed in the context of supporting everyday decisions such as choosing an apartment, a financial product or a medical procedure. We argue that the lack of an underlying prescriptive theory has limited the development and evaluation of these interventions. We draw on recent descriptive research on the cognitive competencies that underpin human decision making to suggest new ways of interpreting how and why existing decision aids may be effective and suggest a different way of evaluating their effectiveness. We also briefly outline how our approach has the potential to develop new interventions to support everyday decision making and highlight the benefits of drawing on descriptive research when developing and evaluating interventions. PMID:26779052

Effects of a decision support intervention on decisional conflict associated with microsatellite instability testing.

PubMed

Hall, Michael J; Manne, Sharon L; Winkel, Gary; Chung, Daniel S; Weinberg, David S; Meropol, Neal J

2011-02-01

Decision support to facilitate informed consent is increasingly important for complicated medical tests. Here, we test a theoretical model of factors influencing decisional conflict in a study examining the effects of a decision support aid that was designed to assist patients at high risk for hereditary nonpolyposis colorectal cancer (CRC) deciding whether to pursue the microsatellite instability (MSI) test. Participants were 239 CRC patients at high familial risk for a genetic mutation who completed surveys before and after exposure to the intervention. Half of the sample was assigned to the CD-ROM aid and half received a brief description of the test. Structural equation modeling was employed to examine associations among the intervention, knowledge, pros and cons to having MSI testing, self-efficacy, preparedness, and decisional conflict. The goodness of fit for the model was acceptable [FIML, full information maximum likelihood, χ(2) (df = 280) = 392.24; P = 0.00]. As expected, the paths to decisional conflict were significant for postintervention pros of MSI testing (t = -2.43; P < 0.05), cons of MSI testing (t = 2.78; P < 0.05), and preparedness (t = -7.27; P < 0.01). The intervention impacted decisional conflict by increasing knowledge about the MSI test and knowledge exerted its effects on decisional conflict by increasing preparedness to make a decision about the test and by increases in perceived benefits of having the test. Increasing knowledge, preparedness, and perceived benefits of undergoing the MSI test facilitate informed decision making for this test. Understanding mechanisms underlying health decisions is critical for improving decisional support. Individuals with Lynch syndrome have an elevated lifetime risk of CRC. Risk of Lynch syndrome may be assessed with a tumor-based screening test (MSI testing or immunohistochemical tissue staining). ©2011 AACR.

Selecting essential information for biosurveillance--a multi-criteria decision analysis.

PubMed

Generous, Nicholas; Margevicius, Kristen J; Taylor-McCabe, Kirsten J; Brown, Mac; Daniel, W Brent; Castro, Lauren; Hengartner, Andrea; Deshpande, Alina

2014-01-01

The National Strategy for Biosurveillance defines biosurveillance as "the process of gathering, integrating, interpreting, and communicating essential information related to all-hazards threats or disease activity affecting human, animal, or plant health to achieve early detection and warning, contribute to overall situational awareness of the health aspects of an incident, and to enable better decision-making at all levels." However, the strategy does not specify how "essential information" is to be identified and integrated into the current biosurveillance enterprise, or what the metrics qualify information as being "essential". The question of data stream identification and selection requires a structured methodology that can systematically evaluate the tradeoffs between the many criteria that need to be taken in account. Multi-Attribute Utility Theory, a type of multi-criteria decision analysis, can provide a well-defined, structured approach that can offer solutions to this problem. While the use of Multi-Attribute Utility Theoryas a practical method to apply formal scientific decision theoretical approaches to complex, multi-criteria problems has been demonstrated in a variety of fields, this method has never been applied to decision support in biosurveillance.We have developed a formalized decision support analytic framework that can facilitate identification of "essential information" for use in biosurveillance systems or processes and we offer this framework to the global BSV community as a tool for optimizing the BSV enterprise. To demonstrate utility, we applied the framework to the problem of evaluating data streams for use in an integrated global infectious disease surveillance system.

Toward a multi-objective decision support framework to support regulations of unconventional oil and gas development

NASA Astrophysics Data System (ADS)

Alongi, M.; Howard, C.; Kasprzyk, J. R.; Ryan, J. N.

2015-12-01

Unconventional oil and gas development (UOGD) using hydraulic fracturing and horizontal drilling has recently fostered an unprecedented acceleration in energy development. Regulations seek to protect environmental quality of areas surrounding UOGD, while maintaining economic benefits. One such regulation is a setback distance, which dictates the minimum proximity between an oil and gas well and an object such as a residential or commercial building, property line, or water source. In general, most setback regulations have been strongly politically motivated without a clear scientific basis for understanding the relationship between the setback distance and various performance outcomes. This presentation discusses a new decision support framework for setback regulations, as part of a large NSF-funded sustainability research network (SRN) on UOGD. The goal of the decision support framework is to integrate a wide array of scientific information from the SRN into a coherent framework that can help inform policy regarding UOGD. The decision support framework employs multiobjective evolutionary algorithm (MOEA) optimization coupled with simulation models of air quality and other performance-based outcomes on UOGD. The result of the MOEA optimization runs are quantitative tradeoff curves among different objectives. For example, one such curve could demonstrate air pollution concentrations versus estimates of energy development profits, for different levels of setback distance. Our results will also inform policy-relevant discussions surrounding UOGD such as comparing single- and multi-well pads, as well as regulations on the density of well development over a spatial area.

Multi-criteria decision making to support waste management: A critical review of current practices and methods.

PubMed

Goulart Coelho, Lineker M; Lange, Liséte C; Coelho, Hosmanny Mg

2017-01-01

Solid waste management is a complex domain involving the interaction of several dimensions; thus, its analysis and control impose continuous challenges for decision makers. In this context, multi-criteria decision-making models have become important and convenient supporting tools for solid waste management because they can handle problems involving multiple dimensions and conflicting criteria. However, the selection of the multi-criteria decision-making method is a hard task since there are several multi-criteria decision-making approaches, each one with a large number of variants whose applicability depends on information availability and the aim of the study. Therefore, to support researchers and decision makers, the objectives of this article are to present a literature review of multi-criteria decision-making applications used in solid waste management, offer a critical assessment of the current practices, and provide suggestions for future works. A brief review of fundamental concepts on this topic is first provided, followed by the analysis of 260 articles related to the application of multi-criteria decision making in solid waste management. These studies were investigated in terms of the methodology, including specific steps such as normalisation, weighting, and sensitivity analysis. In addition, information related to waste type, the study objective, and aspects considered was recorded. From the articles analysed it is noted that studies using multi-criteria decision making in solid waste management are predominantly addressed to problems related to municipal solid waste involving facility location or management strategy.

Show Me My Health Plans: a study protocol of a randomized trial testing a decision support tool for the federal health insurance marketplace in Missouri.

PubMed

Politi, Mary C; Barker, Abigail R; Kaphingst, Kimberly A; McBride, Timothy; Shacham, Enbal; Kebodeaux, Carey S

2016-02-16

The implementation of the ACA has improved access to quality health insurance, a necessary first step to improving health outcomes. However, access must be supplemented by education to help individuals make informed choices for plans that meet their individual financial and health needs. Drawing on a model of information processing and on prior research, we developed a health insurance decision support tool called Show Me My Health Plans. Developed with extensive stakeholder input, the current tool (1) simplifies information through plain language and graphics in an educational component; (2) assesses and reviews knowledge interactively to ensure comprehension of key material; (3) incorporates individual and/or family health status to personalize out-of-pocket cost estimates; (4) assesses preferences for plan features; and (5) helps individuals weigh information appropriate to their interests and needs through a summary page with "good fit" plans generated from a tailored algorithm. The current study will evaluate whether the online decision support tool improves health insurance decisions compared to a usual care condition (the healthcare.gov marketplace website). The trial will include 362 individuals (181 in each group) from rural, suburban, and urban settings within a 90 mile radius around St. Louis. Eligibility criteria includes English-speaking individuals 18-64 years old who are eligible for the ACA marketplace plans. They will be computer randomized to view the intervention or usual care condition. Presenting individuals with options that they can understand tailored to their needs and preferences could help improve decision quality. By helping individuals narrow down the complexity of health insurance plan options, decision support tools such as this one could prepare individuals to better navigate enrollment in a plan that meets their individual needs. The randomized trial was registered in clinicaltrials.gov (NCT02522624) on August 6, 2015.

Aviation Weather Information Communications Study (AWIN). Phase 1 and 2

NASA Technical Reports Server (NTRS)

Ball, J. W.; Herron, R. G.; Nozawa, E. T.; Thomas, E. A.; Witchey, R. D.

2000-01-01

This two part study examines the communication requirements to provide weather information in the cockpit as well as public and private communication systems available to address the requirements. Ongoing research projects combined with user needs for weather related information are used to identify and describe potential weather products that address decision support in three time frames: Far-Term Strategic, Near-Term Strategic and Tactical. Data requirements of these future products are identified and quantified. Communications systems and technologies available in the public as well as private sector are analyzed to identify potential solutions. Recommendations for further research identify cost, performance, and safety benefits to justify the investment. The study concludes that not all weather information has the same level of urgency to safety-of-flight and some information is more critical to one category of flight than another. Specific weather products need to be matched with communication systems with appropriate levels of reliability to support the criticality of the information. Available bandwidth for highly critical information should be preserved and dedicated to safety. Meanwhile, systems designed for in-flight-entertainment and other passenger/crew services could be used to support less critical information that is used only for planning and economic decision support.

Technical Assistance for States | State, Local, and Tribal Governments |

Science.gov Websites

on energy efficiency and renewable energy policies and issues for state and local government decision issues for state and local government decision makers. The expert assistance is intended to support legislators, regulators, state agencies, and their staff members in making informed decisions about solar

Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers' use of information in decision-making: experience from Cape Town, South Africa.

PubMed

Scott, Vera; Gilson, Lucy

2017-09-15

Governance, which includes decision-making at all levels of the health system, and information have been identified as key, interacting levers of health system strengthening. However there is an extensive literature detailing the challenges of supporting health managers to use formal information from health information systems (HISs) in their decision-making. While health information needs differ across levels of the health system there has been surprisingly little empirical work considering what information is actually used by primary healthcare facility managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers' use of information for decision-making influenced by governance across levels of the health system? The research is novel in that it both explores what information these facility managers actually use in decision-making, and considers how wider governance processes influence this information use. An academic researcher and four facility managers worked as co-researchers in a multi-case study in which three areas of management were served as the cases. There were iterative cycles of data collection and collaborative analysis with individual and peer reflective learning over a period of three years. Central governance shaped what information and knowledge was valued - and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based HIS which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to perform the people management tasks required. Despite central level influences, modes of governance operating at the subdistrict level had influence over what information was valued, generated and used locally. Strengthening local level managers' ability to create enabling environments is an important leverage point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including equity goals, into appropriate service delivery practices.

Information and decision-making needs among people with mental disorders: a systematic review of the literature.

PubMed

Tlach, Lisa; Wüsten, Caroline; Daubmann, Anne; Liebherz, Sarah; Härter, Martin; Dirmaier, Jörg

2015-12-01

Assessment of users' information and decision-making needs is one key step in the development of decision-support interventions. To identify patients' information and decision-making needs as a pre-requisite for the development of high-quality web-based patient decision aids (PtDAs) for common mental disorders. A systematic MEDLINE search for papers published until December 2012 was conducted, and reference lists of included articles and relevant reviews were searched. Original studies containing data on information or decision-making needs of adults with depression, anxiety disorders, somatoform disorders, alcohol-related disorders and schizophrenia were included. Data extraction was performed using a standardized form, and data synthesis was conducted using a theory-based deductive approach by two independent reviewers. Studies were quality assessed using the Mixed Methods Appraisal Tool. Twelve studies were included focusing on information needs or the identification of decisions patients with depression and schizophrenia were facing. No studies were found for the other mental disorders. Overall, seven information needs categories were identified with the topics 'basic facts', 'treatment' and 'coping' being of major relevance. Six decision categories were identified of which decisions on 'medication' and 'treatment setting' were most often classified. This review reveals that patients with schizophrenia and depression show extensive information and decision-making needs. The identified needs can initially inform the design of PtDAs for schizophrenia and depression. However, there is an urgent need to investigate information and decision-making needs among patients with other mental disorders. © 2014 John Wiley & Sons Ltd.

Decision strategies for handling the uncertainty of future extreme rainfall under the influence of climate change.

PubMed

Gregersen, I B; Arnbjerg-Nielsen, K

2012-01-01

Several extraordinary rainfall events have occurred in Denmark within the last few years. For each event, problems in urban areas occurred as the capacity of the existing drainage systems were exceeded. Adaptation to climate change is necessary but also very challenging as urban drainage systems are characterized by long technical lifetimes and high, unrecoverable construction costs. One of the most important barriers for the initiation and implementation of the adaptation strategies is therefore the uncertainty when predicting the magnitude of the extreme rainfall in the future. This challenge is explored through the application and discussion of three different theoretical decision support strategies: the precautionary principle, the minimax strategy and Bayesian decision support. The reviewed decision support strategies all proved valuable for addressing the identified uncertainties, at best applied together as they all yield information that improved decision making and thus enabled more robust decisions.

[Information from the invoicing sector as support for decision-making: a case study at the University Hospital of the Federal University of Grande Dourados (UFGD)].

PubMed

Cintra, Renato Fabiano; Vieira, Saulo Fabiano Amâncio; Hall, Rosemar José; Fernandes, Cristiano Rodrigues

2013-10-01

The public sector is the main financing agent of hospital admissions and the information generated constitutes the input for the hospital information network of the Unified Health System (SUS). This paper seeks to design a report template to be used for decision-making in both public and university hospitals. The theoretical approach sought inspiration in discussions about the SUS, hospital institutions, hospital information systems and decision-making. The methodological procedures used are characterized as qualitative-descriptive methods and were conducted in a single case study and action research. The primary data analysis was carried out in two stages from January through December 2007 and from January through December 2008. Based on these periods, the findings were described and the elaboration of new reports was presented, with the importance and need for each being duly emphasized. Lastly, a structured report template was created for the case study that includes information discussed in the article. The conclusion reached is that the hospital information system can become a potential support tool, as the necessary adjustments are made and the report is structured to furnish the institution with an objective communication tool for decision-making.

Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform.

PubMed

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 < 0.01). Combining decision science and health informatics approaches facilitated rapid 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-based decision aid component performed comparably with the videobooklet decision aid used in clinical practice. Future studies may use this interactive research platform to study patients' decision making processes in real-time, explore interdisciplinary approaches to designing web-based decision aids, and test strategies for tailoring decision support to meet patients' needs and preferences.

Age Differences in Information Use While Making Decisions: Resource Limitations or Processing Differences?

PubMed

Jacobs-Lawson, Joy M; Schumacher, Mitzi M; Wackerbarth, Sarah B

2016-09-20

Recent research on the decision-making abilities of older adults has shown that they use less information than young adults. One explanation ascribes this age difference to reductions in cognitive abilities with age. The article includes three experimental studies that focused on determining the conditions in which older and young adults would display dissimilar information processing characteristics. Findings from Studies 1 and 2 demonstrated that older adults are not necessarily at greater disadvantage than young adults in decision contexts that demand more information processing resources. Findings from Study 3 indicated that older adults when faced with decisions that require greater processing are likely to use a strategy that reduces the amount of information needed, whereas younger adults rely on strategies that utilize more resources. Combined the findings indicate that older adults change their decision-making strategies based on the context and information provided. Furthermore, support is provided for processing difference. © The Author(s) 2016.

A Decision Support Prototype Tool for Predicting Student Performance in an ODL Environment

ERIC Educational Resources Information Center

Kotsiantis, S. B.; Pintelas, P. E.

