Data driven and practice-based evidence : design and development of efficient and effective clinical decision support system

Decision-making is such an integral aspect in health care routine that the ability to make the right decisions at crucial moments can lead to patient health improvements. Evidence-based practice, the paradigm used to make those informed decisions, relies on the use of current best evidence from systematic research such as randomized controlled trials. Limitations of the outcomes from randomized controlled trials (RCT), such as “quantity” and “quality” of evidence generated, has lowered healthcare professionals’ confidence in using EBP. An alternate paradigm of Practice-Based Evidence has evolved with the key being evidence drawn from practice settings. Through the use of health information technology, electronic health records (EHR) capture relevant clinical practice “evidence”. A data-driven approach is proposed to capitalize on the benefits of EHR. The issues of data privacy, security and integrity are diminished by an information accountability concept. Data warehouse architecture completes the data-driven approach by integrating health data from multi-source systems, unique within the healthcare environment.

A decision support framework for prioritization of engineering asset management activities under uncertainty

Engineers and asset managers must often make decisions on how to best allocate limited resources amongst different interrelated activities, including repair, renewal, inspection, and procurement of new assets. The presence of project interdependencies and the lack of sufficient information on the true value of an activity often produce complex problems and leave the decision maker guessing about the quality and robustness of their decision. In this paper, a decision support framework for uncertain interrelated activities is presented. The framework employs a methodology for multi-criteria ranking in the presence of uncertainty, detailing the effect that uncertain valuations may have on the priority of a particular activity. The framework employs employing semi-quantitative risk measures that can be tailored to an organisation and enable a transparent and simple-to-use uncertainty specification by the decision maker. The framework is then demonstrated on a real world project set from a major Australian utility provider.

Predicting wood value in Queensland Caribbean pine plantations using a decision support system

A decision support system has been developed in Queensland to evaluate how changes in silvicultural regimes affect wood quality, and specifically the graded recovery of structural timber. Models of tree growth, branch architecture and wood properties were developed from data collected in routine Caribbean pine plantations and specific silvicultural experiments. These models were incorporated in software that simulates the conversion of standing trees into logs, and the logs into boards, and generates detailed data on knot location and basic density distribution. The structural grade of each board was determined by simulating the machine stress-grading process, and the predicted graded recovery provided an indicator of wood value. The decision support system improves the basis of decision-making by simulating the performance of elite genetic material under specified silvicultural regimes and by predicting links between wood quality and general stand attributes such as stocking and length of rotation.

Choosing a model of maternity care: decision support needs of Australian women

- BACKGROUND Access to information on the features and outcomes associated with the various models of maternity care available in Australia is vital for women's informed decision-making. This study sought to identify women's preferences for information access and decision-making involvement, as well as their priority information needs, for model of care decision-making. - METHODS A convenience sample of adult women of childbearing age in Queensland, Australia were recruited to complete an online survey assessing their model of care decision support needs. Knowledge on models of care and socio-demographic characteristics were also assessed. - RESULTS Altogether, 641 women provided usable survey data. Of these women, 26.7 percent had heard of all available models of care before starting the survey. Most women wanted access to information on models of care (90.4%) and an active role in decision-making (99.0%). Nine priority information needs were identified: cost, access to choice of mode of birth and care provider, after hours provider contact, continuity of carer in labor/birth, mobility during labor, discussion of the pros/cons of medical procedures, rates of skin-to-skin contact after birth, and availability at a preferred birth location. This information encompassed the priority needs of women across age, birth history, and insurance status subgroups. - CONCLUSIONS This study demonstrates Australian women's unmet needs for information that supports them to effectively compare available options for model of maternity care. Findings provide clear direction on what information should be prioritized and ideal channels for information access to support quality decision-making in practice.

A Practitioner-Oriented Decision Support Process for Forestry Pest Management

The article discusses a new decision support process for forestry pest management. Over the past few years, DSS have been introduced for forestry pest management, providing forest growers with advice in areas such as selecting the most suitable pesticide and relevant treatment. Most of the initiatives process knowledge from various domains for providing support for specific decision making problems. However, very few studies have identified the requirements of developing a combined process model in which all relevant practitioners can contribute and share knowledge for effective decision making; such an approach would need to include the decision makers’ perspective along with other relevant attributes such as the problem context and relevant policies. We outline a decision support process for forestry pest management, based on the design science research paradigm, in which a focus group technique has application to acquire both expert and practical knowledge in order to construct the DSS solution.

