Design and implementation of a multicriteria medical decision support system for diagnosis and treatment

Health care providers face the problem of trying to make decisions with inadequate information and also with an overload of (often contradictory) information. Physicians often choose treatment long before they know which disease is present. Indeed, uncertainty is intrinsic to the practice of medicine. Decision analysis can help physicians structure and work through a medical decision problem, and can provide reassurance that decisions are rational and consistent with the beliefs and preferences of other physicians and patients. ^ The primary purpose of this research project is to develop the theory, methods, techniques and tools necessary for designing and implementing a system to support solving medical decision problems. A case study involving “abdominal pain” serves as a prototype for implementing the system. The research, however, focuses on a generic class of problems and aims at covering theoretical as well as practical aspects of the system developed. ^ The main contributions of this research are: (1) bridging the gap between the statistical approach and the knowledge-based (expert) approach to medical decision making; (2) linking a collection of methods, techniques and tools together to allow for the design of a medical decision support system, based on a framework that involves the Analytic Network Process (ANP), the generalization of the Analytic Hierarchy Process (AHP) to dependence and feedback, for problems involving diagnosis and treatment; (3) enhancing the representation and manipulation of uncertainty in the ANP framework by incorporating group consensus weights; and (4) developing a computer program to assist in the implementation of the system. ^

Clinical decision support system for point of care use: ontology driven design and software implementation

OBJECTIVES: The objective of this research was to design a clinical decision support system (CDSS) that supports heterogeneous clinical decision problems and runs on multiple computing platforms. Meeting this objective required a novel design to create an extendable and easy to maintain clinical CDSS for point of care support. The proposed solution was evaluated in a proof of concept implementation. METHODS: Based on our earlier research with the design of a mobile CDSS for emergency triage we used ontology-driven design to represent essential components of a CDSS. Models of clinical decision problems were derived from the ontology and they were processed into executable applications during runtime. This allowed scaling applications' functionality to the capabilities of computing platforms. A prototype of the system was implemented using the extended client-server architecture and Web services to distribute the functions of the system and to make it operational in limited connectivity conditions. RESULTS: The proposed design provided a common framework that facilitated development of diversified clinical applications running seamlessly on a variety of computing platforms. It was prototyped for two clinical decision problems and settings (triage of acute pain in the emergency department and postoperative management of radical prostatectomy on the hospital ward) and implemented on two computing platforms-desktop and handheld computers. CONCLUSIONS: The requirement of the CDSS heterogeneity was satisfied with ontology-driven design. Processing of application models described with the help of ontological models allowed having a complex system running on multiple computing platforms with different capabilities. Finally, separation of models and runtime components contributed to improved extensibility and maintainability of the system.

A decision support system for supplier selection and order allocation in stochastic, multi-stakeholder and multi-criteria environments

Integrated supplier selection and order allocation is an important decision for both designing and operating supply chains. This decision is often influenced by the concerned stakeholders, suppliers, plant operators and customers in different tiers. As firms continue to seek competitive advantage through supply chain design and operations they aim to create optimized supply chains. This calls for on one hand consideration of multiple conflicting criteria and on the other hand consideration of uncertainties of demand and supply. Although there are studies on supplier selection using advanced mathematical models to cover a stochastic approach, multiple criteria decision making techniques and multiple stakeholder requirements separately, according to authors' knowledge there is no work that integrates these three aspects in a common framework. This paper proposes an integrated method for dealing with such problems using a combined Analytic Hierarchy Process-Quality Function Deployment (AHP-QFD) and chance constrained optimization algorithm approach that selects appropriate suppliers and allocates orders optimally between them. The effectiveness of the proposed decision support system has been demonstrated through application and validation in the bioenergy industry.

A decision support system to facilitate management of patients with acute gastrointestinal bleeding