2004-01-01

Machine Learning algorithms fed with data sets which include information such as attendance data, test scores and other student information can provide tutors with powerful tools for decision-making. Until now, much of the research has been limited to the relation between single variables and student performance. Combining multiple variables as…

Reengineering for optimized control of DC networks

NASA Astrophysics Data System (ADS)

Vintea, Adela; Schiopu, Paul

2015-02-01

The management of the Independent Power Grids is the global body/structure with flexible technological support for Command-Control-Communications and Informatized Management having the responsibility for providing the conditions and information (the informational flux of decision) for the decision-maker aiming at predictable and harmonic administration of the situations (crises) and for generating the harmonic situations (results).

Defense Agencies Initiative Increment 2 (DAI Inc 2)

DTIC Science & Technology

2016-03-01

2016 Major Automated Information System Annual Report Defense Agencies Initiative Increment 2 (DAI Inc 2) Defense Acquisition Management...Automated Information System MAIS OE - MAIS Original Estimate MAR – MAIS Annual Report MDA - Milestone Decision Authority MDD - Materiel Development...management systems supporting diverse operational functions and the warfighter in decision making and financial reporting . These disparate, non

A three-talk model for shared decision making: multistage consultation process

PubMed Central

Durand, Marie Anne; Song, Julia; Aarts, Johanna; Barr, Paul J; Berger, Zackary; Cochran, Nan; Frosch, Dominick; Galasiński, Dariusz; Gulbrandsen, Pål; Han, Paul K J; Härter, Martin; Kinnersley, Paul; Lloyd, Amy; Mishra, Manish; Perestelo-Perez, Lilisbeth; Scholl, Isabelle; Tomori, Kounosuke; Trevena, Lyndal; Witteman, Holly O; Van der Weijden, Trudy

2017-01-01

Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design Multistage consultation process. Setting Key informant group, communities of interest, and survey of clinical specialties. Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on “team talk,” “option talk,” and “decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences. PMID:29109079

Ensemble modelling and structured decision-making to support Emergency Disease Management.

PubMed

Webb, Colleen T; Ferrari, Matthew; Lindström, Tom; Carpenter, Tim; Dürr, Salome; Garner, Graeme; Jewell, Chris; Stevenson, Mark; Ward, Michael P; Werkman, Marleen; Backer, Jantien; Tildesley, Michael

2017-03-01

Epidemiological models in animal health are commonly used as decision-support tools to understand the impact of various control actions on infection spread in susceptible populations. Different models contain different assumptions and parameterizations, and policy decisions might be improved by considering outputs from multiple models. However, a transparent decision-support framework to integrate outputs from multiple models is nascent in epidemiology. Ensemble modelling and structured decision-making integrate the outputs of multiple models, compare policy actions and support policy decision-making. We briefly review the epidemiological application of ensemble modelling and structured decision-making and illustrate the potential of these methods using foot and mouth disease (FMD) models. In case study one, we apply structured decision-making to compare five possible control actions across three FMD models and show which control actions and outbreak costs are robustly supported and which are impacted by model uncertainty. In case study two, we develop a methodology for weighting the outputs of different models and show how different weighting schemes may impact the choice of control action. Using these case studies, we broadly illustrate the potential of ensemble modelling and structured decision-making in epidemiology to provide better information for decision-making and outline necessary development of these methods for their further application. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Taking risks and taking advice: The role of experience in airline pilot diversions

NASA Technical Reports Server (NTRS)

Cohen, Marvin S.

1993-01-01

The research asks how pilots make diversion decisions, what factors determine whether they are make well or poorly, and how they may be improved. The results support the view that experienced decision makers may solve problems in a way that is qualitatively different from the approaches of less experienced decision makers. The results also support a concept of expertise that goes beyond a stock of specialized recognitional templates, to include domain-specific methods for processing information. Such metacognitive skills evolve through long experience. They may enhance both the accuracy and the efficiency of decision processes.

Advancing clinical decision support using lessons from outside of healthcare: an interdisciplinary systematic review.

PubMed

Wu, Helen W; Davis, Paul K; Bell, Douglas S

2012-08-17

Greater use of computerized decision support (DS) systems could address continuing safety and quality problems in healthcare, but the healthcare field has struggled to implement DS technology. This study surveys DS experience across multiple non-healthcare disciplines for new insights that are generalizable to healthcare provider decisions. In particular, it sought design principles and lessons learned from the other disciplines that could inform efforts to accelerate the adoption of clinical decision support (CDS). Our systematic review drew broadly from non-healthcare databases in the basic sciences, social sciences, humanities, engineering, business, and defense: PsychINFO, BusinessSource Premier, Social Sciences Abstracts, Web of Science, and Defense Technical Information Center. Because our interest was in DS that could apply to clinical decisions, we selected articles that (1) provided a review, overview, discussion of lessons learned, or an evaluation of design or implementation aspects of DS within a non-healthcare discipline and (2) involved an element of human judgment at the individual level, as opposed to decisions that can be fully automated or that are made at the organizational level. Clinical decisions share some similarities with decisions made by military commanders, business managers, and other leaders: they involve assessing new situations and choosing courses of action with major consequences, under time pressure, and with incomplete information. We identified seven high-level DS system design features from the non-healthcare literature that could be applied to CDS: providing broad, system-level perspectives; customizing interfaces to specific users and roles; making the DS reasoning transparent; presenting data effectively; generating multiple scenarios covering disparate outcomes (e.g., effective; effective with side effects; ineffective); allowing for contingent adaptations; and facilitating collaboration. The article provides examples of each feature. The DS literature also emphasizes the importance of organizational culture and training in implementation success. The literature contrasts "rational-analytic" vs. "naturalistic-intuitive" decision-making styles, but the best approach is often a balanced approach that combines both styles. It is also important for DS systems to enable exploration of multiple assumptions, and incorporation of new information in response to changing circumstances. Complex, high-level decision-making has common features across disciplines as seemingly disparate as defense, business, and healthcare. National efforts to advance the health information technology agenda through broader CDS adoption could benefit by applying the DS principles identified in this review.

Data to Decisions: Valuing the Societal Benefit of Geospatial Information

NASA Astrophysics Data System (ADS)

Pearlman, F.; Kain, D.

2016-12-01

The March 10-11, 2016 GEOValue workshop on "Data to Decisions" was aimed at creating a framework for identification and implementation of best practices that capture the societal value of geospatial information for both public and private uses. The end-to-end information flow starts with the earth observation and data acquisition systems, includes the full range of processes from geospatial information to decisions support systems, and concludes with the end user. Case studies, which will be described in this presentation, were identified for a range of applications. The goal was to demonstrate and compare approaches to valuation of geospatial information and forge a path forward for research that leads to standards of practice.

Using automatically extracted information from mammography reports for decision-support

PubMed Central

Bozkurt, Selen; Gimenez, Francisco; Burnside, Elizabeth S.; Gulkesen, Kemal H.; Rubin, Daniel L.

2016-01-01

Objective To evaluate a system we developed that connects natural language processing (NLP) for information extraction from narrative text mammography reports with a Bayesian network for decision-support about breast cancer diagnosis. The ultimate goal of this system is to provide decision support as part of the workflow of producing the radiology report. Materials and methods We built a system that uses an NLP information extraction system (which extract BI-RADS descriptors and clinical information from mammography reports) to provide the necessary inputs to a Bayesian network (BN) decision support system (DSS) that estimates lesion malignancy from BI-RADS descriptors. We used this integrated system to predict diagnosis of breast cancer from radiology text reports and evaluated it with a reference standard of 300 mammography reports. We collected two different outputs from the DSS: (1) the probability of malignancy and (2) the BI-RADS final assessment category. Since NLP may produce imperfect inputs to the DSS, we compared the difference between using perfect (“reference standard”) structured inputs to the DSS (“RS-DSS”) vs NLP-derived inputs (“NLP-DSS”) on the output of the DSS using the concordance correlation coefficient. We measured the classification accuracy of the BI-RADS final assessment category when using NLP-DSS, compared with the ground truth category established by the radiologist. Results The NLP-DSS and RS-DSS had closely matched probabilities, with a mean paired difference of 0.004 ± 0.025. The concordance correlation of these paired measures was 0.95. The accuracy of the NLP-DSS to predict the correct BI-RADS final assessment category was 97.58%. Conclusion The accuracy of the information extracted from mammography reports using the NLP system was sufficient to provide accurate DSS results. We believe our system could ultimately reduce the variation in practice in mammography related to assessment of malignant lesions and improve management decisions. PMID:27388877

An information system to improve financial management, resource allocation and activity planning: evaluation results.

PubMed

Ruland, C M; Ravn, I H

2001-01-01

An important strategy for improving resource management and cost containment in health care is to develop information systems that assist hospital managers in financial management, resource allocation, and activity planning. A crucial part of such development is a rigorous evaluation to assess whether the system accomplishes it's intended goals. To evaluate CLASSICA, a Decision Support System (DSS), that assists nurse managers in financial management, resource allocation, staffing, and activity planning. Using a pre-post test design with control units, CLASSICA was evaluated in four test units. Baseline data and simultaneous parallel measures were collected prior to system implementation at test sites and control units. Using expense reports, staffing and financial statistics, surveys, interviews with nurse managers, and logs as data sources, CLASSICA was evaluated on: cost reduction, quality of management information; usefulness as decision support for improved financial management and decision-making; user satisfaction; and ease of use. Evaluation results showed a 41% reduction in expenditures for overtime and extra hours as compared to a 1.8% reduction in control units during the same time period. Users reported a significant improvement in management information; nurse managers stated that they had gained control over costs. The system helped them analyze the relationships between patient activity staffing, and cost of care. Users reported high satisfaction with the system, the information and decision support it provided, and its ease of use. These results suggest that CLASSICA is a DSS that successfully assists nurse managers in cost effective management of their units.

Toward theoretical understanding of the fertility preservation decision-making process: examining information processing among young women with cancer.

PubMed

Hershberger, Patricia E; Finnegan, Lorna; Altfeld, Susan; Lake, Sara; Hirshfeld-Cytron, Jennifer

2013-01-01

Young women with cancer now face the complex decision about whether to undergo fertility preservation. Yet little is known about how these women process information involved in making this decision. The purpose of this article is to expand theoretical understanding of the decision-making process by examining aspects of information processing among young women diagnosed with cancer. Using a grounded theory approach, 27 women with cancer participated in individual, semistructured interviews. Data were coded and analyzed using constant-comparison techniques that were guided by 5 dimensions within the Contemplate phase of the decision-making process framework. In the first dimension, young women acquired information primarily from clinicians and Internet sources. Experiential information, often obtained from peers, occurred in the second dimension. Preferences and values were constructed in the third dimension as women acquired factual, moral, and ethical information. Women desired tailored, personalized information that was specific to their situation in the fourth dimension; however, women struggled with communicating these needs to clinicians. In the fifth dimension, women offered detailed descriptions of clinician behaviors that enhance or impede decisional debriefing. Better understanding of theoretical underpinnings surrounding women's information processes can facilitate decision support and improve clinical care.

The Enterprise Data Trust at Mayo Clinic: a semantically integrated warehouse of biomedical data

PubMed Central

Beck, Scott A; Fisk, Thomas B; Mohr, David N

2010-01-01

Mayo Clinic's Enterprise Data Trust is a collection of data from patient care, education, research, and administrative transactional systems, organized to support information retrieval, business intelligence, and high-level decision making. Structurally it is a top-down, subject-oriented, integrated, time-variant, and non-volatile collection of data in support of Mayo Clinic's analytic and decision-making processes. It is an interconnected piece of Mayo Clinic's Enterprise Information Management initiative, which also includes Data Governance, Enterprise Data Modeling, the Enterprise Vocabulary System, and Metadata Management. These resources enable unprecedented organization of enterprise information about patient, genomic, and research data. While facile access for cohort definition or aggregate retrieval is supported, a high level of security, retrieval audit, and user authentication ensures privacy, confidentiality, and respect for the trust imparted by our patients for the respectful use of information about their conditions. PMID:20190054

The Enterprise Data Trust at Mayo Clinic: a semantically integrated warehouse of biomedical data.

PubMed

Chute, Christopher G; Beck, Scott A; Fisk, Thomas B; Mohr, David N

2010-01-01

Mayo Clinic's Enterprise Data Trust is a collection of data from patient care, education, research, and administrative transactional systems, organized to support information retrieval, business intelligence, and high-level decision making. Structurally it is a top-down, subject-oriented, integrated, time-variant, and non-volatile collection of data in support of Mayo Clinic's analytic and decision-making processes. It is an interconnected piece of Mayo Clinic's Enterprise Information Management initiative, which also includes Data Governance, Enterprise Data Modeling, the Enterprise Vocabulary System, and Metadata Management. These resources enable unprecedented organization of enterprise information about patient, genomic, and research data. While facile access for cohort definition or aggregate retrieval is supported, a high level of security, retrieval audit, and user authentication ensures privacy, confidentiality, and respect for the trust imparted by our patients for the respectful use of information about their conditions.

An Automated System for Generating Situation-Specific Decision Support in Clinical Order Entry from Local Empirical Data

ERIC Educational Resources Information Center

Klann, Jeffrey G.

2011-01-01

Clinical Decision Support is one of the only aspects of health information technology that has demonstrated decreased costs and increased quality in healthcare delivery, yet it is extremely expensive and time-consuming to create, maintain, and localize. Consequently, a majority of health care systems do not utilize it, and even when it is…

Modeling uncertainty in requirements engineering decision support

NASA Technical Reports Server (NTRS)

Feather, Martin S.; Maynard-Zhang, Pedrito; Kiper, James D.

2005-01-01

One inherent characteristic of requrements engineering is a lack of certainty during this early phase of a project. Nevertheless, decisions about requirements must be made in spite of this uncertainty. Here we describe the context in which we are exploring this, and some initial work to support elicitation of uncertain requirements, and to deal with the combination of such information from multiple stakeholders.

SynopSIS: integrating physician sign-out with the electronic medical record.

PubMed

Sarkar, Urmimala; Carter, Jonathan T; Omachi, Theodore A; Vidyarthi, Arpana R; Cucina, Russell; Bokser, Seth; van Eaton, Erik; Blum, Michael

2007-09-01

Safe delivery of care depends on effective communication among all health care providers, especially during transfers of care. The traditional medical chart does not adequately support such communication. We designed a patient-tracking tool that enhances provider communication and supports clinical decision making. To develop a problem-based patient-tracking tool, called Sign-out, Information Retrieval, and Summary (SynopSIS), in order to support patient tracking, transfers of care (ie, sign-outs), and daily rounds. Tertiary-care, university-based teaching hospital. SynopSIS compiles and organizes information from the electronic medical record to support hospital discharge and disposition decisions, daily provider decisions, and overnight or cross-coverage decisions. It reflects the provider's patient-care and daily work-flow needs. We plan to use Web-based surveys, audits of daily use, and interdisciplinary focus groups to evaluate SynopSIS's impact on communication between providers, quality of sign-out, patient continuity of care, and rounding efficiency. We expect SynopSIS to improve care by facilitating communication between care teams, standardizing sign-out, and automating daily review of clinical and laboratory trends. SynopSIS redesigns the clinical chart to better serve provider and patient needs. (c) 2007 Society of Hospital Medicine.

Personalization and Patient Involvement in Decision Support Systems: Current Trends

PubMed Central

Sacchi, L.; Lanzola, G.; Viani, N.

2015-01-01

Summary Objectives This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care. Methods We considered papers published on scientific journals, by querying PubMed and Web of Science™. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support. Results We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness. Conclusions Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large. PMID:26293857

Towards integration of clinical decision support in commercial hospital information systems using distributed, reusable software and knowledge components.

