Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review

Objective: To summarise the findings of an updated Cochrane review of interventions aimed at improving the appropriate use of polypharmacy in older people. Design: Cochrane systematic review. Multiple electronic databases were searched including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (from inception to November 2013). Hand searching of references was also performed. Randomised controlled trials (RCTs), controlled clinical trials, controlled before-and-after studies and interrupted time series analyses reporting on interventions targeting appropriate polypharmacy in older people in any healthcare setting were included if they used a validated measure of prescribing appropriateness. Evidence quality was assessed using the Cochrane risk of bias tool and GRADE (Grades of Recommendation, Assessment, Development and Evaluation).
Setting: All healthcare settings. 
Participants: Older people (≥65 years) with ≥1 long-term condition who were receiving polypharmacy (≥4 regular medicines).
Primary and secondary outcome measures: Primary outcomes were the change in prevalence of appropriate polypharmacy and hospital admissions. Medication-related problems (eg, adverse drug reactions), medication adherence and quality of life were included as secondary outcomes.
Results: 12 studies were included: 8 RCTs, 2 cluster RCTs and 2 controlled before-and-after studies. 1 study involved computerised decision support and 11 comprised pharmaceutical care approaches across various settings. Appropriateness was measured using validated tools, including the Medication Appropriateness Index, Beers’ criteria and Screening Tool of Older Person’s Prescriptions (STOPP)/ Screening Tool to Alert doctors to Right Treatment (START). The interventions demonstrated a reduction in inappropriate prescribing. Evidence of effect on hospital admissions and medication-related problems was conflicting. No differences in health-related quality of life were reported.
Conclusions: The included interventions demonstrated improvements in appropriate polypharmacy based on reductions in inappropriate prescribing. However, it remains unclear if interventions resulted in clinically significant improvements (eg, in terms of hospital admissions). Future intervention studies would benefit from available guidance on intervention development, evaluation and reporting to facilitate replication in clinical practice.

Interactive management control via analytic hierarchy process (AHP). An empirical study in a public university hospital

Management control in public university hospitals is a challenging task because of continuous changes due to external pressures (e.g. economic pressures, stakeholder focuses and scientific progress) and internal complexities (top management turnover, shared leadership, technological evolution, and researcher oriented mission). Interactive budgeting contributed to improving vertical and horizontal communication between hospital and stakeholders and between different organizational levels. This paper describes an application of Analytic Hierarchy Process (AHP) to enhance interactive budgeting in one of the biggest public university hospital in Italy. AHP improved budget allocation facilitating elicitation and formalization of units' needs. Furthermore, AHP facilitated vertical communication among manager and stakeholders, as it allowed multilevel hierarchical representation of hospital needs, and horizontal communication among staff of the same hospital, as it allowed units' need prioritization and standardization, with a scientific multi-criteria approach, without using complex mathematics. Finally, AHP allowed traceability of a complex decision making processes (as budget allocation), this aspect being of paramount importance in public sectors, where managers are called to respond to many different stakeholders about their choices.

A multi-attribute ranking solutions confirmation procedure

Ranking problems arise from the knowledge of several binary relations defined on a set of alternatives, which we intend to rank. In a previous work, the authors introduced a tool to confirm the solutions of multi-attribute ranking problems as linear extensions of a weighted sum of preference relations. An extension of this technique allows the recognition of critical preference pairs of alternatives, which are often caused by inconsistencies. Herein, a confirmation procedure is introduced and applied to confirm the results obtained by a multi-attribute decision methodology on a tender for the supply of buses to the Porto Public Transport Operator. © 2005 Springer Science + Business Media, Inc.

Public transport travel planning application

Here it is presented an application that plans out travel on public transports and that chooses the best ones, according to preference criteria provided by the user. These criteria are: the time spent on the travel, the price of the tickets and the quality of the transports. The application combines different means of transport. Algorithms and heuristics were developed to draw up transport plans and to choose the best ones. The best plans are determined using the multi-attributes decision techniques. The application uses a database that was developed in a Relational Database Management System. To draw the database at the conceptual and the applicational level, it was used one of the models based on the object, the Entity-Relationship Mode

Adding value to performance measurement by using system dynamics and multicriteria analysis

Tese de dout., Filosofia, Department of Management Science, University of Strathclyde, 2004

Desenvolvimento de ferramentas de apoio multicritério à decisão em problemas de localização

Tese de doutoramento, Estatística e Investigação Operacional (Análise de Sistemas), Universidade de Lisboa, Faculdade de Ciências, 2014

Changing climate, changing decisions : understanding climate adaptation decision-making and the way science supports it

Tese de doutoramento, Ciências do Ambiente, Universidade de Lisboa, Faculdade de Ciências, Universidade Nova de Lisboa, 2015

Balancing market integration in MASCEM electricity market simulator

With the restructuring of the energy sector in industrialized countries there is an increased complexity in market players’ interactions along with emerging problems and new issues to be addressed. Decision support tools that facilitate the study and understanding of these markets are extremely useful to provide players with competitive advantage. In this context arises MASCEM, a multi-agent simulator for competitive electricity markets. It is essential to reinforce MASCEM with the ability to recreate electricity markets reality in the fullest possible extent, making it able to simulate as many types of markets models and players as possible. This paper presents the development of the Balancing Market in MASCEM. A key module to the study of competitive electricity markets, as it has well defined and distinct characteristics previously implemented.