Owner-driven decision support in holding-specific forest planning

Socio-economic and demographic changes among family forest owners and demands for versatile forestry decision aid motivated this study, which sought grounds for owner-driven forest planning. Finnish family forest owners’ forest-related decision making was analyzed in two interview-based qualitative studies, the main findings of which were surveyed quantitatively. Thereafter, a scheme for adaptively mixing methods in individually tailored decision support processes was constructed. The first study assessed owners’ decision-making strategies by examining varying levels of the sharing of decision-making power and the desire to learn. Five decision-making modes – trusting, learning, managing, pondering, and decisive – were discerned and discussed against conformable decision-aid approaches. The second study conceptualized smooth communication and assessed emotional, practical, and institutional boosters of and barriers to such smoothness in communicative decision support. The results emphasize the roles of trust, comprehension, and contextual services in owners’ communicative decision making. In the third study, a questionnaire tool to measure owners’ attitudes towards communicative planning was constructed by using trusting, learning, and decisive dimensions. Through a multivariate analysis of survey data, three owner groups were identified as fusions of the original decision-making modes: trusting learners (53%), decisive learners (27%), and decisive managers (20%). Differently weighted communicative services are recommended for these compound wishes. The findings of the studies above were synthesized in a form of adaptive decision analysis (ADA), which allows and encourages the decision-maker (owner) to make deliberate choices concerning the phases of a decision aid (planning) process. The ADA model relies on adaptability and feedback management, which foster smooth communication with the owner and (inter-)organizational learning of the planning institution(s). The summarized results indicate that recognizing the communication-related amenity values of family forest owners may be crucial in developing planning and extension services. It is therefore recommended that owners, root-level planners, consultation professionals, and pragmatic researchers collaboratively continue to seek stable change.

Exploring the Potential Impacts of Climate Variability on Spring Wheat Yield with the APSIM Decision Support Tool

Assessing the impacts of climate variability on agricultural productivity at regional, national or global scale is essential for defining adaptation and mitigation strategies. We explore in this study the potential changes in spring wheat yields at Swift Current and Melfort, Canada, for different sowing windows under projected climate scenarios (i.e., the representative concentration pathways, RCP4.5 and RCP8.5). First, the APSIM model was calibrated and evaluated at the study sites using data from long term experimental field plots. Then, the impacts of change in sowing dates on final yield were assessed over the 2030-2099 period with a 1990-2009 baseline period of observed yield data, assuming that other crop management practices remained unchanged. Results showed that the performance of APSIM was quite satisfactory with an index of agreement of 0.80, R2 of 0.54, and mean absolute error (MAE) and root mean square error (RMSE) of 529 kg/ha and 1023 kg/ha, respectively (MAE = 476 kg/ha and RMSE = 684 kg/ha in calibration phase). Under the projected climate conditions, a general trend in yield loss was observed regardless of the sowing window, with a range from -24 to -94 depending on the site and the RCP, and noticeable losses during the 2060s and beyond (increasing CO2 effects being excluded). Smallest yield losses obtained through earlier possible sowing date (i.e., mid-April) under the projected future climate suggested that this option might be explored for mitigating possible adverse impacts of climate variability. Our findings could therefore serve as a basis for using APSIM as a decision support tool for adaptation/mitigation options under potential climate variability within Western Canada.

A randomized controlled trial protocol testing a decision support intervention for older patients with advanced kidney disease

Aim To assess the effectiveness of a decision support intervention using a pragmatic single blind Randomized Controlled Trial. Background Worldwide the proportion of older people (aged 65 years and over) is rising. This population is known to have a higher prevalence of chronic diseases including chronic kidney disease. The resultant effect of the changing health landscape is seen in the increase in older patients (aged ≥65 years) commencing on dialysis. Emerging evidence suggests that for some older patients dialysis may provide minimal benefit. In a majority of renal units non-dialysis management is offered as an alternative to undertaking dialysis. Research regarding decision-making support that is required to assist this population in choosing between dialysis or non-dialysis management is limited. Design. A multisite single blinded pragmatic randomized controlled trial is proposed. Methods Patients will be recruited from four Queensland public hospitals and randomizd into either the control or intervention group. The decision support intervention is multimodal and includes counselling provided by a trained nurse. The comparator is standard decision-making support. The primary outcomes are decisional regret and decisional conflict. Secondary outcomes are improved knowledge and quality of life. Ethics approval obtained November 2014. Conclusion This is one of the first randomized controlled trials assessing a decision support intervention in older people with advance chronic kidney disease. The results may provide guidance for clinicians in future approaches to assist this population in decision-making to ensure reduced decisional regret and decisional conflict.