PubMed

Müller, M L; Ganslandt, T; Eich, H P; Lang, K; Ohmann, C; Prokosch, H U

2001-12-01

Clinicians' acceptance of clinical decision support depends on its workflow-oriented, context-sensitive accessibility and availability at the point of care, integrated into the Electronic Patient Record (EPR). Commercially available Hospital Information Systems (HIS) often focus on administrative tasks and mostly do not provide additional knowledge based functionality. Their traditionally monolithic and closed software architecture encumbers integration of and interaction with external software modules. Our aim was to develop methods and interfaces to integrate knowledge sources into two different commercial hospital information systems to provide the best decision support possible within the context of available patient data. An existing, proven standalone scoring system for acute abdominal pain was supplemented by a communication interface. In both HIS we defined data entry forms and developed individual and reusable mechanisms for data exchange with external software modules. We designed an additional knowledge support frontend which controls data exchange between HIS and the knowledge modules. Finally, we added guidelines and algorithms to the knowledge library. Despite some major drawbacks which resulted mainly from the HIS' closed software architectures we showed exemplary, how external knowledge support can be integrated almost seamlessly into different commercial HIS. This paper describes the prototypical design and current implementation and discusses our experiences.

Some Results of Weak Anticipative Concept Applied in Simulation Based Decision Support in Enterprise

NASA Astrophysics Data System (ADS)

Kljajić, Miroljub; Kofjač, Davorin; Kljajić Borštnar, Mirjana; Škraba, Andrej

2010-11-01

The simulation models are used as for decision support and learning in enterprises and in schools. Tree cases of successful applications demonstrate usefulness of weak anticipative information. Job shop scheduling production with makespan criterion presents a real case customized flexible furniture production optimization. The genetic algorithm for job shop scheduling optimization is presented. Simulation based inventory control for products with stochastic lead time and demand describes inventory optimization for products with stochastic lead time and demand. Dynamic programming and fuzzy control algorithms reduce the total cost without producing stock-outs in most cases. Values of decision making information based on simulation were discussed too. All two cases will be discussed from optimization, modeling and learning point of view.

Modelling and Decision Support of Clinical Pathways

NASA Astrophysics Data System (ADS)

Gabriel, Roland; Lux, Thomas

The German health care market is under a rapid rate of change, forcing especially hospitals to provide high-quality services at low costs. Appropriate measures for more effective and efficient service provision are process orientation and decision support by information technology of clinical pathway of a patient. The essential requirements are adequate modelling of clinical pathways as well as usage of adequate systems, which are capable of assisting the complete path of a patient within a hospital, and preferably also outside of it, in a digital way. To fulfil these specifications the authors present a suitable concept, which meets the challenges of well-structured clinical pathways as well as rather poorly structured diagnostic and therapeutic decisions, by interplay of process-oriented and knowledge-based hospital information systems.

Developing Digital Dashboard Management for Learning System Dynamic Cooperative Simulation Behavior of Indonesia. (Study on Cooperative Information Organization in the Ministry of Cooperatives and SME)

NASA Astrophysics Data System (ADS)

Eni, Yuli; Aryanto, Rudy

2014-03-01

There are problems being experienced by the Ministry of cooperatives and SME (Small and Medium Enterprise) including the length of time in the decision by the Government to establish a policy that should be taken for local cooperatives across the province of Indonesia. The decision-making process is still analyzed manually, so that sometimes the decisions taken are also less appropriate, effective and efficient. The second problem is the lack of monitoring data cooperative process province that is too much, making it difficult for the analysis of dynamic information to be useful. Therefore the authors want to fix the system that runs by using digital dashboard management system supported by the modeling of system dynamics. In addition, the author also did the design of a system that can support the system. Design of this system is aimed to ease the experts, head, and the government to decide (DSS - Decision Support System) accurately effectively and efficiently, because in the system are raised alternative simulation in a description of the decision to be taken and the result from the decision. The system is expected to be designed dan simulated can ease and expedite the decision making. The design of dynamic digital dashboard management conducted by method of OOAD (Objects Oriented Analysis and Design) complete with UML notation.

A clinical information systems strategy for a large integrated delivery network.

PubMed Central

Kuperman, G. J.; Spurr, C.; Flammini, S.; Bates, D.; Glaser, J.

2000-01-01

Integrated delivery networks (IDNs) are an emerging class of health care institutions. IDNs are formed from the affiliation of individual health care institutions and are intended to be more efficient in the current fiscal health care environment. To realize efficiencies and support their strategic visions, IDNs rely critically on excellent information technology (IT). Because of its importance to the mission of the IDN, strategic decisions about IT are made by the top leadership of the IDN. At Partners HealthCare System, a large IDN in Boston, MA, a clinical information systems strategy has been created to support the Partners clinical vision. In this paper, we discuss the Partners' structure, clinical vision, and current IT initiatives in place to address the clinical vision. The initiatives are: a clinical data repository, inpatient process support, electronic medical records, a portal strategy, referral applications, knowledge resources, support for product lines, patient computing, confidentiality, and clinical decision support. We address several of the issues encountered in trying to bring excellent information technology to a large IDN. PMID:11079921

A qualitative evaluation of the crucial attributes of contextual information necessary in EHR design to support patient-centered medical home care.

PubMed

Weir, Charlene R; Staggers, Nancy; Gibson, Bryan; Doing-Harris, Kristina; Barrus, Robyn; Dunlea, Robert

2015-04-16

Effective implementation of a Primary Care Medical Home model of care (PCMH) requires integration of patients' contextual information (physical, mental, social and financial status) into an easily retrievable information source for the healthcare team and clinical decision-making. This project explored clinicians' perceptions about important attributes of contextual information for clinical decision-making, how contextual information is expressed in CPRS clinical documentation as well as how clinicians in a highly computerized environment manage information flow related to these areas. A qualitative design using Cognitive Task Analyses and a modified Critical Incident Technique were used. The study was conducted in a large VA with a fully implemented EHR located in the western United States. Seventeen providers working in a PCMH model of care in Primary Care, Home Based Care and Geriatrics reported on a recent difficult transition requiring contextual information for decision-making. The transcribed interviews were qualitatively analyzed for thematic development related to contextual information using an iterative process and multiple reviewers with ATLAS@ti software. Six overarching themes emerged as attributes of contextual information: Informativeness, goal language, temporality, source attribution, retrieval effort, and information quality. These results indicate that specific attributes are needed to in order for contextual information to fully support clinical decision-making in a Medical Home care delivery environment. Improved EHR designs are needed for ease of contextual information access, displaying linkages across time and settings, and explicit linkages to both clinician and patient goals. Implications relevant to providers' information needs, team functioning and EHR design are discussed.

What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders.

PubMed

Hamilton, Jada G; Lillie, Sarah E; Alden, Dana L; Scherer, Laura; Oser, Megan; Rini, Christine; Tanaka, Miho; Baleix, John; Brewster, Mikki; Craddock Lee, Simon; Goldstein, Mary K; Jacobson, Robert M; Myers, Ronald E; Zikmund-Fisher, Brian J; Waters, Erika A

2017-02-01

Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process.

Value of information analysis in healthcare: a review of principles and applications.

PubMed

Tuffaha, Haitham W; Gordon, Louisa G; Scuffham, Paul A

2014-06-01

Economic evaluations are increasingly utilized to inform decisions in healthcare; however, decisions remain uncertain when they are not based on adequate evidence. Value of information (VOI) analysis has been proposed as a systematic approach to measure decision uncertainty and assess whether there is sufficient evidence to support new technologies. The objective of this paper is to review the principles and applications of VOI analysis in healthcare. Relevant databases were systematically searched to identify VOI articles. The findings from the selected articles were summarized and narratively presented. Various VOI methods have been developed and applied to inform decision-making, optimally designing research studies and setting research priorities. However, the application of this approach in healthcare remains limited due to technical and policy challenges. There is a need to create more awareness about VOI analysis, simplify its current methods, and align them with the needs of decision-making organizations.

Mill and the right to remain uninformed.

PubMed

Strasser, M

1986-08-01

In a recent article in the Journal of Medicine and Philosophy, David Ost (1984) claims that patients do not have a right to waive their right to information. He argues that patients cannot make informed rational decisions without full information and thus, a right to waive information would involve a right to avoid one's responsibility to act as an autonomous moral agent. In support of his position, Ost cites a passage from Mill. Yet, a correct interpretation of the passage in question would support one's right to remain uninformed in certain situations. If the information would hurt one's chances for survival or hurt one's ability to make calm, rational decisions, then one not only does not have a duty to find out the information, but one's exercising one's right to remain uninformed may be the only rational course of action to take.

Use of technology to support information needs for continuity of operations planning in public health: a systematic review.

PubMed

Reeder, Blaine; Turner, Anne; Demiris, George

2010-01-01

Continuity of operations planning focuses on an organization's ability to deliver essential services before, during and after an emergency. Public health leaders must make decisions based on information from many sources and their information needs are often facilitated or hindered by technology. The aim of this study is to provide a systematic review of studies of technology projects that address public health continuity of operations planning information needs and to discuss patterns, themes, and challenges to inform the design of public health continuity of operations information systems. To return a comprehensive results set in an under-explored area, we searched broadly in the Medline and EBSCOHost bibliographic databases using terms from prior work in public health emergency management and continuity of operations planning in other domains. In addition, we manually searched the citation lists of publications included for review. A total of 320 publications were reviewed. Twenty studies were identified for inclusion (twelve risk assessment decision support tools, six network and communications-enabled decision support tools, one training tool and one dedicated video-conferencing tool). Levels of implementation for information systems in the included studies range from proposed frameworks to operational systems. There is a general lack of documented efforts in the scientific literature for technology projects about public health continuity of operations planning. Available information about operational information systems suggest inclusion of public health practitioners in the design process as a factor in system success.

An organizational intervention to influence evidence-informed decision making in home health nursing.

PubMed

Gifford, Wendy; Lefebre, Nancy; Davies, Barbara

2014-01-01

The aims of this study were to field test and evaluate a series of organizational strategies to promote evidence-informed decision making (EIDM) by nurse managers and clinical leaders in home healthcare. EIDM is central to delivering high-quality and effective healthcare. Barriers exist and organizational strategies are needed to support EIDM. Management and clinical leaders from 4 units participated in a 20-week organization-focused intervention. Preintervention (n = 32) and postintervention (n = 17) surveys and semistructured interviews (n = 15) were completed. Statistically significant increases were found on 4 of 31 survey items reflecting an increased organizational capacity for participants to acquire and apply research evidence in decision making. Support from designated facilitators with advanced skills in finding, appraising, and applying research was the highest rated intervention strategy. Results are useful to inform the development of organizational infrastructures to increase EIDM capacity in community-based healthcare organizations.

Interactive and Participatory Decision Support: Linking Cyberinfrastructure, Multi-Touch Interfaces, and Substantive Dialogue for Geothermal Systems

NASA Astrophysics Data System (ADS)

Malin, R.; Pierce, S. A.; Bass, B. J.

2012-12-01

Socio-technical approaches to complex, ill-structured decision problems are needed to identify adaptive responses for earth resource management. This research presents a hybrid approach to create decision tools and engender dialogue among stakeholders for geothermal development in Idaho, United States and El Tatio, Chile. Based on the scarcity of data, limited information availability, and tensions across stakeholder interests we designed and constructed a decision support model that allows stakeholders to rapidly collect, input, and visualize geoscientific data to assess geothermal system impacts and possible development strategies. We have integrated this decision support model into multi-touch interfaces that can be easily used by scientists and stakeholders alike. This toolkit is part of a larger cyberinfrastructure project designed to collect and present geoscientific information to support decision making processes. Consultation with stakeholders at the El Tatio geothermal complex of northern Chile—indigenous communities, local and national government agencies, developers, and geoscientists - informed the implementation of a sustained dialogue process. The El Tatio field case juxtaposes basic parameters such as pH, spring temperature, geochemical content, and FLIR imagery with stakeholder perceptions of risks due to mineral extraction and energy exploration efforts. The results of interviews and a participatory workshop are driving the creation of three initiatives within an indigenous community group; 1) microentrepreneurial efforts for science-based tourism, 2) design of a citizen-led environmental monitoring network in the Altiplano, and 3) business planning for an indigenous renewable energy cooperative. This toolkit is also being applied in the Snake River Plain of Idaho has as part of the DOE sponsored National Student Geothermal Competition. The Idaho case extends results from the Chilean case to implement a more streamlined system to analyze geothermal resource potential as well as integrate the decision support system with multi-touch interfaces which allow multiple stakeholders to view and interact with data. Beyond visual and tactile appeal, these interfaces also allow participants to dynamically update decision variables and decision preferences to create multiple scenarios and evaluate potential outcomes. Through this interactive scenario building, potential development sites can be targeted and stakeholders can interact with data to engage in substantive dialogue for related long-term planning or crisis response.

Social Support, Self-Efficacy for Decision Making, and Follow-up Care Use in Long-term Cancer Survivors

PubMed Central

Forsythe, Laura P.; Alfano, Catherine M.; Kent, Erin E.; Weaver, Kathryn E.; Bellizzi, Keith; Arora, Neeraj; Aziz, Noreen; Keel, Gretchen; Rowland, Julia H.

2014-01-01

Objective Cancer survivors play an important role in coordinating their follow-up care and making treatment-related decisions. Little is known about how modifiable factors like social support are associated with active participation in follow-up care. This study tests associations between social support, cancer-related follow-up care use, and self-efficacy for participation in decision making related to follow-up care (SEDM). We also identified sociodemographic and clinical factors associated with social support among long-term survivors. Methods The FOllow-up Care Use among Survivors (FOCUS) study is a cross-sectional, population based survey of breast, prostate, colon, and gynecologic cancer survivors (n=1522) 4 to 14 years post-diagnosis. Multivariable regression models were used to test associations between perceived social support (tangible and emotional/informational support modeled separately), follow-up care use (past two years), and SEDM, as well as to identify factors associated with perceived support. Results Neither support type was associated with follow-up care use (all p>0.05), although marital status was uniquely, positively associated with follow-up care use (p<0.05). Both tangible support (B for a standard deviation increase (SE)=9.75(3.15), p<0.05) and emotional/informational support (B(SE)=12.61(3.05), p<0.001) were modestly associated with SEDM. Being married, having adequate financial resources, history of recurrence, and better perceived health status were associated with higher perceived tangible and emotional support (all p<0.05). Conclusions While perceived social support may facilitate survivor efficacy for participation in decision making during cancer follow-up care, other factors, including marital satisfaction, appear to influence follow-up care use. Marital status and social support may be important factors to consider in survivorship care planning. PMID:24481884

Social support, self-efficacy for decision-making, and follow-up care use in long-term cancer survivors.

PubMed

Forsythe, Laura P; Alfano, Catherine M; Kent, Erin E; Weaver, Kathryn E; Bellizzi, Keith; Arora, Neeraj; Aziz, Noreen; Keel, Gretchen; Rowland, Julia H

2014-07-01

Cancer survivors play an important role in coordinating their follow-up care and making treatment-related decisions. Little is known about how modifiable factors such as social support are associated with active participation in follow-up care. This study tests associations between social support, cancer-related follow-up care use, and self-efficacy for participation in decision-making related to follow-up care (SEDM). We also identified sociodemographic and clinical factors associated with social support among long-term survivors. The FOllow-up Care Use among Survivors study is a cross-sectional, population-based survey of breast, prostate, colon, and gynecologic cancer survivors (n=1522) 4-14 years post-diagnosis. Multivariable regression models were used to test associations between perceived social support (tangible and emotional/informational support modeled separately), follow-up care use (past 2 years), and SEDM, as well as to identify factors associated with perceived support. Neither support type was associated with follow-up care use (all p>0.05), although marital status was uniquely, positively associated with follow-up care use (p<0.05). Both tangible support (B for a standard deviation increase (SE)=9.75(3.15), p<0.05) and emotional/informational support (B(SE)=12.61(3.05), p<0.001) were modestly associated with SEDM. Being married, having adequate financial resources, history of recurrence, and better perceived health status were associated with higher perceived tangible and emotional support (all p<0.05). While perceived social support may facilitate survivor efficacy for participation in decision-making during cancer follow-up care, other factors, including marital satisfaction, appear to influence follow-up care use. Marital status and social support may be important factors to consider in survivorship care planning. Copyright © 2014 John Wiley & Sons, Ltd.