Dynamic artificial neural network for electricity market prices forecast

This paper presents an artificial neural network applied to the forecasting of electricity market prices, with the special feature of being dynamic. The dynamism is verified at two different levels. The first level is characterized as a re-training of the network in every iteration, so that the artificial neural network can able to consider the most recent data at all times, and constantly adapt itself to the most recent happenings. The second level considers the adaptation of the neural network’s execution time depending on the circumstances of its use. The execution time adaptation is performed through the automatic adjustment of the amount of data considered for training the network. This is an advantageous and indispensable feature for this neural network’s integration in ALBidS (Adaptive Learning strategic Bidding System), a multi-agent system that has the purpose of providing decision support to the market negotiating players of MASCEM (Multi-Agent Simulator of Competitive Electricity Markets).

Virtual power producers market strategies

This paper presents MASCEM - a multi-agent based electricity market simulator. MASCEM uses game theory, machine learning techniques, scenario analysis and optimisation techniques to model market agents and to provide them with decision-support. This paper mainly focus on the MASCEM ability to provide the means to model and simulate Virtual Power Producers (VPP). VPPs are represented as a coalition of agents, with specific characteristics and goals. The paper detail some of the most important aspects considered in VPP formation and in the aggregation of new producers and includes a case study.

Complex market integration in MASCEM electricity market simulator

The restructuring that the energy sector has suffered in industrialized countries originated a greater complexity in market players’ interactions, and thus new problems and issues to be addressed. Decision support tools that facilitate the study and understanding of these markets become extremely useful to provide players with competitive advantage. In this context arises MASCEM, a multi-agent system for simulating competitive electricity markets. To provide MASCEM with the capacity to recreate the electricity markets reality in the fullest possible extent, it is essential to make it able to simulate as many market models and player types as possible. This paper presents the development of the Complex Market in MASCEM. This module is fundamental to study competitive electricity markets, as it exhibits different characteristics from the already implemented market types.

ANN based support for distributed energy resources scheduling in smart grids

The future scenarios for operation of smart grids are likely to include a large diversity of players, of different types and sizes. With control and decision making being decentralized over the network, intelligence should also be decentralized so that every player is able to play in the market environment. In the new context, aggregator players, enabling medium, small, and even micro size players to act in a competitive environment, will be very relevant. Virtual Power Players (VPP) and single players must optimize their energy resource management in order to accomplish their goals. This is relatively easy to larger players, with financial means to have access to adequate decision support tools, to support decision making concerning their optimal resource schedule. However, the smaller players have difficulties in accessing this kind of tools. So, it is required that these smaller players can be offered alternative methods to support their decisions. This paper presents a methodology, based on Artificial Neural Networks (ANN), intended to support smaller players’ resource scheduling. The used methodology uses a training set that is built using the energy resource scheduling solutions obtained with a reference optimization methodology, a mixed-integer non-linear programming (MINLP) in this case. The trained network is able to achieve good schedule results requiring modest computational means.

ANN based day-ahead spinning reserve forecast for electricity market simulation

Electricity market players operating in a liberalized environment require adequate decision support tools, allowing them to consider all the business opportunities and take strategic decisions. Ancillary services represent a good negotiation opportunity that must be considered by market players. This paper deals with short-term predication of day-ahead spinning reserve (SR) requirement that helps the ISO to make effective and timely decisions. Based on these forecasted information, market participants can use strategic bidding for day-ahead SR market. The proposed concepts and methodologies are implemented in MASCEM, a multi-agent based electricity market simulator. A case study based on California ISO (CAISO) data is included; the forecasted results are presented and compared with CAISO published forecast.

Ancillary service market simulation

Power systems operation in a liberalized environment requires that market players have access to adequate decision support tool, allowing them to consider all the business opportunities and take strategic decisions. Ancillary services represent a good negotiation opportunity that must be considered by market players. For this, decision support tools must include ancillary market simulation. This paper deals with ancillary services negotiation in electricity markets. The proposed concepts and methodologies are implemented in MASCEM, a multi-agent based electricity market simulator. A test case concerning the dispatch of ancillary services using two different methods (Linear Programming and Genetic Algorithm approaches) is included in the paper.

ANN based day-ahead ancillary services forecast for electricity market simulation

Adequate decision support tools are required by electricity market players operating in a liberalized environment, allowing them to consider all the business opportunities and take strategic decisions. Ancillary services (AS) represent a good negotiation opportunity that must be considered by market players. Based on the ancillary services forecasting, market participants can use strategic bidding for day-ahead ancillary services markets. For this reason, ancillary services market simulation is being included in MASCEM, a multi-agent based electricity market simulator that can be used by market players to test and enhance their bidding strategies. The paper presents the methodology used to undertake ancillary services forecasting, based on an Artificial Neural Network (ANN) approach. ANNs are used to day-ahead prediction of non-spinning reserve (NS), regulation-up (RU), and regulation down (RD). Spinning reserve (SR) is mentioned as past work for comparative analysis. A case study based on California ISO (CAISO) data is included; the forecasted results are presented and compared with CAISO published forecast.