A review of multi-factor capacity expansion models for manufacturing plants:searching for a holistic decision aid

Investment in capacity expansion remains one of the most critical decisions for a manufacturing organisation with global production facilities. Multiple factors need to be considered making the decision process very complex. The purpose of this paper is to establish the state-of-the-art in multi-factor models for capacity expansion of manufacturing plants within a corporation. The research programme consisting of an extensive literature review and a structured assessment of the strengths and weaknesses of the current research is presented. The study found that there is a wealth of mathematical multi-factor models for evaluating capacity expansion decisions however no single contribution captures all the different facets of the problem.

Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation

Background Current guidelines recommend oral anticoagulation therapy for patients with atrial fibrillation who are at moderate-to-high risk of stroke, however anticoagulation control (time in therapeutic range (TTR)) is dependent on many factors. Educational and behavioural interventions may impact on patients’ ability to maintain their International Normalised Ratio (INR) control. Objectives To evaluate the effects on TTR of educational and behavioural interventions for oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF). Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) in The Cochrane Library (2012, Issue 7 of 12), MEDLINE Ovid (1950 to week 4 July 2012), EMBASE Classic + EMBASE Ovid (1947 to Week 31 2012), PsycINFO Ovid (1806 to 2012 week 5 July) on 8 August 2012 and CINAHL Plus with Full Text EBSCO (to August 2012) on 9 August 2012. We applied no language restrictions. Selection criteria The primary outcome analysed was TTR. Secondary outcomes included decision conflict (patient's uncertainty in making health-related decisions), percentage of INRs in the therapeutic range, major bleeding, stroke and thromboembolic events, patient knowledge, patient satisfaction, quality of life (QoL), and anxiety. Data collection and analysis The two review authors independently extracted data. Where insufficient data were present to conduct a meta-analysis, effect sizes and confidence intervals (CIs) of the included studies were reported. Data were pooled for two outcomes, TTR and decision conflict. Main results Eight trials with a total of 1215 AF patients (number of AF participants included in the individual trials ranging from 14 to 434) were included within the review. Studies included education, decision aids, and self-monitoring plus education. For the primary outcome of TTR, data for the AF participants in two self-monitoring plus education trials were pooled and did not favour self-monitoring plus education or usual care in improving TTR, with a mean difference of 6.31 (95% CI -5.63 to 18.25). For the secondary outcome of decision conflict, data from two decision aid trials favoured usual care over the decision aid in terms of reducing decision conflict, with a mean difference of -0.1 (95% CI -0.2 to -0.02). Authors' conclusions This review demonstrated that there is insufficient evidence to draw definitive conclusions regarding the impact of educational or behavioural interventions on TTR in AF patients receiving OAT. Thus, more trials are needed to examine the impact of interventions on anticoagulation control in AF patients and the mechanisms by which they are successful. It is also important to explore the psychological implications for patients suffering from this long-term chronic condition.

Development and trialling of a behavioural intervention for patients with atrial fibrillation initiating oral anticoagulation:the 'treat' study

Purpose: Atrial fibrillation (AF) is the most common heart arrhythmia and is associated with an increased risk of stroke. Stroke risk is commonly treated with oral anticoagulation (OAC) with a narrow therapeutic range (INR 2.0 to 3.0); which is poorly controlled in practice. Barriers to adherence include poor knowledge, and inaccurate perceptions surrounding illness and medications. Trial registration: ISRCTN93952605. Systematic review: Seven trials of educational, self-monitoring and decision aid interventions were included in a systematic review. Pooled analysis suggested education OR, 95% CI 7.89 (5.54-10.24) and self monitoring OR (95% CI) 5.47(2.55-8.39) significantly improve TTR; whereas decision aids are no more effective in reducing decision conflict than usual care, OR (95% CI) -0.10 (-0.17 to -0.02). Intervention development: The intervention was theoretically-driven (utilising the common sense and beliefs about medication models) and developed with expert patient feedback. Described using behavioural change techniques, the one-off group session included an educational booklet, ‘expert-patient’ focussed DVD, and worksheet. Methods: Ninety seven warfarin-naïve AF patients were randomised to receive the intervention (n=43), or usual care (n=54). The primary endpoint was time within therapeutic range (TTR), secondary endpoints included knowledge, quality of life (AF-QoL-18), beliefs about medication (BMQ), illness perceptions (IPQ-B), and anxiety and depression (HADS). Results: Intervention group had significantly higher TTR than usual care (78.5% vs. 66.7%; p=0.01). Knowledge changed significantly across time (F (3, 47) = 6.4; p<0.01), but not between groups (F (1, 47) = 3.3; p = 0.07). At six months knowledge predicted TTR (r=0.245; p=0.04). Illness concern negatively correlated with TTR (r= - 0.199; p=0.05). General Harm scores at one month predicted TTR (F (1, 72) = 4.08; p=0.048). There were significant differences in emotional representations (F (3, 49) = 3.3 (3, 49); p= 0.03), anxiety (F (3, 46) = 25.2; p<0.01) and depression (F (3, 46) = 37.7; p<0.01) across time. Conclusion: A theory-driven educational intervention can improve TTR in AF patients and potentially reduce the risk of adverse clinical outcomes. Improving education provision for AF patients is essential to ensure efficacious treatment.

Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation

background Current guidelines recommend oral anticoagulation therapy for patients with atrial fibrillation who are at moderate-to-high risk of stroke, however anticoagulation control (time in therapeutic range (TTR)) is dependent on many factors. Educational and behavioural interventions may impact on patients’ ability to maintain their International Normalised Ratio (INR) control. Objectives To evaluate the effects on TTR of educational and behavioural interventions for oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF). Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) in The Cochrane Library (2012, Issue 7 of 12), MEDLINE Ovid (1950 to week 4 July 2012), EMBASE Classic + EMBASE Ovid (1947 to Week 31 2012), PsycINFO Ovid (1806 to 2012 week 5 July) on 8 August 2012 and CINAHL Plus with Full Text EBSCO (to August 2012) on 9 August 2012. We applied no language restrictions. Selection criteria The primary outcome analysed was TTR. Secondary outcomes included decision conflict (patient's uncertainty in making health-related decisions), percentage of INRs in the therapeutic range, major bleeding, stroke and thromboembolic events, patient knowledge, patient satisfaction, quality of life (QoL), and anxiety. Data collection and analysis The two review authors independently extracted data. Where insufficient data were present to conduct a meta-analysis, effect sizes and confidence intervals (CIs) of the included studies were reported. Data were pooled for two outcomes, TTR and decision conflict. Main results Eight trials with a total of 1215 AF patients (number of AF participants included in the individual trials ranging from 14 to 434) were included within the review. Studies included education, decision aids, and self-monitoring plus education. For the primary outcome of TTR, data for the AF participants in two self-monitoring plus education trials were pooled and did not favour self-monitoring plus education or usual care in improving TTR, with a mean difference of 6.31 (95% CI -5.63 to 18.25). For the secondary outcome of decision conflict, data from two decision aid trials favoured usual care over the decision aid in terms of reducing decision conflict, with a mean difference of -0.1 (95% CI -0.2 to -0.02). Authors' conclusions This review demonstrated that there is insufficient evidence to draw definitive conclusions regarding the impact of educational or behavioural interventions on TTR in AF patients receiving OAT. Thus, more trials are needed to examine the impact of interventions on anticoagulation control in AF patients and the mechanisms by which they are successful. It is also important to explore the psychological implications for patients suffering from this long-term chronic condition.

A critique of a model for an academic staff activity database developed to aid a department in strategic and operational decision making

This paper discusses the use of a Model developed by Aston Business School to record the work load of its academic staff. By developing a database to register annual activity in all areas of teaching, administration and research the School has created a flexible tool which can be used for facilitating both day-to-day managerial and longer term strategic decisions. This paper gives a brief outline of the Model and discusses the factors which were taken into account when setting it up. Particular attention is paid to the uses made of the Model and the problems encountered in developing it. The paper concludes with an appraisal of the Model’s impact and of additional developments which are currently being considered. Aston Business School has had a Load Model in some form for many years. The Model has, however, been refined over the past five years, so that it has developed into a form which can be used for a far greater number of purposes within the School. The Model is coordinated by a small group of academic and administrative staff, chaired by the Head of the School. This group is responsible for the annual cycle of collecting and inputting data, validating returns, carrying out analyses of the raw data, and presenting the mater ial to different sections of the School. The authors of this paper are members of this steer ing group.

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.

A methodology for implementing a decision support system:a small company case study

The importance of non-technical factors in the design and implementation of information systems has been increasingly recognised by both researchers and practitioners, and recent literature highlights the need for new tools and techniques with an organisational, rather than technical, focus. The gap between what is technically possible and what is generally practised, is particularly wide in the sales and marketing field. This research describes the design and implementation of a decision support system (DSS) for marketing planning and control in a small, but complex company and examines the nature of the difficulties encountered. An intermediary with functional, rather than technical, expertise is used as a strategy for overcoming these by taking control of the whole of the systems design and implementation cycle. Given the practical nature of the research, an action research approach is adopted with the researcher undertaking this role. This approach provides a detailed case study of what actually happens during the DSS development cycle, allowing the influence of organisational factors to be captured. The findings of the research show how the main focus of the intermediary's role needs to be adapted over the systems development cycle; from coordination and liaison in the pre-design and design stages, to systems champion during the first part of the implementation stage, and finally to catalyst to ensure that the DSS is integrated into the decision-making process. Two practical marketing exercises are undertaken which illustrate the nature of the gap between the provision of information and its use. The lack of a formal approach to planning and control is shown to have a significant effect on the way the DSS is used and the role of the intermediary is extended successfully to accommodate this factor. This leads to the conclusion that for the DSS to play a fully effective role, small firms may need to introduce more structure into their marketing planning, and that the role of the intermediary, or Information Coordinator, should include the responsibility for introducing new techniques and ideas to aid with this.