Reef Ecosystem Services and Decision Support Database

EPA Science Inventory

This scientific and management information database utilizes systems thinking to describe the linkages between decisions, human activities, and provisioning of reef ecosystem goods and services. This database provides: (1) Hierarchy of related topics - Click on topics to navigat...

SADA: Ecological Risk Based Decision Support System for Selective Remediation

EPA Science Inventory

Spatial Analysis and Decision Assistance (SADA) is freeware that implements terrestrial ecological risk assessment and yields a selective remediation design using its integral geographical information system, based on ecological and risk assessment inputs. Selective remediation ...

Enabling joined-up decision making with geotemporal information

NASA Astrophysics Data System (ADS)

Smith, M. J.; Ahmed, S. E.; Purves, D. W.; Emmott, S.; Joppa, L. N.; Caldararu, S.; Visconti, P.; Newbold, T.; Formica, A. F.

2015-12-01

While the use of geospatial data to assist in decision making is becoming increasingly common, the use of geotemporal information: information that can be indexed by geographical space AND time, is much rarer. I will describe our scientific research and software development efforts intended to advance the availability and use of geotemporal information in general. I will show two recent examples of "stacking" geotemporal information to support land use decision making in the Brazilian Amazon and Kenya, involving data-constrained predictive models and empirically derived datasets of road development, deforestation, carbon, agricultural yields, water purification and poverty alleviation services and will show how we use trade-off analyses and constraint reasoning algorithms to explore the costs and benefits of different decisions. For the Brazilian Amazon we explore tradeoffs involved in different deforestation scenarios, while for Kenya we explore the impacts of conserving forest to support international carbon conservation initiatives (REDD+). I will also illustrate the cloud-based software tools we have developed to enable anyone to access geotemporal information, gridded (e.g. climate) or non-gridded (e.g. protected areas), for the past, present or future and incorporate such information into their analyses (e.g. www.fetchclimate.org), including how we train new predictive models to such data using Bayesian techniques: on this latter point I will show how we combine satellite and ground measured data with predictive models to forecast how crops might respond to climate change.

A Decision Support System for Evaluating and Selecting Information Systems Projects

NASA Astrophysics Data System (ADS)

Deng, Hepu; Wibowo, Santoso

2009-01-01

This chapter presents a decision support system (DSS) for effectively solving the information systems (IS) project selection problem. The proposed DSS recognizes the multidimensional nature of the IS project selection problem, the availability of multicriteria analysis (MA) methods, and the preferences of the decision-maker (DM) on the use of specific MA methods in a given situation. A knowledge base consisting of IF-THEN production rules is developed for assisting the DM with a systematic adoption of the most appropriate method with the efficient use of the powerful reasoning and explanation capabilities of intelligent DSS. The idea of letting the problem to be solved determines the method to be used is incorporated into the proposed DSS. As a result, effective decisions can be made for solving the IS project selection problem. An example is presented to demonstrate the applicability of the proposed DSS for solving the problem of selecting IS projects in real world situations.

[Modeling in value-based medicine].

PubMed

Neubauer, A S; Hirneiss, C; Kampik, A

2010-03-01

Modeling plays an important role in value-based medicine (VBM). It allows decision support by predicting potential clinical and economic consequences, frequently combining different sources of evidence. Based on relevant publications and examples focusing on ophthalmology the key economic modeling methods are explained and definitions are given. The most frequently applied model types are decision trees, Markov models, and discrete event simulation (DES) models. Model validation includes besides verifying internal validity comparison with other models (external validity) and ideally validation of its predictive properties. The existing uncertainty with any modeling should be clearly stated. This is true for economic modeling in VBM as well as when using disease risk models to support clinical decisions. In economic modeling uni- and multivariate sensitivity analyses are usually applied; the key concepts here are tornado plots and cost-effectiveness acceptability curves. Given the existing uncertainty, modeling helps to make better informed decisions than without this additional information.

Modular Architecture for Integrated Model-Based Decision Support.

PubMed

Gaebel, Jan; Schreiber, Erik; Oeser, Alexander; Oeltze-Jafra, Steffen

2018-01-01

Model-based decision support systems promise to be a valuable addition to oncological treatments and the implementation of personalized therapies. For the integration and sharing of decision models, the involved systems must be able to communicate with each other. In this paper, we propose a modularized architecture of dedicated systems for the integration of probabilistic decision models into existing hospital environments. These systems interconnect via web services and provide model sharing and processing capabilities for clinical information systems. Along the lines of IHE integration profiles from other disciplines and the meaningful reuse of routinely recorded patient data, our approach aims for the seamless integration of decision models into hospital infrastructure and the physicians' daily work.

Personalized Clinical Diagnosis in Data Bases for Treatment Support in Phthisiology.

PubMed

Lugovkina, T K; Skornyakov, S N; Golubev, D N; Egorov, E A; Medvinsky, I D

2016-01-01

The decision-making is a key event in the clinical practice. The program products with clinical decision support models in electronic data-base as well as with fixed decision moments of the real clinical practice and treatment results are very actual instruments for improving phthisiological practice and may be useful in the severe cases caused by the resistant strains of Mycobacterium tuberculosis. The methodology for gathering and structuring of useful information (critical clinical signals for decisions) is described. Additional coding of clinical diagnosis characteristics was implemented for numeric reflection of the personal situations. The created methodology for systematization and coding Clinical Events allowed to improve the clinical decision models for better clinical results.

Shared decision making in the management of children with newly diagnosed immune thrombocytopenia.

PubMed

Beck, Carolyn E; Boydell, Katherine M; Stasiulis, Elaine; Blanchette, Victor S; Llewellyn-Thomas, Hilary; Birken, Catherine S; Breakey, Vicky R; Parkin, Patricia C

2014-10-01

This study aimed to examine the treatment decision-making process for children hospitalized with newly diagnosed immune thrombocytopenia (ITP). Using focus groups, we studied children with ITP, parents of children with ITP, and health care professionals, inquiring about participants' experience with decision support and decision making in newly diagnosed ITP. Data were examined using thematic analysis. Themes that emerged from children were feelings of "anxiety, fear, and confusion"; the need to "understand information"; and "treatment choice," the experience of which was age dependent. For parents, "anxiety, fear, and confusion" was a dominant theme; "treatment choice" revealed that participants felt directed toward intravenous immune globulin (IVIG) for initial treatment. For health care professionals, "comfort level" highlighted factors contributing to professionals' comfort with offering options; "assumptions" were made about parental desire for participation in shared decision making (SDM) and parental acceptance of treatment options; "providing information" was informative regarding modes of facilitating SDM; and "treatment choice" revealed a discrepancy between current practice (directed toward IVIG) and the ideal of SDM. At our center, families of children with newly diagnosed ITP are not experiencing SDM. Our findings support the implementation of SDM to facilitate patient-centered care for the management of pediatric ITP.

Improving performance with clinical decision support.

PubMed

Brailer, D J; Goldfarb, S; Horgan, M; Katz, F; Paulus, R A; Zakrewski, K

1996-07-01

CADU/CIS (Clinical and Administrative Decision-support Utility and Clinical Information System) is a clinical decision-support workstation that allows large volumes of clinical information systems data to be analyzed in a timely and user-friendly fashion. CARE PROCESS MEASUREMENT: For any given disease, subgroups of patients are identified, and automated, customized "clinical pathways" are generated. For each subgroup, the best practice norms for use of test and therapies are identified. Practice style variations are then compared to outcomes to focus inquiry on decisions that significantly affect outcomes. INTESTINAL OBSTRUCTION: Graduate Health Systems, a multisite integrated provider in the Philadelphia area, has used CADU/CIS to improve quality problems, reduce treatment-intensity variations, and improve clinical participation in care process evaluation and decision making. A task force selected intestinal obstruction without hernia as its first study because of the related high-volume and high-morbidity complications. Use of a ten-step method for clinical performance improvement showed that the intravenous administration of unnecessary fluids to 104 patients with intestinal obstruction induced congestive heart failure (CHF) in 5 patients. Task force members and other practicing physicians are now developing guidelines and other interventions aimed at fluid use. Indeed, the task force used CADU/CIS to identify an additional 250 patients in one year whose conditions were complicated by CHF. A clinical decision support tool can be instrumental in detecting problems with important clinical and economic implications, identifying their important underlying causes, tracking the associated tests and therapies, and monitoring interventions.

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

PubMed Central

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

2018-01-01

Background 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. Objective The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. Methods 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. Results 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. Conclusions 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. PMID:29712620

Heuristics in Managing Complex Clinical Decision Tasks in Experts’ Decision Making

PubMed Central

Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme

2016-01-01

Background Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. Objective The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. Method After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. Results We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Conclusion Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Application Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design. PMID:27275019

Heuristics in Managing Complex Clinical Decision Tasks in Experts' Decision Making.

PubMed

Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme

2014-09-01

Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design.

Linking climate change and fish conservation efforts using spatially explicit decision support tools

Treesearch

Douglas P. Peterson; Seth J. Wenger; Bruce E. Rieman; Daniel J. Isaak

2013-01-01

Fisheries professionals are increasingly tasked with incorporating climate change projections into their decisions. Here we demonstrate how a structured decision framework, coupled with analytical tools and spatial data sets, can help integrate climate and biological information to evaluate management alternatives. We present examples that link downscaled climate...

A quantitative risk model for early lifecycle decision making

NASA Technical Reports Server (NTRS)

Feather, M. S.; Cornford, S. L.; Dunphy, J.; Hicks, K.

2002-01-01

Decisions made in the earliest phases of system development have the most leverage to influence the success of the entire development effort, and yet must be made when information is incomplete and uncertain. We have developed a scalable cost-benefit model to support this critical phase of early-lifecycle decision-making.

Behavioral and Organizational Considerations in the Design of Information Systems and Processes for Planning and Decision Support,

DTIC Science & Technology

1981-06-01

analysis and display capability provided by management information systems to include interpretation and aggregation of information and values such as...accomplishment of these) 2. analysis of the issue d) systems analysis and modeling (determination of the structure of the decision situation, the...existingltrtie2) Surveying lsata i situation’ alternatives I altraivDsad Is this alternative -" altrnav acceptable? ANALYSIS o NOYES SHave a sufficient

Cost-effectiveness and value of information analysis of nutritional support for preventing pressure ulcers in high-risk patients: implement now, research later.

PubMed

Tuffaha, Haitham W; Roberts, Shelley; Chaboyer, Wendy; Gordon, Louisa G; Scuffham, Paul A

2015-04-01

Pressure ulcers are a major cause of mortality, morbidity, and increased healthcare cost. Nutritional support may reduce the incidence of pressure ulcers in hospitalised patients who are at risk of pressure ulcer and malnutrition. To evaluate the cost-effectiveness of nutritional support in preventing pressure ulcers in high-risk hospitalised patients, and to assess the value of further research to inform the decision to implement this intervention using value of information analysis (VOI). The analysis was from the perspective of Queensland Health, Australia using a decision model with evidence derived from a systematic review and meta-analysis. Resources were valued using 2014 prices and the time horizon of the analysis was one year. Monte Carlo simulation was used to estimate net monetary benefits (NB) and to calculate VOI measures. Compared with standard hospital diet, nutritional support was cost saving at AU$425 per patient, and more effective with an average 0.005 quality-adjusted life years (QALY) gained. At a willingness-to-pay of AU$50,000 per QALY, the incremental NB was AU$675 per patient, with a probability of 87 % that nutritional support is cost-effective. The expected value of perfect information was AU$5 million and the expected value of perfect parameter information was highest for the relative risk of developing a pressure ulcer at AU$2.5 million. For a future trial investigating the relative effectiveness of the interventions, the expected net benefit of research would be maximised at AU$100,000 with 1,200 patients in each arm if nutritional support was perfectly implemented. The opportunity cost of withholding the decision to implement the intervention until the results of the future study are available would be AU$14 million. Nutritional support is cost-effective in preventing pressure ulcers in high-risk hospitalised patients compared with standard diet. Future research to reduce decision uncertainty is worthwhile; however, given the opportunity losses associated with delaying the implementation, "implement and research" is the approach recommended for this intervention.

Internet use in pregnancy informs women's decision making: a web-based survey.

PubMed

Lagan, Briege M; Sinclair, Marlene; Kernohan, W George

2010-06-01

Internet access and usage is almost ubiquitous, providing new opportunities and increasing challenges for health care practitioners and users. With pregnant women reportedly turning to the Internet for information during pregnancy, a better understanding of this behavior is needed. The objective of this study was to ascertain why and how pregnant women use the Internet as a health information source, and the overall effect it had on their decision making. Kuhlthau's (1993) information-seeking model was adapted to provide the underpinning theoretical framework for the study. The design was exploratory and descriptive. Data were collected using a valid and reliable web-based questionnaire. Over a 12-week period, 613 women from 24 countries who had confirmed that they had used the Internet for pregnancy-related information during their pregnancy completed and submitted a questionnaire. Most women (97%) used search engines such as Google to identify online web pages to access a large variety of pregnancy-related information and to use the Internet for pregnancy-related social networking, support, and electronic commerce (i.e., e-commerce). Almost 94 percent of women used the Internet to supplement information already provided by health professionals and 83 percent used it to influence their pregnancy decision making. Nearly half of the respondents reported dissatisfaction with information given by health professionals (48.6%) and lack of time to ask health professionals questions (46.5%) as key factors influencing them to access the Internet. Statistically, women's confidence levels significantly increased with respect to making decisions about their pregnancy after Internet usage (p < 0.05). In this study, the Internet played a significant part in the respondents' health information seeking and decision making in pregnancy. Health professionals need to be ready to support pregnant women in online data retrieval, interpretation, and application.

Information Product Development: Data product life cycle links engineering, science, and applications

NASA Astrophysics Data System (ADS)

Stavros, E. N.; Owen, S. E.

2016-12-01

Information products are assimilated and used to: a) conduct scientific research and b) provide decision support for management and policy. For example, aboveground biomass (i.e. an information product) can be integrated into Earth system models to test hypotheses about the changing world, or used to inform decision-making with respect to natural resource management and policy. Production and dissemination of an information product is referred to as the data product life cycle, which includes: 1) identifying needed information from decision-makers and researchers, 2) engineering an instrument and collecting the raw physical measurements (e.g, number of photons returned), 3) the scientific algorithm(s) for processing the data into an observable (e.g., number of dying trees), and 4) the integration and utilization of that observables by researchers and decision-makers. In this talk, I will discuss the data product life cycle in detail and provide examples from the pre-Hyperspectral Infrared Imager (HyspIRI) airborne campaign and the upcoming NASA-ISRO Synthetic Aperture Radar (NISAR) mission. Examples will focus on information products related to terrestrial ecosystems and natural resource management and will demonstrate that the key to providing information products for advancing scientific understanding and informing decision-makers, is the interdisciplinary integration of science, engineering and applied science - noting that applied science defines the wider impact and adoption of scientific principles by a wider community. As pre-HyspIRI airborne data is for research and development and NISAR is not yet launched, examples will include current plans for developing exemplar data products (from pre-HyspIRI) and the mission Applications Plan (for NISAR). Copyright 2016 California Institute of Technology. All Rights Reserved. We acknowledge support of the US Government, NASA, the Earth Science Division and Terrestrial Ecology program.

