A concept-based framework for retrieving evidence to support emergency physician decision making at the point of care

The goal of evidence-based medicine is to uniformly apply evidence gained from scientific research to aspects of clinical practice. In order to achieve this goal, new applications that integrate increasingly disparate health care information resources are required. Access to and provision of evidence must be seamlessly integrated with existing clinical workflow and evidence should be made available where it is most often required - at the point of care. In this paper we address these requirements and outline a concept-based framework that captures the context of a current patient-physician encounter by combining disease and patient-specific information into a logical query mechanism for retrieving relevant evidence from the Cochrane Library. Returned documents are organized by automatically extracting concepts from the evidence-based query to create meaningful clusters of documents which are presented in a manner appropriate for point of care support. The framework is currently being implemented as a prototype software agent that operates within the larger context of a multi-agent application for supporting workflow management of emergency pediatric asthma exacerbations. © 2008 Springer-Verlag Berlin Heidelberg.

Measuring and modelling the influence of investor behaviour on investment decision making

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Study of management decision making by ward sisters in a hospital and the effects on decision making after the implementation of a decision support sytem

This thesis considers management decision making at the ward level in hospitals especially by ward sisters, and the effectiveness of the intervention of a decision support system. Nursing practice theories were related to organisation and management theories in order to conceptualise a decision making framework for nurse manpower planning and deployment at the ward level. Decision and systems theories were explored to understand the concepts of decision making and the realities of power in an organisation. In essence, the hypothesis was concerned with changes in patterns of decision making that could occur with the intervention of a decision support system and that the degree of change would be governed by a set of `difficulty' factors within wards in a hospital. During the course of the study, a classification of ward management decision making was created, together with the development and validation of measuring instruments to test the research hypothesis. The decision support system used was rigorously evaluated to test whether benefits did accrue from its implementation. Quantitative results from sample wards together with qualitative information collected, were used to test this hypothesis and the outcomes postulated were supported by these findings. The main conclusion from this research is that a more rational approach to management decision making is feasible, using information from a decision support system. However, wards and ward sisters that need the most assistance, where the `difficulty' factors in the organisation are highest, benefit the least from this type of system. Organisational reviews are needed on these identified wards, involving managers and doctors, to reduce the levels of un-coordinated activities and disruption.

A longitudinal study of Chinese managerial behaviour:an inside view of decision-making under the economic reform

This research compared decision making processes in six Chinese state-owned enterprises during the period 1985 to 1988. The research objectives were: a) To examine changes in the managerial behaviour over a period of 1985 to 1988 with a focus on decision-making; b) Through this examination, to throw light on the means by which government policies on economic reform were implemented at the enterprise level; c) To illustrate problems encountered in the decentralization programme which was a major part of China's economic reform. The research was conducted by means of intensive interviews with more than eighty managers and a survey of documents relating to specific decisions. A total of sixty cases of decision-making were selected from five decision topics: purchasing of inputs, pricing of outputs, recruitment of labour, organizational change and innovation, which occurred in 1985 (or before) and in 1988/89. Data from the interviews were used to investigate environmental conditions, relations between the enterprise and its higher authority, interactions between management and the party system, the role of information, and effectiveness of regulations and government policies on enterprise management. The analysis of the data indicates that the decision processes in the different enterprises have some similarities in regard to actor involvement, the flow of decision activities, interactions with the authorities, information usage and the effect of regulations. Comparison of the same or similar decision contents over time indicates that the achievement of decentralization varied according to the topic of decision. Managerial authority was delegated to enterprises when the authorities relaxed their control over resource allocation. When acquisition of necessary resources is dependent upon the planning system or the decision matter is sensitive, because it involves change to the institutional framework (e.g. the Party), then a high degree of centralization was retained, resulting in a marginal change in managerial behaviour. The economic reform failed to increase decision efficiency and effectiveness of decision-making. The prevailing institutional frameworks were regarded as negative to the change. The research argues that the decision process is likely to be more contingent on the decision content than the organization. Three types of decision process have been conceptualized, each of them related to a certain type of decision content. This argument gives attention to the perspectives of institution and power in a way which facilitates an elaboration of organizational analysis. The problems encountered in the reform of China's industrial enterprises are identified and discussed. General recommendations for policies of further reform are offered, based on the analysis of decision process and managerial behaviour.

Decision making in nuclear waste management:the use of the synoptic approach

This thesis is concerned with the use of the synoptic approach within decision making concerning nuclear waste management. The synoptic approach to decision making refers to an approach to rational decision making that assumes as an ideal, comprehensiveness of information and analysis. Two case studies are examined in which a high degree of synoptic analysis has been used within the decision making process. The case studies examined are the Windscale Inquiry into the decision to build the THORP reprocessing plant and the Nirex safety assessment of nuclear waste disposal. The case studies are used to test Lindblom's hypothesis that a synoptic approach to decision making is not achievable. In the first case study Lindblom's hypothesis is tested through the evaluation of the decision to build the THORP plant, taken following the Windscale Inquiry. It is concluded that the incongruity of this decision supports Lindblom's hypothesis. However, it has been argued that the Inquiry should be seen as a legitimisation exercise for a decision that was effectively predetermined, rather than a rigorous synoptic analysis. Therefore, the Windscale Inquiry does not provide a robust test of the synoptic method. It was concluded that a methodology was required, that allowed robust conclusions to be drawn, despite the ambiguity of the role of the synoptic method in decision making. Thus, the methodology adopted for the second case study was modified. In this case study the synoptic method was evaluated directly. This was achieved through the analysis of the cogency of the Nirex safety assessment. It was concluded that the failure of Nirex to provide a cogent synoptic analysis supported Lindblom's criticism of the synoptic method. Moreover, it was found that the synoptic method failed in the way that Lindblom predicted that it would.