Objective: To develop a model to predict the bleeding source and identify the cohort amongst patients with acute gastrointestinal bleeding (GIB) who require urgent intervention, including endoscopy. Patients with acute GIB, an unpredictable event, are most commonly evaluated and managed by non-gastroenterologists. Rapid and consistently reliable risk stratification of patients with acute GIB for urgent endoscopy may potentially improve outcomes amongst such patients by targeting scarce health-care resources to those who need it the most. Design and methods: Using ICD-9 codes for acute GIB, 189 patients with acute GIB and all. available data variables required to develop and test models were identified from a hospital medical records database. Data on 122 patients was utilized for development of the model and on 67 patients utilized to perform comparative analysis of the models. Clinical data such as presenting signs and symptoms, demographic data, presence of co-morbidities, laboratory data and corresponding endoscopic diagnosis and outcomes were collected. Clinical data and endoscopic diagnosis collected for each patient was utilized to retrospectively ascertain optimal management for each patient. Clinical presentations and corresponding treatment was utilized as training examples. Eight mathematical models including artificial neural network (ANN), support vector machine (SVM), k-nearest neighbor, linear discriminant analysis (LDA), shrunken centroid (SC), random forest (RF), logistic regression, and boosting were trained and tested. The performance of these models was compared using standard statistical analysis and ROC curves. Results: Overall the random forest model best predicted the source, need for resuscitation, and disposition with accuracies of approximately 80% or higher (accuracy for endoscopy was greater than 75%). The area under ROC curve for RF was greater than 0.85, indicating excellent performance by the random forest model Conclusion: While most mathematical models are effective as a decision support system for evaluation and management of patients with acute GIB, in our testing, the RF model consistently demonstrated the best performance. Amongst patients presenting with acute GIB, mathematical models may facilitate the identification of the source of GIB, need for intervention and allow optimization of care and healthcare resource allocation; these however require further validation. (c) 2007 Elsevier B.V. All rights reserved.

A proactive intelligent decision support system for predicting the popularity of online news

"Lecture notes in computer science series, ISSN 0302-9743, vol. 9273"

Development of a decision support system for the integrated control of membrane bioreactors

The work presented in this PhD thesis includes various partial studies aimed at developing a decision support system for membrane bioreactor integrated control. The decision support systems (DSS) have as a main goal to facilitate the operation of complex processes due to the multiple variables that are processed. For this reason, the research used has focused on aspects related to nutrient removal, and on the development of indicators or sensors capable of facilitating, automating and controlling the filtration process in an integrated way with the biological processes that taking place. Work has also been done on the design, development, implementation and validation of tools based on the knowledge made available by the automatic control and the supervision of the MBRs

Developing green supply chain management taxonomy-based decision support system

The aim of this paper is to develop a comprehensive taxonomy of green supply chain management (GSCM) practices and develop a structural equation modelling-driven decision support system following GSCM taxonomy for managers to provide better understanding of the complex relationship between the external and internal factors and GSCM operational practices. Typology and/or taxonomy play a key role in the development of social science theories. The current taxonomies focus on a single or limited component of the supply chain. Furthermore, they have not been tested using different sample compositions and contexts, yet replication is a prerequisite for developing robust concepts and theories. In this paper, we empirically replicate one such taxonomy extending the original study by (a) developing broad (containing the key components of supply chain) taxonomy; (b) broadening the sample by including a wider range of sectors and organisational size; and (c) broadening the geographic scope of the previous studies. Moreover, we include both objective measures and subjective attitudinal measurements. We use a robust two-stage cluster analysis to develop our GSCM taxonomy. The main finding validates the taxonomy previously proposed and identifies size, attitude and level of environmental risk and impact as key mediators between internal drivers, external drivers and GSCM operational practices.

Design evaluation of a prototype user interface to support a guideline-based decision support system in gestational diabetes

Gestational Diabetes (GD) has increased over the last 20 years, affecting up to 15% of pregnant women worldwide. The complications associated can be reduced with the appropriate glycemic control during the pregnancy.

Evaluating a web-based clinical decision support system for language disorders screening in a nursery school

Background: Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. Objective: This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care. Methods: This paper details the evaluation results of the ?Gades? CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child?s language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results. Results: The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development. Conclusions: This research demonstrated the benefit of a Web-based CDSS to monitor children?s neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts.

Decision support system for project selection

The evaluation and selection of industrial projects before investment decision is customarily done using marketing, technical, and financial information. Subsequently, environmental impact assessment and social impact assessment are carried out mainly to satisfy the statutory agencies. Because of stricter environment regulations in developed and developing countries, quite often impact assessment suggests alternate sites, technologies, designs, and implementation methods as mitigating measures. This causes considerable delay to complete project feasibility analysis and selection as complete analysis requires to be taken up again and again until the statutory regulatory authority approves the project. Moreover, project analysis through the above process often results in suboptimal projects as financial analysis may eliminate better options as more environment friendly alternative will always be cost intensive. In this circumstance, this study proposes a decision support system which analyses projects with respect to market, technicalities, and social and environmental impact in an integrated framework using analytic hierarchy process, a multiple attribute decision-making technique. This not only reduces duration of project evaluation and selection, but also helps select an optimal project for the organization for sustainable development. The entire methodology has been applied to a cross-country oil pipeline project in India and its effectiveness has been demonstrated. © 2008, IGI Global.

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.

Decision support system for pipeline route selection

Presents information on a study which proposed a decision support system (DSS) for a petroleum pipeline route selection with the application of analytical hierarchy process. Factors governing route-selection for cross-country petroleum pipelines; Application of the DSS from an Indian perspective; Cost benefit comparison of the shortest route and the optimal route; Results and findings.