Supporting Clinical Cognition: A Human-Centered Approach to a Novel ICU Information Visualization Dashboard.

PubMed

Faiola, Anthony; Srinivas, Preethi; Duke, Jon

2015-01-01

Advances in intensive care unit bedside displays/interfaces and electronic medical record (EMR) technology have not adequately addressed the topic of visual clarity of patient data/information to further reduce cognitive load during clinical decision-making. We responded to these challenges with a human-centered approach to designing and testing a decision-support tool: MIVA 2.0 (Medical Information Visualization Assistant, v.2). Envisioned as an EMR visualization dashboard to support rapid analysis of real-time clinical data-trends, our primary goal originated from a clinical requirement to reduce cognitive overload. In the study, a convenience sample of 12 participants were recruited, in which quantitative and qualitative measures were used to compare MIVA 2.0 with ICU paper medical-charts, using time-on-task, post-test questionnaires, and interviews. Findings demonstrated a significant difference in speed and accuracy with the use of MIVA 2.0. Qualitative outcomes concurred, with participants acknowledging the potential impact of MIVA 2.0 for reducing cognitive load and enabling more accurate and quicker decision-making.

Knowledge-based geographic information systems on the Macintosh computer: a component of the GypsES project

Treesearch

Gregory Elmes; Thomas Millette; Charles B. Yuill

1991-01-01

GypsES, a decision-support and expert system for the management of Gypsy Moth addresses five related research problems in a modular, computer-based project. The modules are hazard rating, monitoring, prediction, treatment decision and treatment implementation. One common component is a geographic information system designed to function intelligently. We refer to this...

All Source Solution Decision Support Products Created for Stennis Space Center in Response to Hurricane Katrina

NASA Technical Reports Server (NTRS)

Ross, Kenton W.; Graham, William D.

2007-01-01

In the aftermath of Hurricane Katrina and in response to the needs of SSC (Stennis Space Center), NASA required the generation of decision support products with a broad range of geospatial inputs. Applying a systems engineering approach, the NASA ARTPO (Applied Research and Technology Project Office) at SSC evaluated the Center's requirements and source data quality. ARTPO identified data and information products that had the potential to meet decision-making requirements; included were remotely sensed data ranging from high-spatial-resolution aerial images through high-temporal-resolution MODIS (Moderate Resolution Imaging Spectroradiometer) products. Geospatial products, such as FEMA's (Federal Emergency Management Agency's) Advisory Base Flood Elevations, were also relevant. Where possible, ARTPO applied SSC calibration/validation expertise to both clarify the quality of various data source options and to validate that the inputs that were finally chosen met SSC requirements. ARTPO integrated various information sources into multiple decision support products, including two maps: Hurricane Katrina Inundation Effects at Stennis Space Center (highlighting surge risk posture) and Vegetation Change In and Around Stennis Space Center: Katrina and Beyond (highlighting fire risk posture).

Clinical genomics information management software linking cancer genome sequence and clinical decisions.

PubMed

Watt, Stuart; Jiao, Wei; Brown, Andrew M K; Petrocelli, Teresa; Tran, Ben; Zhang, Tong; McPherson, John D; Kamel-Reid, Suzanne; Bedard, Philippe L; Onetto, Nicole; Hudson, Thomas J; Dancey, Janet; Siu, Lillian L; Stein, Lincoln; Ferretti, Vincent

2013-09-01

Using sequencing information to guide clinical decision-making requires coordination of a diverse set of people and activities. In clinical genomics, the process typically includes sample acquisition, template preparation, genome data generation, analysis to identify and confirm variant alleles, interpretation of clinical significance, and reporting to clinicians. We describe a software application developed within a clinical genomics study, to support this entire process. The software application tracks patients, samples, genomic results, decisions and reports across the cohort, monitors progress and sends reminders, and works alongside an electronic data capture system for the trial's clinical and genomic data. It incorporates systems to read, store, analyze and consolidate sequencing results from multiple technologies, and provides a curated knowledge base of tumor mutation frequency (from the COSMIC database) annotated with clinical significance and drug sensitivity to generate reports for clinicians. By supporting the entire process, the application provides deep support for clinical decision making, enabling the generation of relevant guidance in reports for verification by an expert panel prior to forwarding to the treating physician. Copyright © 2013 Elsevier Inc. All rights reserved.

Informed Decision-Making in the Context of Prenatal Chromosomal Microarray.

PubMed

Baker, Jessica; Shuman, Cheryl; Chitayat, David; Wasim, Syed; Okun, Nan; Keunen, Johannes; Hofstedter, Renee; Silver, Rachel

2018-03-07

The introduction of chromosomal microarray (CMA) into the prenatal setting has involved considerable deliberation due to the wide range of possible outcomes (e.g., copy number variants of uncertain clinical significance). Such issues are typically discussed in pre-test counseling for pregnant women to support informed decision-making regarding prenatal testing options. This research study aimed to assess the level of informed decision-making with respect to prenatal CMA and the factor(s) influencing decision-making to accept CMA for the selected prenatal testing procedure (i.e., chorionic villus sampling or amniocentesis). We employed a questionnaire that was adapted from a three-dimensional measure previously used to assess informed decision-making with respect to prenatal screening for Down syndrome and neural tube defects. This measure classifies an informed decision as one that is knowledgeable, value-consistent, and deliberated. Our questionnaire also included an optional open-ended question, soliciting factors that may have influenced the participants' decision to accept prenatal CMA; these responses were analyzed qualitatively. Data analysis on 106 participants indicated that 49% made an informed decision (i.e., meeting all three criteria of knowledgeable, deliberated, and value-consistent). Analysis of 59 responses to the open-ended question showed that "the more information the better" emerged as the dominant factor influencing both informed and uninformed participants' decisions to accept prenatal CMA. Despite learning about the key issues in pre-test genetic counseling, our study classified a significant portion of women as making uninformed decisions due to insufficient knowledge, lack of deliberation, value-inconsistency, or a combination of these three measures. Future efforts should focus on developing educational approaches and counseling strategies to effectively increase the rate of informed decision-making among women offered prenatal CMA.

Dynamic Integration of Value Information into a Common Probability Currency as a Theory for Flexible Decision Making

PubMed Central

Christopoulos, Vassilios; Schrater, Paul R.

2015-01-01

Decisions involve two fundamental problems, selecting goals and generating actions to pursue those goals. While simple decisions involve choosing a goal and pursuing it, humans evolved to survive in hostile dynamic environments where goal availability and value can change with time and previous actions, entangling goal decisions with action selection. Recent studies suggest the brain generates concurrent action-plans for competing goals, using online information to bias the competition until a single goal is pursued. This creates a challenging problem of integrating information across diverse types, including both the dynamic value of the goal and the costs of action. We model the computations underlying dynamic decision-making with disparate value types, using the probability of getting the highest pay-off with the least effort as a common currency that supports goal competition. This framework predicts many aspects of decision behavior that have eluded a common explanation. PMID:26394299

The benefit of using additional hydrological information from earth observations and reanalysis data on water allocation decisions in irrigation districts

NASA Astrophysics Data System (ADS)

Kaune, Alexander; López, Patricia; Werner, Micha; de Fraiture, Charlotte

2017-04-01

Hydrological information on water availability and demand is vital for sound water allocation decisions in irrigation districts, particularly in times of water scarcity. However, sub-optimal water allocation decisions are often taken with incomplete hydrological information, which may lead to agricultural production loss. In this study we evaluate the benefit of additional hydrological information from earth observations and reanalysis data in supporting decisions in irrigation districts. Current water allocation decisions were emulated through heuristic operational rules for water scarce and water abundant conditions in the selected irrigation districts. The Dynamic Water Balance Model based on the Budyko framework was forced with precipitation datasets from interpolated ground measurements, remote sensing and reanalysis data, to determine the water availability for irrigation. Irrigation demands were estimated based on estimates of potential evapotranspiration and coefficient for crops grown, adjusted with the interpolated precipitation data. Decisions made using both current and additional hydrological information were evaluated through the rate at which sub-optimal decisions were made. The decisions made using an amended set of decision rules that benefit from additional information on demand in the districts were also evaluated. Results show that sub-optimal decisions can be reduced in the planning phase through improved estimates of water availability. Where there are reliable observations of water availability through gauging stations, the benefit of the improved precipitation data is found in the improved estimates of demand, equally leading to a reduction of sub-optimal decisions.

The Role of Informal Support Networks in Teaching the Nature of Science

NASA Astrophysics Data System (ADS)

Herman, Benjamin C.; Olson, Joanne K.; Clough, Michael P.

2017-06-01

This study reports the participation of 13 secondary science teachers in informal support networks and how that participation was associated with their nature of science (NOS) teaching practices 2 to 5 years after having graduated from the same science teacher education program. The nine teachers who participated in informal support networks taught the NOS at high/medium levels, while the four non-participating teachers taught the NOS at low levels. The nine high/medium NOS implementation teachers credited the informal support networks for maintaining/heightening their sense of responsibility for teaching NOS and for helping them navigate institutional constraints that impede effective NOS instruction. Several high/medium NOS instruction implementers initially struggled to autonomously frame and resolve the complexities experienced in schools and thus drew from the support networks to engage in more sophisticated forms of teacher decision-making. In contrast, the NOS pedagogical decisions of the four teachers not participating in support networks were governed primarily by the expectations and constraints experienced in their schools. Implications of this study include the need for reconsidering the structure of teacher mentorship programs to ensure they do not promote archaic science teaching practices that are at odds with reform efforts in science education.

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting.

PubMed

Armstrong, Rebecca; Waters, Elizabeth; Moore, Laurence; Dobbins, Maureen; Pettman, Tahna; Burns, Cate; Swinburn, Boyd; Anderson, Laurie; Petticrew, Mark

2014-12-14

The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions. The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health. In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making. This study makes an important contribution to understanding how evidence is used within the public health LG context. ACTRN12609000953235.

The Development and Validation of a Special Education Intelligent Administration Support Program. Final Report.

ERIC Educational Resources Information Center

Utah State Univ., Logan. Center for Persons with Disabilities.

This project studied the effects of implementing a computerized management information system developed for special education administrators. The Intelligent Administration Support Program (IASP), an expert system and database program, assisted in information acquisition and analysis pertaining to the district's quality of decisions and procedures…

A legal framework to enable sharing of Clinical Decision Support knowledge and services across institutional boundaries.

PubMed

Hongsermeier, Tonya; Maviglia, Saverio; Tsurikova, Lana; Bogaty, Dan; Rocha, Roberto A; Goldberg, Howard; Meltzer, Seth; Middleton, Blackford

2011-01-01

The goal of the CDS Consortium (CDSC) is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale - across multiple ambulatory care settings and Electronic Health Record technology platforms. In the course of the CDSC research effort, it became evident that a sound legal foundation was required for knowledge sharing and clinical decision support services in order to address data sharing, intellectual property, accountability, and liability concerns. This paper outlines the framework utilized for developing agreements in support of sharing, accessing, and publishing content via the CDSC Knowledge Management Portal as well as an agreement in support of deployment and consumption of CDSC developed web services in the context of a research project under IRB oversight.

Questioning the Relevance of Model-Based Probability Statements on Extreme Weather and Future Climate

NASA Astrophysics Data System (ADS)

Smith, L. A.

2007-12-01

We question the relevance of climate-model based Bayesian (or other) probability statements for decision support and impact assessment on spatial scales less than continental and temporal averages less than seasonal. Scientific assessment of higher resolution space and time scale information is urgently needed, given the commercial availability of "products" at high spatiotemporal resolution, their provision by nationally funded agencies for use both in industry decision making and governmental policy support, and their presentation to the public as matters of fact. Specifically we seek to establish necessary conditions for probability forecasts (projections conditioned on a model structure and a forcing scenario) to be taken seriously as reflecting the probability of future real-world events. We illustrate how risk management can profitably employ imperfect models of complicated chaotic systems, following NASA's study of near-Earth PHOs (Potentially Hazardous Objects). Our climate models will never be perfect, nevertheless the space and time scales on which they provide decision- support relevant information is expected to improve with the models themselves. Our aim is to establish a set of baselines of internal consistency; these are merely necessary conditions (not sufficient conditions) that physics based state-of-the-art models are expected to pass if their output is to be judged decision support relevant. Probabilistic Similarity is proposed as one goal which can be obtained even when our models are not empirically adequate. In short, probabilistic similarity requires that, given inputs similar to today's empirical observations and observational uncertainties, we expect future models to produce similar forecast distributions. Expert opinion on the space and time scales on which we might reasonably expect probabilistic similarity may prove of much greater utility than expert elicitation of uncertainty in parameter values in a model that is not empirically adequate; this may help to explain the reluctance of experts to provide information on "parameter uncertainty." Probability statements about the real world are always conditioned on some information set; they may well be conditioned on "False" making them of little value to a rational decision maker. In other instances, they may be conditioned on physical assumptions not held by any of the modellers whose model output is being cast as a probability distribution. Our models will improve a great deal in the next decades, and our insight into the likely climate fifty years hence will improve: maintaining the credibility of the science and the coherence of science based decision support, as our models improve, require a clear statement of our current limitations. What evidence do we have that today's state-of-the-art models provide decision-relevant probability forecasts? What space and time scales do we currently have quantitative, decision-relevant information on for 2050? 2080?

Study protocol: a mixed methods study to assess mental health recovery, shared decision-making and quality of life (Plan4Recovery).

PubMed

Coffey, Michael; Hannigan, Ben; Meudell, Alan; Hunt, Julian; Fitzsimmons, Deb

2016-08-17

Recovery in mental health care is complex, highly individual and can be facilitated by a range of professional and non-professional support. In this study we will examine how recovery from mental health problems is promoted in non-medical settings. We hypothesise a relationship between involvement in decisions about care, social support and recovery and quality of life outcomes. We will use standardised validated instruments of involvement in decision-making, social contacts, recovery and quality of life with a random sample of people accessing non-statutory mental health social care services in Wales. We will add to this important information with detailed one to one case study interviews with people, their family members and their support workers. We will use a series of these interviews to examine how people build recovery over time to help us understand more about their involvement in decisions and the social links they build. We want to see how being involved in decisions about care and the social links people have are related to recovery and quality of life for people with experience of using mental health support services. We want to understand the different perspectives of the people involved in making recovery possible. We will use this information to guide further studies of particular types of social interventions and their use in helping recovery from mental health problems.

Free and open source enabling technologies for patient-centric, guideline-based clinical decision support: a survey.

PubMed

Leong, T Y; Kaiser, K; Miksch, S

2007-01-01

Guideline-based clinical decision support is an emerging paradigm to help reduce error, lower cost, and improve quality in evidence-based medicine. The free and open source (FOS) approach is a promising alternative for delivering cost-effective information technology (IT) solutions in health care. In this paper, we survey the current FOS enabling technologies for patient-centric, guideline-based care, and discuss the current trends and future directions of their role in clinical decision support. We searched PubMed, major biomedical informatics websites, and the web in general for papers and links related to FOS health care IT systems. We also relied on our background and knowledge for specific subtopics. We focused on the functionalities of guideline modeling tools, and briefly examined the supporting technologies for terminology, data exchange and electronic health record (EHR) standards. To effectively support patient-centric, guideline-based care, the computerized guidelines and protocols need to be integrated with existing clinical information systems or EHRs. Technologies that enable such integration should be accessible, interoperable, and scalable. A plethora of FOS tools and techniques for supporting different knowledge management and quality assurance tasks involved are available. Many challenges, however, remain in their implementation. There are active and growing trends of deploying FOS enabling technologies for integrating clinical guidelines, protocols, and pathways into the main care processes. The continuing development and maturation of such technologies are likely to make increasingly significant contributions to patient-centric, guideline-based clinical decision support.

