Assessing the accuracy of a computerized decision support system for digoxin dosing in primary care: an observational study

Background: This study was carried out as part of a European Union funded project (PharmDIS-e+), to develop and evaluate software aimed at assisting physicians with drug dosing. A drug that causes particular problems with drug dosing in primary care is digoxin because of its narrow therapeutic range and low therapeutic index. Objectives: To determine (i) accuracy of the PharmDIS-e+ software for predicting serum digoxin levels in patients who are taking this drug regularly; (ii) whether there are statistically significant differences between predicted digoxin levels and those measured by a laboratory and (iii) whether there are differences between doses prescribed by general practitioners and those suggested by the program. Methods: We needed 45 patients to have 95% Power to reject the null hypothesis that the mean serum digoxin concentration was within 10% of the mean predicted digoxin concentration. Patients were recruited from two general practices and had been taking digoxin for at least 4 months. Exclusion criteria were dementia, low adherence to digoxin and use of other medications known to interact to a clinically important extent with digoxin. Results: Forty-five patients were recruited. There was a correlation of 0·65 between measured and predicted digoxin concentrations (P < 0·001). The mean difference was 0·12 μg/L (SD 0·26; 95% CI 0·04, 0·19, P = 0·005). Forty-seven per cent of the patients were prescribed the same dose as recommended by the software, 44% were prescribed a higher dose and 9% a lower dose than recommended. Conclusion: PharmDIS-e+ software was able to predict serum digoxin levels with acceptable accuracy in most patients.

European Union: Shadow WTO agricultural domestic support notifications

The notification of the level of domestic support to the World Trade Organization (WTO) is intended to reflect compliance with obligations entered into at the time of the Uruguay Round. WTO members have often been slow to provide notification of domestic support levels. This makes the process of notification less useful as an indicator of the degree to which changes in policy have or have not benefited the trade system as a whole and exporting countries in particular. The notification of domestic support in the E.U. illustrates the value of a measure that reflects current policies and can therefore act as a basis for negotiation of further disciplines where these are necessary. The E.U. has made major changes in its Common Agricultural Policy (CAP) over the period since 1992 when the MacSharry reforms were implemented. Payments originally notified in the blue box (related to supply control) have over time been changed until in their present form they are unrelated to current production or price levels, and hence can satisfy the criteria for the green box. The E.U. has therefore much more latitude in trade talks to agree to reductions in the allowable trade-distorting support. This paper reproduced the E.U. notifications relating to 2003/04 and extends these with official statistics to the year 2006/07. It then projects forward the components of domestic support until the year 2013/14, based on forecasts of future production and estimates of policy parameters. The impact of a successful Doha Round is simulated, showing that the constraints envisaged in the WTO draft modalities document of May 19, 2008, would be binding by the year 2013, at about the time the next budget cycle in the E.U. starts. Without the Doha Round constraints, further reform might still happen for domestic reasons, but the framework provided by the WTO for domestic policy spending would be less relevant. In that case, much could hinge on the legitimacy of the Single Farm Payment system under the current rules governing the green box.

Entropic risk analysis by a high level decision support system (e-FDSS) for construction SMEs

The method of entropy has been useful in evaluating inconsistency on human judgments. This paper illustrates an entropy-based decision support system called e-FDSS to the solution of multicriterion risk and decision analysis in projects of construction small and medium enterprises (SMEs). It is optimized and solved by fuzzy logic, entropy, and genetic algorithms. A case study demonstrated the use of entropy in e-FDSS on analyzing multiple risk criteria in the predevelopment stage of SME projects. Survey data studying the degree of impact of selected project risk criteria on different projects were input into the system in order to evaluate the preidentified project risks in an impartial environment. Without taking into account the amount of uncertainty embedded in the evaluation process; the results showed that all decision vectors are indeed full of bias and the deviations of decisions are finally quantified providing a more objective decision and risk assessment profile to the stakeholders of projects in order to search and screen the most profitable projects.

An agent based approach to distributed task modeling for co-operative task support

This paper describes the design and implementation of an agent based network for the support of collaborative switching tasks within the control room environment of the National Grid Company plc. This work includes aspects from several research disciplines, including operational analysis, human computer interaction, finite state modelling techniques, intelligent agents and computer supported co-operative work. Aspects of these procedures have been used in the analysis of collaborative tasks to produce distributed local models for all involved users. These models have been used as the basis for the production of local finite state automata. These automata have then been embedded within an agent network together with behavioural information extracted from the task and user analysis phase. The resulting support system is capable of task and communication management within the transmission despatch environment.

Design of an active arm support for assisting arm movements

In this paper we have explored areas of application for health care manipulators and possible user groups. We have shown the steps in the design approach to the conceptual mechanism from the AAS. The future work will be measurement from properties of the muscle with the elbow parameterization test-bed to get a database to design one part of the control area from the AAS. More work on the mechanical design is required before a functional prototype can be built.