The use of expert systems for decision making in organizations

The research described in this thesis investigates three issues related to the use of expert systems for decision making in organizations. These are the effectiveness of ESs when used in different roles, to replace a human decision maker or to advise a human decision maker, the users' behaviourand opinions towards using an expertadvisory system and, the possibility of organization-wide deployment of expert systems and the role of an ES in different organizational levels. The research was based on the development of expert systems within a business game environment, a simulation of a manufacturing company. This was chosen to give more control over the `experiments' than would be possible in a real organization. An expert system (EXGAME) was developed based on a structure derived from Anthony's three levels of decision making to manage the simulated company in the business game itself with little user intervention. On the basis of EXGAME, an expert advisory system (ADGAME) was built to help game players to make better decisions in managing the game company. EXGAME and ADGAME are thus two expert systems in the same domain performing different roles; it was found that ADGAME had, in places, to be different from EXGAME, not simply an extension of it. EXGAME was tested several times against human rivals and was evaluated by measuring its performance. ADGAME was also tested by different users and was assessed by measuring the users' performance and analysing their opinions towards it as a helpful decision making aid. The results showed that an expert system was able to replace a human at the operational level, but had difficulty at the strategic level. It also showed the success of the organization-wide deployment of expert systems in this simulated company.

Designing a safety management support system using open architecture databases: the requirements of information representation in the support of managers' risk-related decision-making

This research was conducted at the Space Research and Technology Centre o the European Space Agency at Noordvijk in the Netherlands. ESA is an international organisation that brings together a range of scientists, engineers and managers from 14 European member states. The motivation for the work was to enable decision-makers, in a culturally and technologically diverse organisation, to share information for the purpose of making decisions that are well informed about the risk-related aspects of the situations they seek to address. The research examined the use of decision support system DSS) technology to facilitate decision-making of this type. This involved identifying the technology available and its application to risk management. Decision-making is a complex activity that does not lend itself to exact measurement or precise understanding at a detailed level. In view of this, a prototype DSS was developed through which to understand the practical issues to be accommodated and to evaluate alternative approaches to supporting decision-making of this type. The problem of measuring the effect upon the quality of decisions has been approached through expert evaluation of the software developed. The practical orientation of this work was informed by a review of the relevant literature in decision-making, risk management, decision support and information technology. Communication and information technology unite the major the,es of this work. This allows correlation of the interests of the research with European public policy. The principles of communication were also considered in the topic of information visualisation - this emerging technology exploits flexible modes of human computer interaction (HCI) to improve the cognition of complex data. Risk management is itself an area characterised by complexity and risk visualisation is advocated for application in this field of endeavour. The thesis provides recommendations for future work in the fields of decision=making, DSS technology and risk management.

Planning and decision-making for energy recovery from waste at the sub-regional level

This research project has developed a novel decision support system using Geographical Information Systems and Multi Criteria Decision Analysis and used it to develop and evaluate energy-from-waste policy options. The system was validated by applying it to the UK administrative areas of Cornwall and Warwickshire. Different strategies have been defined by the size and number of the facilities, as well as the technology chosen. Using sensitivity on the results from the decision support system, it was found that key decision criteria included those affected by cost, energy efficiency, transport impacts and air/dioxin emissions. The conclusions of this work are that distributed small-scale energy-from-waste facilities score most highly overall and that scale is more important than technology design in determining overall policy impact. This project makes its primary contribution to energy-from-waste planning by its development of a Decision Support System that can be used to assist waste disposal authorities to identify preferred energy-from-waste options that have been tailored specifically to the socio-geographic characteristics of their jurisdictional areas. The project also highlights the potential of energy-from-waste policies that are seldom given enough attention to in the UK, namely those of a smaller-scale and distributed nature that often have technology designed specifically to cater for this market.

Does reviewing lead to better learning and decision making? Answers from a randomized stock market experiment

Background - The literature is not univocal about the effects of Peer Review (PR) within the context of constructivist learning. Due to the predominant focus on using PR as an assessment tool, rather than a constructivist learning activity, and because most studies implicitly assume that the benefits of PR are limited to the reviewee, little is known about the effects upon students who are required to review their peers. Much of the theoretical debate in the literature is focused on explaining how and why constructivist learning is beneficial. At the same time these discussions are marked by an underlying presupposition of a causal relationship between reviewing and deep learning. Objectives - The purpose of the study is to investigate whether the writing of PR feedback causes students to benefit in terms of: perceived utility about statistics, actual use of statistics, better understanding of statistical concepts and associated methods, changed attitudes towards market risks, and outcomes of decisions that were made. Methods - We conducted a randomized experiment, assigning students randomly to receive PR or non–PR treatments and used two cohorts with a different time span. The paper discusses the experimental design and all the software components that we used to support the learning process: Reproducible Computing technology which allows students to reproduce or re–use statistical results from peers, Collaborative PR, and an AI–enhanced Stock Market Engine. Results - The results establish that the writing of PR feedback messages causes students to experience benefits in terms of Behavior, Non–Rote Learning, and Attitudes, provided the sequence of PR activities are maintained for a period that is sufficiently long.