CIRUN: Climate Information Responding to User Needs

NASA Astrophysics Data System (ADS)

Busalacchi, A. J.

2009-12-01

The Earth System will experience real climate change over the next 50 years, exceeding the scope of natural climate variability. A paramount question facing society is how to adapt to this certainty of climate variability and change. In response, OSTP and NOAA are considering how comprehensive climate services would best inform decisions about adaptation. Similarly, NASA is considering the optimal configuration of the next generation of Earth, environmental, and climate observations to be deployed over the coming 10-20 years. Moreover, much of the added-value information for specific climate-related decisions will be provided by private, academic and non-governmental organizations. In this context, over the past several years the University of Maryland has established the CIRUN (Climate Information: Responding to User Needs) initiative to identify the nature of national needs for climate information and services from a decision support perspective. To date, CIRUN has brought together decisionmakers in a number of sectors to help understand their perspectives on climate with the goal of improving the usefulness of climate information, observations and prediction products to specific user communities. CIRUN began with a major workshop in October 2007 that convened 430 participants in agriculture, parks and recreation, terrestrial ecosystems, insurance/investment, energy, national security, state/local/municipal, water, human health, commerce and manufacturing, transportation, and coastal/marine sectors. Plenary speakers such as Norman Augustine, R. James Woolsey, James Mahoney, and former Senator Joseph Tydings, breakout panel sessions, and participants provided input based on the following: - How would you characterize the exposure or vulnerability to climate variability or change impacting your organization? - Does climate variability and/or change currently factor into your organization's objectives or operations? - Are any of your existing plans being affected by climate or projections of climate change? - Is your organization developing a plan for adapting to climate change? - What are your needs for climate observations, predictions, and services? Please cite one or more specific examples when possible. - Do you currently have access to the climate information your organization needs? - What next steps are needed to assure effective use of climate services in your decision making? As a result, a dialogue with various user communities and a subsequent series of more sector specific workshops has been established regarding how significantly enhanced climate observations, data management, modeling, and predictions can provide valuable decision support for business and policy decisions. In particular, CIRUN has helped - To identify how users, stakeholders, and decision makers are influenced by climate on time scales from seasons to decades - To identify the needs and requirements of users, stakeholders, and decision makers for climate information, observations, predictions, and services from global to local scales - To identify what adaptation measures are being considered in the private and public sectors, and how this might result in new classes of information for decision support - To recommend principal elements of the path forward toward more effective use of climate services in decision making.

Exploring patient involvement in healthcare decision making across different education and functional health literacy groups.

PubMed

Smith, Sian K; Dixon, Ann; Trevena, Lyndal; Nutbeam, Don; McCaffery, Kirsten J

2009-12-01

Education and health literacy potentially limit a person's ability to be involved in decisions about their health. Few studies, however, have explored understandings and experiences of involvement in decision making among patients varying in education and health literacy. This paper reports on a qualitative interview study of 73 men and women living in Sydney, Australia, with varying education and functional health literacy levels. Participants were recruited from a community sample with lower educational attainment, plus an educated sample of University of Sydney alumni. The transcripts were analysed using the 'Framework' approach, a matrix-based method of thematic analysis. We found that participants with different education conceptualised their involvement in decision making in diverse ways. Participants with higher education appeared to conceive their involvement as sharing the responsibility with the doctor throughout the decision-making process. This entailed verifying the credibility of the information and exploring options beyond those presented in the consultation. They also viewed themselves as helping others in their health decisions and acting as information resources. In contrast, participants with lower education appeared to conceive their involvement in terms of consenting to an option recommended by the doctor, and having responsibility for the ultimate decision, to agree or disagree with the recommendation. They also described how relatives and friends sought information on their behalf and played a key role in their decisions. Both education groups described how aspects of the patient-practitioner relationship (e.g. continuity, negotiation, trust) and the practitioner's interpersonal communication skills influenced their involvement. Health information served a variety of needs for all groups (e.g. supporting psychosocial, practical and decision support needs). These findings have practical implications for how to involve patients with different education and literacy levels in decision making, and highlight the important role of the patient-practitioner relationship in the process of decision making.

Computers for Command and Control: An Airland Battle Requirement!

DTIC Science & Technology

1984-05-01

systems can enhance communications, improve data management, and support decision making through information display (SEE REVERSE) JAN 173 E~lNOS~SIISLT...organizations to improve communications, enhance data management, and support decision making through graphical display techniques and mathematical...tactical commander’s control of maneuver forces. There are many reasons for the Army’s apparent inability to develop and field these systems. Among the

Quantitative Systems Pharmacology: A Case for Disease Models

PubMed Central

Ramanujan, S; Schmidt, BJ; Ghobrial, OG; Lu, J; Heatherington, AC

2016-01-01

Quantitative systems pharmacology (QSP) has emerged as an innovative approach in model‐informed drug discovery and development, supporting program decisions from exploratory research through late‐stage clinical trials. In this commentary, we discuss the unique value of disease‐scale “platform” QSP models that are amenable to reuse and repurposing to support diverse clinical decisions in ways distinct from other pharmacometrics strategies. PMID:27709613

An Organizational Informatics Analysis of Colorectal, Breast, and Cervical Cancer Screening Clinical Decision Support and Information Systems within Community Health Centers

ERIC Educational Resources Information Center

Carney, Timothy Jay

2012-01-01

A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services…

Knowledge Flow Mesh and Its Dynamics: A Decision Support Environment

DTIC Science & Technology

2008-06-01

paper was the ability of the United States military to achieve dominance through information superiority. The use of intelligent sensors and... Intelligence Agency, National Security Agency, Defense Intelligence Agency, and individual Service intelligence agencies). In fact, these edge entities would... intelligence , design, choice, and implementation. 6. Support variety of decision processes and styles. 7. DSS should be adaptable and flexible. 8. DSS

Digital technology and clinical decision making in depression treatment: Current findings and future opportunities.

PubMed

Hallgren, Kevin A; Bauer, Amy M; Atkins, David C

2017-06-01

Clinical decision making encompasses a broad set of processes that contribute to the effectiveness of depression treatments. There is emerging interest in using digital technologies to support effective and efficient clinical decision making. In this paper, we provide "snapshots" of research and current directions on ways that digital technologies can support clinical decision making in depression treatment. Practical facets of clinical decision making are reviewed, then research, design, and implementation opportunities where technology can potentially enhance clinical decision making are outlined. Discussions of these opportunities are organized around three established movements designed to enhance clinical decision making for depression treatment, including measurement-based care, integrated care, and personalized medicine. Research, design, and implementation efforts may support clinical decision making for depression by (1) improving tools to incorporate depression symptom data into existing electronic health record systems, (2) enhancing measurement of treatment fidelity and treatment processes, (3) harnessing smartphone and biosensor data to inform clinical decision making, (4) enhancing tools that support communication and care coordination between patients and providers and within provider teams, and (5) leveraging treatment and outcome data from electronic health record systems to support personalized depression treatment. The current climate of rapid changes in both healthcare and digital technologies facilitates an urgent need for research, design, and implementation of digital technologies that explicitly support clinical decision making. Ensuring that such tools are efficient, effective, and usable in frontline treatment settings will be essential for their success and will require engagement of stakeholders from multiple domains. © 2017 Wiley Periodicals, Inc.

Expectant parents' views of factors influencing infant feeding decisions in the antenatal period: A systematic review.

PubMed

Roll, Coralie L; Cheater, Francine

2016-08-01

To explore the factors that influence expectant parents' infant feeding decisions in the antenatal period. Mixed method systematic review focussing on participant views data. CINAHL, Medline, Embase and PsychInfo databases were interrogated using initial keywords and then refined terms to elicit relevant studies. Reference lists were checked and hand-searching was undertaken for 2 journals ('Midwifery' and 'Social Science and Medicine') covering a 3 year time period (January 2011-March 2014). Key inclusion criteria: studies reflecting expectant parents' views of the factors influencing their infant feeding decisions in the antenatal period; Studies in the English language published after 1990, from developed countries and of qualitative, quantitative or mixed method design. A narrative interpretive synthesis of the views data from studies of qualitative, quantitative and mixed method design. Data were extracted on study characteristics and parents' views, using the Social Ecological Model to support data extraction and thematic synthesis. Synthesis was influenced by the Evidence for Policy and Practice Information and Co-Ordinating Centre approach to mixed method reviews. Of the 409 studies identified through search methods, 17 studies met the inclusion criteria for the review. Thematic synthesis identified 9 themes: Bonding/Attachment; Body Image; Self Esteem/Confidence; Female Role Models; Family and Support Network; Lifestyle; Formal Information Sources; Knowledge; and Feeding in front of others/Public. The review identified a significant bias in the data towards negative factors relating to the breastfeeding decision, suggesting that infant feeding was not a choice between two feeding options, but rather a process of weighing reasons for and against breastfeeding. Findings reflected the perception of the maternal role as intrinsic to the expectant mothers' infant feeding decisions. Cultural perceptions permeated personal, familial and social influences on the decision-making process. Expectant mothers were sensitive to the way professionals attempted to support and inform them about infant feeding choices. By taking a Social Ecological perspective, we were able to explore and demonstrate the multiple influences impacting on expectant parents in the decision-making process. A better understanding of expectant parents' views and experiences in making infant feeding decisions in the prenatal and antenatal periods will inform public health policy and the coordination of service provision to support infant feeding activities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Precautionary principles: a jurisdiction-free framework for decision-making under risk.

PubMed

Ricci, Paolo F; Cox, Louis A; MacDonald, Thomas R

2004-12-01

Fundamental principles of precaution are legal maxims that ask for preventive actions, perhaps as contingent interim measures while relevant information about causality and harm remains unavailable, to minimize the societal impact of potentially severe or irreversible outcomes. Such principles do not explain how to make choices or how to identify what is protective when incomplete and inconsistent scientific evidence of causation characterizes the potential hazards. Rather, they entrust lower jurisdictions, such as agencies or authorities, to make current decisions while recognizing that future information can contradict the scientific basis that supported the initial decision. After reviewing and synthesizing national and international legal aspects of precautionary principles, this paper addresses the key question: How can society manage potentially severe, irreversible or serious environmental outcomes when variability, uncertainty, and limited causal knowledge characterize their decision-making? A decision-analytic solution is outlined that focuses on risky decisions and accounts for prior states of information and scientific beliefs that can be updated as subsequent information becomes available. As a practical and established approach to causal reasoning and decision-making under risk, inherent to precautionary decision-making, these (Bayesian) methods help decision-makers and stakeholders because they formally account for probabilistic outcomes, new information, and are consistent and replicable. Rational choice of an action from among various alternatives--defined as a choice that makes preferred consequences more likely--requires accounting for costs, benefits and the change in risks associated with each candidate action. Decisions under any form of the precautionary principle reviewed must account for the contingent nature of scientific information, creating a link to the decision-analytic principle of expected value of information (VOI), to show the relevance of new information, relative to the initial (and smaller) set of data on which the decision was based. We exemplify this seemingly simple situation using risk management of BSE. As an integral aspect of causal analysis under risk, the methods developed in this paper permit the addition of non-linear, hormetic dose-response models to the current set of regulatory defaults such as the linear, non-threshold models. This increase in the number of defaults is an important improvement because most of the variants of the precautionary principle require cost-benefit balancing. Specifically, increasing the set of causal defaults accounts for beneficial effects at very low doses. We also show and conclude that quantitative risk assessment dominates qualitative risk assessment, supporting the extension of the set of default causal models.

Service-Oriented Architecture Approach to MAGTF Logistics Support Systems

DTIC Science & Technology

2013-09-01

Support System-Marine Corps IT Information Technology KPI Key Performance Indicators LCE Logistics Command Element ITV In-transit Visibility LCM...building blocks, options, KPI (key performance indicators), design decisions and the corresponding; the physical attributes which is the second attribute... KPI ) that they impact. h. Layer 8 (Information Architecture) The business intelligence layer and information architecture safeguards the inclusion

Interventions to support shared decision-making for women with heavy menstrual bleeding: A systematic review.

PubMed

Zandstra, D; Busser, J A S; Aarts, J W M; Nieboer, T E

2017-04-01

This review studies women's preferences for shared decision-making about heavy menstrual bleeding treatment and evaluates interventions that support shared decision-making and their effectiveness. PubMed, Cochrane, Embase, Medline and ClinicalTrials.gov were searched. Three research questions were predefined: 1) What is the range of perspectives gathered in studies that examine women facing a decision related to heavy menstrual bleeding management?; 2) What types of interventions have been developed to support shared decision-making for women experiencing heavy menstrual bleeding?; and 3) In what way might women benefit from interventions that support shared decision-making? All original studies were included if the study population consisted of women experiencing heavy menstrual bleeding. We used the TIDieR (Template for Intervention: Description and Replication) checklist to assess the quality of description and the reproducibility of interventions. Interventions were categorized using Grande et al. guidelines and collated and summarized outcomes measures into three categories: 1) patient-reported outcomes; 2) observer-reported outcomes; and 3) doctor-reported outcomes. Fifteen studies were included. Overall, patients preferred to decide together with their doctor (74%). Women's previsit preference was the strongest predictor for treatment choice in two studies. Information packages did not have a statistically significant effect on treatment choice or satisfaction. However, adding a structured interview or decision aid to increase patient involvement did show a positive effect on treatment choice and results, patient satisfaction and shared decision-making related outcomes. In conclusion shared decision-making is becoming more important in the care of women with heavy menstrual bleeding. Structured interviews or well-designed (computerized) tools such as decision aids seem to facilitate this process, but there is room for improvement. A shared treatment choice is only possible after careful provision of information, elicitation of patients' preferences and integrating those preferences. Interventions should be designed accordingly. Copyright © 2017 Elsevier B.V. All rights reserved.

Decision Support and Shared Decision Making About Active Surveillance Versus Active Treatment Among Men Diagnosed with Low-Risk Prostate Cancer: a Pilot Study.

PubMed

Myers, Ronald E; Leader, Amy E; Censits, Jean Hoffman; Trabulsi, Edouard J; Keith, Scott W; Petrich, Anett M; Quinn, Anna M; Den, Robert B; Hurwitz, Mark D; Lallas, Costas D; Hegarty, Sarah E; Dicker, Adam P; Zeigler-Johnson, Charnita M; Giri, Veda N; Ayaz, Hasan; Gomella, Leonard G

2018-02-01

This study aimed to explore the effects of a decision support intervention (DSI) and shared decision making (SDM) on knowledge, perceptions about treatment, and treatment choice among men diagnosed with localized low-risk prostate cancer (PCa). At a multidisciplinary clinic visit, 30 consenting men with localized low-risk PCa completed a baseline survey, had a nurse-mediated online DS session to clarify preference for active surveillance (AS) or active treatment (AT), and met with clinicians for SDM. Participants also completed a follow-up survey at 30 days. We assessed change in treatment knowledge, decisional conflict, and perceptions and identified predictors of AS. At follow-up, participants exhibited increased knowledge (p < 0.001), decreased decisional conflict (p < 0.001), and more favorable perceptions of AS (p = 0.001). Furthermore, 25 of the 30 participants (83 %) initiated AS. Increased family and clinician support predicted this choice (p < 0.001). DSI/SDM prepared patients to make an informed decision. Perceived support of the decision facilitated patient choice of AS.

Choosing to Decline: Finding Common Ground through the Perspective of Shared Decision Making.

PubMed

Megregian, Michele; Nieuwenhuijze, Marianne

2018-05-18

Respectful communication is a key component of any clinical relationship. Shared decision making is the process of collaboration that occurs between a health care provider and patient in order to make health care decisions based upon the best available evidence and the individual's preferences. A midwife and woman (and her support persons) engage together to make health care decisions, using respectful communication that is based upon the best available evidence and the woman's preferences, values, and goals. Supporting a woman's autonomy, however, can be particularly challenging in maternity care when recommended treatments or interventions are declined. In the past, the real or perceived increased risk to a woman's health or that of her fetus as a result of that choice has occasionally resulted in coercion. Through the process of shared decision making, the woman's autonomy may be supported, including the choice to decline interventions. The case presented here demonstrates how a shared decision-making framework can support the health care provider-patient relationship in the context of informed refusal. © 2018 by the American College of Nurse-Midwives.

Risk-Informed Decision Making: Application to Technology Development Alternative Selection

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Maggio, Gaspare; Everett, Christopher

2010-01-01

NASA NPR 8000.4A, Agency Risk Management Procedural Requirements, defines risk management in terms of two complementary processes: Risk-informed Decision Making (RIDM) and Continuous Risk Management (CRM). The RIDM process is used to inform decision making by emphasizing proper use of risk analysis to make decisions that impact all mission execution domains (e.g., safety, technical, cost, and schedule) for program/projects and mission support organizations. The RIDM process supports the selection of an alternative prior to program commitment. The CRM process is used to manage risk associated with the implementation of the selected alternative. The two processes work together to foster proactive risk management at NASA. The Office of Safety and Mission Assurance at NASA Headquarters has developed a technical handbook to provide guidance for implementing the RIDM process in the context of NASA risk management and systems engineering. This paper summarizes the key concepts and procedures of the RIDM process as presented in the handbook, and also illustrates how the RIDM process can be applied to the selection of technology investments as NASA's new technology development programs are initiated.

Information in medical decision making: how consistent is our management?

PubMed

Lorence, Daniel P; Spink, Amanda; Jameson, Robert

2002-01-01

The use of outcomes data in clinical environments requires a correspondingly greater variety of information used in decision making, the measurement of quality, and clinical performance. As information becomes integral in the decision-making process, trustworthy decision support data are required. Using data from a national census of certified health information managers, variation in automated data quality management practices was examined. Relatively low overall adoption of automated data management exists in health care organizations, with significant geographic and practice setting variation. Nonuniform regional adoption of computerized data management exists, despite national mandates that promote and in some cases require uniform adoption. Overall, a significant number of respondents (42.7%) indicated that they had not adopted policies and procedures to direct the timeliness of data capture, with 57.3% having adopted such practices. The inconsistency of patient data policy suggests that provider organizations do not use uniform information management methods, despite growing federal mandates to do so.

Evolution of a CDC Public Health Research Agenda for Low-Risk Prostate Cancer

PubMed Central

Hall, Ingrid J.; Smith, Judith Lee

2016-01-01

Men with prostate cancer face difficult choices when selecting a therapy for localized prostate cancer. Comparative data from controlled studies are lacking and clinical opinions diverge about the benefits and harms of treatment options. Consequently, there is limited guidance for patients regarding the impact of treatment decisions on quality of life. There are opportunities for public health to intervene at several decision-making points. Information on typical quality of life outcomes associated with specific prostate cancer treatments could help patients select treatment options. From 2003 to present, the Division of Cancer Prevention and Control at CDC has supported projects to explore patient information-seeking behavior post-diagnosis, caregiver and provider involvement in treatment decision making, and patient quality of life following prostate cancer treatment. CDC's work also includes research that explores barriers and facilitators to the presentation of active surveillance as a viable treatment option and promotes equal access to information for men and their caregivers. This article provides an overview of the literature and considerations that initiated establishing a prospective public health research agenda around treatment decision making. Insights gathered from CDC-supported studies are poised to enhance understanding of the process of shared decision making and the influence of patient, caregiver, and provider preferences on the selection of treatment choices. These findings provide guidance about attributes that maximize patient experiences in survivorship, including optimal quality of life and patient and caregiver satisfaction with information, treatment decisions, and subsequent care. PMID:26590643

Application of GIS in foreign direct investment decision support system

NASA Astrophysics Data System (ADS)

Zhou, Jianlan; Sun, Koumei

2007-06-01

It is important to make decisions on how to attract foreign direct investment (FDI) to China and know how the inequality of FDI introduction by locational different provinces. Following background descriptions on China's FDI economic environments and FDI-related policies, this paper demonstrates the uses of geographical information system (GIS) and multi-criterion decision-making (MCDM) framework in solving a spatial multi-objective problem of evaluating and ranking China's provinces for FDI introduction. It implements a foreign direct investment decision support system, which reveals the main determinants of FDI in China and gives some results of regional geographical analysis over spatial data.

A three-talk model for shared decision making: multistage consultation process.

PubMed

Elwyn, Glyn; Durand, Marie Anne; Song, Julia; Aarts, Johanna; Barr, Paul J; Berger, Zackary; Cochran, Nan; Frosch, Dominick; Galasiński, Dariusz; Gulbrandsen, Pål; Han, Paul K J; Härter, Martin; Kinnersley, Paul; Lloyd, Amy; Mishra, Manish; Perestelo-Perez, Lilisbeth; Scholl, Isabelle; Tomori, Kounosuke; Trevena, Lyndal; Witteman, Holly O; Van der Weijden, Trudy

2017-11-06

Objectives  To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design  Multistage consultation process. Setting  Key informant group, communities of interest, and survey of clinical specialties. Participants  19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results  After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions  The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences. 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.

An Investment Behavior Analysis using by Brain Computer Interface

NASA Astrophysics Data System (ADS)

Suzuki, Kyoko; Kinoshita, Kanta; Miyagawa, Kazuhiro; Shiomi, Shinichi; Misawa, Tadanobu; Shimokawa, Tetsuya

In this paper, we will construct a new Brain Computer Interface (BCI), for the purpose of analyzing human's investment decision makings. The BCI is made up of three functional parts which take roles of, measuring brain information, determining market price in an artificial market, and specifying investment decision model, respectively. When subjects make decisions, their brain information is conveyed to the part of specifying investment decision model through the part of measuring brain information, whereas, their decisions of investment order are sent to the part of artificial market to form market prices. Both the support vector machine and the 3 layered perceptron are used to assess the investment decision model. In order to evaluate our BCI, we conduct an experiment in which subjects and a computer trader agent trade shares of stock in the artificial market and test how the computer trader agent can forecast market price formation and investment decision makings from the brain information of subjects. The result of the experiment shows that the brain information can improve the accuracy of forecasts, and so the computer trader agent can supply market liquidity to stabilize market volatility without his loss.

Develop a Prototype Personal Health Record Application (PHR-A) that Captures Information About Daily Living Important for Diabetes and Provides Decision Support with Actionable Advice for Diabetes Self Care

DTIC Science & Technology

2014-10-01

designed an Internet-based and mobile application (software) to assist with the following domains pertinent to diabetes self-management: 1...management that provides education, reminders, and support. The new tool is an internet-based and mobile application (software), now called Tracking...is mobile , provides decision support with actionable options, and is based on user input, will enhance diabetes self-care, improve glycemic control

RE:RE: Comments on the Draft US EPA Document Toxicological Review of Inorganic Arsenic: In Support of the Summary Information on the Integrated Risk Information System (IRIS).

EPA Pesticide Factsheets

Letter from the Organic Arsenical Products Task Force expressing concern about aspects of the Science Advisory Board Workgroup's review of a draft document Toxicological Review of Inorganic Arsenic: In Support of the Summary Information on the Integrated Risk Information System (IRIS) and decision not to grant more time to prepare for meeting.

Content Analysis of Social Media Related to Left Ventricular Assist Devices.

PubMed

Kostick, Kristin M; Blumenthal-Barby, Jennifer S; Wilhelms, Lidija A; Delgado, Estevan D; Bruce, Courtenay R

2015-09-01

Social media have the potential to offer important benefits for patient education, support, and shared decision making. Despite the proliferation of social media use during the past decade, little is known about the scope and quality of available information, or the purposes that social media sites serve for patient decisional and support needs. We conducted a mixed method study, including content analysis of social media and principal components analysis analysis of data sites discussing left ventricular assist device treatment for heart failure. This study explored aspects of interactivity, user-friendliness, appeal, medium, purpose, audience, and accuracy of information. Higher levels of interactivity (eg, posting comments) seem to enhance the appeal and usability of available information but also introduce greater potential for inaccuracy and inconsistency. The current lack of oversight into the content and quality of available information constitute a challenge for the reliable use of social media as forums for information-seeking and social network-based support. We conclude that social media outlets constitute a promising source of informational and psychosocial support for patients, caregivers, and candidates, and if used in conjunction with patient-provider dialog, can contribute to informed decision making by facilitating reflection and discussion of personal concerns, values, and informational needs. © 2015 American Heart Association, Inc.

Effect of descriptive information and experience on automation reliance.

PubMed

Yuviler-Gavish, Nirit; Gopher, Daniel

2011-06-01

The present research addresses the issue of reliance on decision support systems for the long-term (DSSLT), which help users develop decision-making strategies and long-term planning. It is argued that providing information about a system's future performance in an experiential manner, as compared with a descriptive manner, encourages users to increase their reliance level. Establishing appropriate reliance on DSSLT is contingent on the system developer's ability to provide users with information about the system's future performance. A sequence of three studies contrasts the effect on automation reliance of providing descriptive information versus experience for DSSLT with two different positive expected values of recommendations. Study I demonstrated that when automation reliance was determined solely on the basis of description, it was relatively low, but it increased significantly when a decision was made after experience with 50 training simulations. Participants were able to learn to increase their automation reliance levels when they encountered the same type of recommendation again. Study 2 showed that the absence of preliminary descriptive information did not affect the automation reliance levels obtained after experience. Study 3 demonstrated that participants were able to generalize their learning about increasing reliance levels to new recommendations. Using experience rather than description to give users information about future performance in DSSLT can help increase automation reliance levels. Implications for designing DSSLT and decision support systems in general are discussed.

Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnographic study.

PubMed

Barken, Tina Lien; Thygesen, Elin; Söderhamn, Ulrika

2017-12-28

Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process. In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses' reasoning process. Nurses' reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses' reasoning process.

Elder women's decision-making in breast cancer care: An Israeli study.

PubMed

Kadmon, Ilana; Pierce, Penny; Antonakos, Cathy L

2012-07-01

Much research has examined women's decision-making behaviour in breast cancer care. Patient age has shaped preferences, values, decision style and participation in treatment decisions. The aim of this study was to test the validity of the Michigan Assessment of Decision Style (MADS) (Pierce, 1995) in an older cohort and provide information on decision styles to identify areas of tailored decision support necessary for Israeli women. This study examined the decision-making styles of older Israeli women receiving routine mammography screening. Fifty two women over 65 years of age, attending a routine mammography screening, were administered a questionnaire containing demographic information and the MADS to determine hypothetical treatment decision-making. The MADS is a 16-item questionnaire assessing decision-making behaviour by characterizing four factors: avoiding, deferring, information-seeking and deliberation. Age, family history of breast cancer, and having a current mammography were not significantly associated with any of the four MADS factors. Deliberation and Deferring had the highest mean scores, followed closely by Information-Seeking and Avoidance. Correlations among the factors indicate a significant, positive correlation between Deliberation and Information-Seeking and a significant negative correlation between Deliberation and Deferring, consistent with previous studies. These findings indicate that older Israeli women's decision style is characterized by information seeking and deliberation reflecting a disposition towards engagement. The findings contribute to clinicians' understanding of women's preferences by countering the traditionally accepted stereotype that older women will employ a passive role when faced with an important health care decision. Copyright © 2011 Elsevier Ltd. All rights reserved.

Toward theoretical understanding of the fertility preservation decision-making process: Examining information processing among young women with cancer

PubMed Central

Hershberger, Patricia E.; Finnegan, Lorna; Altfeld, Susan; Lake, Sara; Hirshfeld-Cytron, Jennifer

2014-01-01

Background Young women with cancer now face the complex decision about whether to undergo fertility preservation. Yet little is known about how these women process information involved in making this decision. Objective The purpose of this paper is to expand theoretical understanding of the decision-making process by examining aspects of information processing among young women diagnosed with cancer. Methods Using a grounded theory approach, 27 women with cancer participated in individual, semi-structured interviews. Data were coded and analyzed using constant-comparison techniques that were guided by five dimensions within the Contemplate phase of the decision-making process framework. Results In the first dimension, young women acquired information primarily from clinicians and Internet sources. Experiential information, often obtained from peers, occurred in the second dimension. Preferences and values were constructed in the third dimension as women acquired factual, moral, and ethical information. Women desired tailored, personalized information that was specific to their situation in the fourth dimension; however, women struggled with communicating these needs to clinicians. In the fifth dimension, women offered detailed descriptions of clinician behaviors that enhance or impede decisional debriefing. Conclusion Better understanding of theoretical underpinnings surrounding women’s information processes can facilitate decision support and improve clinical care. PMID:24552086

Decision-making about complementary and alternative medicine by cancer patients: integrative literature review.

PubMed

Weeks, Laura; Balneaves, Lynda G; Paterson, Charlotte; Verhoef, Marja

2014-01-01

Patients with cancer consistently report conflict and anxiety when making decisions about complementary and alternative medicine (CAM) treatment. To design evidence-informed decision-support strategies, a better understanding is needed of how the decision-making process unfolds for these patients during their experience with cancer. We undertook this study to review the research literature regarding CAM-related decision-making by patients with cancer within the context of treatment, survivorship, and palliation. We also aimed to summarize emergent concepts within a preliminary conceptual framework. We conducted an integrative literature review, searching 12 electronic databases for articles published in English that described studies of the process, context, or outcomes of CAM-related decision-making. We summarized descriptive data using frequencies and used a descriptive constant comparative method to analyze statements about original qualitative results, with the goal of identifying distinct concepts pertaining to CAM-related decision-making by patients with cancer and the relationships among these concepts. Of 425 articles initially identified, 35 met our inclusion criteria. Seven unique concepts related to CAM and cancer decision-making emerged: decision-making phases, information-seeking and evaluation, decision-making roles, beliefs, contextual factors, decision-making outcomes, and the relationship between CAM and conventional medical decision-making. CAM decision-making begins with the diagnosis of cancer and encompasses 3 distinct phases (early, mid, and late), each marked by unique aims for CAM treatment and distinct patterns of information-seeking and evaluation. Phase transitions correspond to changes in health status or other milestones within the cancer trajectory. An emergent conceptual framework illustrating relationships among the 7 central concepts is presented. CAM-related decision-making by patients with cancer occurs as a nonlinear, complex, dynamic process. The conceptual framework presented here identifies influential factors within that process, as well as patients' unique needs during different phases. The framework can guide the development and evaluation of theory-based decision-support programs that are responsive to patients' beliefs and preferences.

Value of information analysis for interventional and counterfactual Bayesian networks in forensic medical sciences.

PubMed

Constantinou, Anthony Costa; Yet, Barbaros; Fenton, Norman; Neil, Martin; Marsh, William

2016-01-01

Inspired by real-world examples from the forensic medical sciences domain, we seek to determine whether a decision about an interventional action could be subject to amendments on the basis of some incomplete information within the model, and whether it would be worthwhile for the decision maker to seek further information prior to suggesting a decision. The method is based on the underlying principle of Value of Information to enhance decision analysis in interventional and counterfactual Bayesian networks. The method is applied to two real-world Bayesian network models (previously developed for decision support in forensic medical sciences) to examine the average gain in terms of both Value of Information (average relative gain ranging from 11.45% and 59.91%) and decision making (potential amendments in decision making ranging from 0% to 86.8%). We have shown how the method becomes useful for decision makers, not only when decision making is subject to amendments on the basis of some unknown risk factors, but also when it is not. Knowing that a decision outcome is independent of one or more unknown risk factors saves us from the trouble of seeking information about the particular set of risk factors. Further, we have also extended the assessment of this implication to the counterfactual case and demonstrated how answers about interventional actions are expected to change when some unknown factors become known, and how useful this becomes in forensic medical science. Copyright © 2015 Elsevier B.V. All rights reserved.

Evaluate the ability of clinical decision support systems (CDSSs) to improve clinical practice.

PubMed

Ajami, Sima; Amini, Fatemeh

2013-01-01

Prevalence of new diseases, medical science promotion and increase of referring to health care centers, provide a good situation for medical errors growth. Errors can involve medicines, surgery, diagnosis, equipment, or lab reports. Medical errors can occur anywhere in the health care system: In hospitals, clinics, surgery centers, doctors' offices, nursing homes, pharmacies, and patients' homes. According to the Institute of Medicine (IOM), 98,000 people die every year from preventable medical errors. In 2010 from all referred medical error records to Iran Legal Medicine Organization, 46/5% physician and medical team members were known as delinquent. One of new technologies that can reduce medical errors is clinical decision support systems (CDSSs). This study was unsystematic-review study. The literature was searched on evaluate the "ability of clinical decision support systems to improve clinical practice" with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. For our searches, we employed the following keywords and their combinations: medical error, clinical decision support systems, Computer-Based Clinical Decision Support Systems, information technology, information system, health care quality, computer systems in the searching areas of title, keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 38 of them were selected based on their relevancy. The CDSSs are computer programs, designed for help to health care careers. These systems as a knowledge-based tool could help health care manager in analyze evaluation, improvement and selection of effective solutions in clinical decisions. Therefore, it has a main role in medical errors reduction. The aim of this study was to express ability of the CDSSs to improve

Prescribing regeneration treatments for mixed-oak forests in the Mid-Atlantic region

Treesearch

Patrick H. Brose; Kurt W. Gottschalk; Stephen B. Horsley; Peter D. Knopp; James N. Kochenderfer; Barbara J. McGuinness; Gary W. Miller; Todd E. Ristau; Scott H. Stoleson; Susan L. Stout

2008-01-01

Includes guidelines for using the SILVAH decision-support system to perpetuate oak forests in the Mid-Atlantic region. Six chapters provide information on values of oak forests, inventory methods, key decision variables, decision charts, and silvicultural prescriptions, as well as guidance on fostering young stands. Sample tally sheets and SILVAH computer printouts are...

Central Office Data-Driven Decision Making in Public Education

ERIC Educational Resources Information Center

Scheikl, Oskar F.

2009-01-01

Data-driven decision making has become part of the lexicon for educational reform efforts. Supported by the federal No Child Left Behind legislation, the use of data to inform educational decisions has become a common-place practice across the country. Using an online survey administered to central office data leaders in all Virginia public school…

The novel use of climate information in water utility planning

NASA Astrophysics Data System (ADS)

Yates, D. N.

2016-12-01

Municipal water utilities have a long history of planning and yet their traditional use of climate information has been rather static in nature, using approaches such as 'safe-yield' to design their water infrastructure. New planning paradigms, such as triple-bottom-line approaches that integerate environemntal, social, and financial aspects of the water enterprise have led water utilies to use climate information in a much more rich and informative way. This presentation will describe examples of how climate climate information, hydrologic modeling, and water systems decision support tools are uniquely bleneded to help water utilties make informed decisions.

[Treatment Decision-Making Process of Cancer Patients].

PubMed

Lee, Shiu-Yu C Katie

2016-10-01

The decision-making process that is used by cancer patients to determine their treatment has become more multi-foci, difficult and complicated in recent years. This has in part been attributed to the increasing incidence rate of cancer in Taiwan and the rapid development of medical technologies and treatment modalities. Oncology nurses must assist patients and family to make informed and value-based treatment decisions. Decision-making is an information process that involves appraising one's own expectation and values based on his/her knowledge on cancer and treatment options. Because cancer treatment involves risks and uncertainties, and impacts quality of life, the treatment decision-making for cancer is often stressful, or even conflicting. This paper discusses the decision-making behaviors of cancer patients and the decisional conflict, participation, and informational needs that are involved in cancer treatment. The trend toward shared decision-making and decisional support will be also explored in order to facilitate the future development of appropriate clinical interventions and research.

Stakeholders’ Perspectives on Postmastectomy Breast Reconstruction: Recognizing Ways to Improve Shared Decision Making

PubMed Central

Hasak, Jessica M.; Myckatyn, Terence M.; Grabinski, Victoria F.; Philpott, Sydney E.; Parikh, Rajiv P.

2017-01-01

Background: Postmastectomy breast reconstruction (PMBR) is an elective, preference-sensitive decision made during a stressful, time-pressured period after a cancer diagnosis. Shared decision making (SDM) can improve decision quality about preference-sensitive choices. Stakeholders’ perspectives on ways to support PMBR decision-making were explored. Methods: Forty semi-structured interviews with stakeholders (20 postmastectomy patients, 10 PMBR surgeons, 10 PMBR nurses) were conducted. Clinicians were recruited from diverse practices across the United States. Patients were recruited using purposive sampling with varying PMBR experiences, including no reconstruction. The interview guide was based on an implementation research framework. Themes were identified using grounded theory approach, based on frequency and emotive force conveyed. Results: Engagement in SDM was variable. Some patients wanted more information about PMBR from clinicians, particularly about risks. Some clinicians acknowledged highlighting benefits and downplaying risks. Many patients felt pressured to make a choice by their clinicians. Clinicians who successfully engaged patients through decisions often used outside resources to supplement conversations. Conclusions: Patient–clinician trust was critical to high-quality decisions, and many patients expressed decision regret when they were not engaged in PMBR discussions. Patients often perceived a race- or age-related bias in clinician information sharing. Interventions to support SDM may enhance decision quality and reduce decision regret about PMBR, ultimately improving patient-centered care for women with breast cancer. PMID:29263969

ENVIRONMENTAL TECHNOLOGY VERIFICATION REPORT, ENVIRONMENTAL DECISION SUPPORT SOFTWARE, DECISION FX, INC., GROUNDWATER FX

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) has created the Environmental Technology Verification Program (ETV) to facilitate the deployment of innovative or improved environmental technologies through performance verification and dissemination of information. The goal of the...

ENVIRONMENTAL TECHNOLOGY VERIFICATION REPORT, ENVIRONMENTAL DECISION SUPPORT SOFTWARE, DECISION FX, INC. SAMPLING FX

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) has created the Environmental Technology Verification Program (ETV) to facilitate the deployment of innovative or improved environmental technologies through performance verification and dissemination of information. The goal of the...

Design of decision support interventions for medication prescribing.

PubMed

Horsky, Jan; Phansalkar, Shobha; Desai, Amrita; Bell, Douglas; Middleton, Blackford

2013-06-01

Describe optimal design attributes of clinical decision support (CDS) interventions for medication prescribing, emphasizing perceptual, cognitive and functional characteristics that improve human-computer interaction (HCI) and patient safety. Findings from published reports on success, failures and lessons learned during implementation of CDS systems were reviewed and interpreted with regard to HCI and software usability principles. We then formulated design recommendations for CDS alerts that would reduce unnecessary workflow interruptions and allow clinicians to make informed decisions quickly, accurately and without extraneous cognitive and interactive effort. Excessive alerting that tends to distract clinicians rather than provide effective CDS can be reduced by designing only high severity alerts as interruptive dialog boxes and less severe warnings without explicit response requirement, by curating system knowledge bases to suppress warnings with low clinical utility and by integrating contextual patient data into the decision logic. Recommended design principles include parsimonious and consistent use of color and language, minimalist approach to the layout of information and controls, the use of font attributes to convey hierarchy and visual prominence of important data over supporting information, the inclusion of relevant patient data in the context of the alert and allowing clinicians to respond with one or two clicks. Although HCI and usability principles are well established and robust, CDS and EHR system interfaces rarely conform to the best known design conventions and are seldom conceived and designed well enough to be truly versatile and dependable tools. These relatively novel interventions still require careful monitoring, research and analysis of its track record to mature. Clarity and specificity of alert content and optimal perceptual and cognitive attributes, for example, are essential for providing effective decision support to clinicians. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Choosing the appropriate treatment setting: which information and decision-making needs do adult inpatients with mental disorders have? A qualitative interview study

PubMed Central

Kivelitz, Laura; Härter, Martin; Mohr, Jil; Melchior, Hanne; Goetzmann, Lutz; Warnke, Max Holger; Kleinschmidt, Silke; Dirmaier, Jörg

2018-01-01

Background Decisions on medical treatment setting are perceived as important but often difficult to make for patients with mental disorders. Shared decision-making as a strategy to decrease decisional conflict has been recommended, but is not yet widely implemented. This study aimed to investigate the information needs and the decision-making preferences of patients with mental disorders prior to the decision for a certain treatment setting. The results will serve as a prerequisite for the development of a high-quality patient decision aid (PtDA) regarding the treatment setting decision. Methods We conducted retrospective individual semi-structured interviews with n=24 patients with mental disorders in three psychotherapeutic inpatient care units. The interviews were audiotaped, transcribed, coded, and content-analyzed. Results The majority of the patients wanted to be involved in the decision-making process. They reported high information needs regarding treatment options in order to feel empowered to participate adequately in the decision for a certain treatment setting. However, some patients did not want to participate or receive information, for example, because of their high burden of mental disorder. Whereas the majority were satisfied with the extent they were involved in the decision, few participants felt sufficiently informed about treatment options. Most patients reported that a decision aid regarding an appropriate treatment setting would have been helpful for them. Important information that should be included in a PtDA was general information about mental illness, effective treatment options, specific information about the different treatment settings, and access to treatment. Discussion The identified information and decision-making needs provide a valuable basis for the development of a PtDA aiming to support patients and caregivers regarding the decision for an adequate treatment setting. As preferences for participation vary among patients and also depend on the current mental state, a flexible approach is needed to meet patients’ individual wishes and needs. PMID:29805250

Choosing the appropriate treatment setting: which information and decision-making needs do adult inpatients with mental disorders have? A qualitative interview study.

PubMed

Kivelitz, Laura; Härter, Martin; Mohr, Jil; Melchior, Hanne; Goetzmann, Lutz; Warnke, Max Holger; Kleinschmidt, Silke; Dirmaier, Jörg

2018-01-01

Decisions on medical treatment setting are perceived as important but often difficult to make for patients with mental disorders. Shared decision-making as a strategy to decrease decisional conflict has been recommended, but is not yet widely implemented. This study aimed to investigate the information needs and the decision-making preferences of patients with mental disorders prior to the decision for a certain treatment setting. The results will serve as a prerequisite for the development of a high-quality patient decision aid (PtDA) regarding the treatment setting decision. We conducted retrospective individual semi-structured interviews with n=24 patients with mental disorders in three psychotherapeutic inpatient care units. The interviews were audiotaped, transcribed, coded, and content-analyzed. The majority of the patients wanted to be involved in the decision-making process. They reported high information needs regarding treatment options in order to feel empowered to participate adequately in the decision for a certain treatment setting. However, some patients did not want to participate or receive information, for example, because of their high burden of mental disorder. Whereas the majority were satisfied with the extent they were involved in the decision, few participants felt sufficiently informed about treatment options. Most patients reported that a decision aid regarding an appropriate treatment setting would have been helpful for them. Important information that should be included in a PtDA was general information about mental illness, effective treatment options, specific information about the different treatment settings, and access to treatment. The identified information and decision-making needs provide a valuable basis for the development of a PtDA aiming to support patients and caregivers regarding the decision for an adequate treatment setting. As preferences for participation vary among patients and also depend on the current mental state, a flexible approach is needed to meet patients' individual wishes and needs.

Development of a tiered and binned genetic counseling model for informed consent in the era of multiplex testing for cancer susceptibility.

PubMed

Bradbury, Angela R; Patrick-Miller, Linda; Long, Jessica; Powers, Jacquelyn; Stopfer, Jill; Forman, Andrea; Rybak, Christina; Mattie, Kristin; Brandt, Amanda; Chambers, Rachelle; Chung, Wendy K; Churpek, Jane; Daly, Mary B; Digiovanni, Laura; Farengo-Clark, Dana; Fetzer, Dominique; Ganschow, Pamela; Grana, Generosa; Gulden, Cassandra; Hall, Michael; Kohler, Lynne; Maxwell, Kara; Merrill, Shana; Montgomery, Susan; Mueller, Rebecca; Nielsen, Sarah; Olopade, Olufunmilayo; Rainey, Kimberly; Seelaus, Christina; Nathanson, Katherine L; Domchek, Susan M

2015-06-01

Multiplex genetic testing, including both moderate- and high-penetrance genes for cancer susceptibility, is associated with greater uncertainty than traditional testing, presenting challenges to informed consent and genetic counseling. We sought to develop a new model for informed consent and genetic counseling for four ongoing studies. Drawing from professional guidelines, literature, conceptual frameworks, and clinical experience, a multidisciplinary group developed a tiered-binned genetic counseling approach proposed to facilitate informed consent and improve outcomes of cancer susceptibility multiplex testing. In this model, tier 1 "indispensable" information is presented to all patients. More specific tier 2 information is provided to support variable informational needs among diverse patient populations. Clinically relevant information is "binned" into groups to minimize information overload, support informed decision making, and facilitate adaptive responses to testing. Seven essential elements of informed consent are provided to address the unique limitations, risks, and uncertainties of multiplex testing. A tiered-binned model for informed consent and genetic counseling has the potential to address the challenges of multiplex testing for cancer susceptibility and to support informed decision making and adaptive responses to testing. Future prospective studies including patient-reported outcomes are needed to inform how to best incorporate multiplex testing for cancer susceptibility into clinical practice.Genet Med 17 6, 485-492.

Intervention decision-making processes and information preferences of parents of children with autism spectrum disorders.

PubMed

Grant, N; Rodger, S; Hoffmann, T

2016-01-01

When a child is diagnosed with autism, parents are faced with the task of choosing from many different intervention options. To find information about the options available, parents turn to a number of different sources. This study explores parents' (n = 23) intervention decision-making processes and information preferences following the diagnosis of ASD for their child. Qualitative thematic analysis of verbatim transcripts from interviews and focus groups involving parents of children with an autism diagnosis was undertaken. Analysis of the results revealed that there are concurrent emotional and pragmatic intervention 'journeys' undertaken by parents post diagnosis, which encompass the primary themes of: (1) information sources used, (2) parents' information preferences and (3) factors influencing intervention decision making. Parents described a journey from the point of diagnosis that involved seeking information on ASD interventions from multiple sources, with the Internet being the primary source. They were overwhelmed by the sheer volume of information available, and their preferences for information varied according to their stage in the journey post diagnosis. Parents had a 'trial and error' approach to choosing ASD interventions, with confidence increasing as they became more familiar with their child's condition, and had opportunities to explore numerous information sources about their child's diagnosis. While confidence increased over time, consideration of the effectiveness or evidence supporting interventions remained largely absent throughout the journey. This study highlights the need for parents of children with ASD to be supported to make informed intervention decisions, particularly with consideration for research evidence. © 2015 John Wiley & Sons Ltd.