Development and evaluation of a spatial decision support system for malaria elimination in Bhutan

Background: Bhutan has reduced its malaria incidence significantly in the last 5 years, and is aiming for malaria elimination by 2016. To assist with the management of the Bhutanese malaria elimination programme a spatial decision support system (SDSS) was developed. The current study aims to describe SDSS development and evaluate SDSS utility and acceptability through informant interviews. Methods: The SDSS was developed based on the open-source Quantum geographical information system (QGIS) and piloted to support the distribution of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) in the two sub-districts of Samdrup Jongkhar District. It was subsequently used to support reactive case detection (RACD) in the two sub-districts of Samdrup Jongkhar and two additional sub-districts in Sarpang District. Interviews were conducted to ascertain perceptions on utility and acceptability of 11 informants using the SDSS, including programme and district managers, and field workers. Results: A total of 1502 households with a population of 7165 were enumerated in the four sub-districts, and a total of 3491 LLINs were distributed with one LLIN per 1.7 persons. A total of 279 households representing 728 residents were involved with RACD. Informants considered that the SDSS was an improvement on previous methods for organizing LLIN distribution, IRS and RACD, and could be easily integrated into routine malaria and other vector-borne disease surveillance systems. Informants identified some challenges at the programme and field level, including the need for more skilled personnel to manage the SDSS, and more training to improve the effectiveness of SDSS implementation and use of hardware. Conclusions: The SDSS was well accepted and informants expected its use to be extended to other malaria reporting districts and other vector-borne diseases. Challenges associated with efficient SDSS use included adequate skills and knowledge, access to training and support, and availability of hardware including computers and global positioning system receivers.

Decision support requirements for intelligent operation of southern grid in India

Control centers (CC) play a very important role in power system operation. An overall view of the system with information about all existing resources and needs is implemented through SCADA (Supervisory control and data acquisition system) and an EMS (energy management system). As advanced technologies have made their way into the utility environment, the operators are flooded with huge amount of data. The last decade has seen extensive applications of AI techniques, knowledge-based systems, Artificial Neural Networks in this area. This paper focuses on the need for development of an intelligent decision support system to assist the operator in making proper decisions. The requirements for realization of such a system are recognized for the effective operation and energy management of the southern grid in India The application of Petri nets leading to decision support system has been illustrated considering 24 bus system that is a part of southern grid.

Towards building an intelligent decision support system for project management

Management of large projects, especially the ones in which a major component of R&D is involved and those requiring knowledge from diverse specialised and sophisticated fields, may be classified as semi-structured problems. In these problems, there is some knowledge about the nature of the work involved, but there are also uncertainties associated with emerging technologies. In order to draw up a plan and schedule of activities of such a large and complex project, the project manager is faced with a host of complex decisions that he has to take, such as, when to start an activity, for how long the activity is likely to continue, etc. An Intelligent Decision Support System (IDSS) which aids the manager in decision making and drawing up a feasible schedule of activities while taking into consideration the constraints of resources and time, will have a considerable impact on the efficient management of the project. This report discusses the design of an IDSS that helps in project planning phase through the scheduling phase. The IDSS uses a new project scheduling tool, the Project Influence Graph (PIG).

Geographic Resources Decision Support System – an Open Source GIS

Fully structured and matured open source spatial and temporal analysis technology seems to be the official carrier of the future for planning of the natural resources especially in the developing nations. This technology has gained enormous momentum because of technical superiority, affordability and ability to join expertise from all sections of the society. Sustainable development of a region depends on the integrated planning approaches adopted in decision making which requires timely and accurate spatial data. With the increased developmental programmes, the need for appropriate decision support system has increased in order to analyse and visualise the decisions associated with spatial and temporal aspects of natural resources. In this regard Geographic Information System (GIS) along with remote sensing data support the applications that involve spatial and temporal analysis on digital thematic maps and the remotely sensed images. Open source GIS would help in wide scale applications involving decisions at various hierarchical levels (for example from village panchayat to planning commission) on economic viability, social acceptance apart from technical feasibility. GRASS (Geographic Resources Analysis Support System, http://wgbis.ces.iisc.ernet.in/grass) is an open source GIS that works on Linux platform (freeware), but most of the applications are in command line argument, necessitating a user friendly and cost effective graphical user interface (GUI). Keeping these aspects in mind, Geographic Resources Decision Support System (GRDSS) has been developed with functionality such as raster, topological vector, image processing, statistical analysis, geographical analysis, graphics production, etc. This operates through a GUI developed in Tcltk (Tool command language / Tool kit) under Linux as well as with a shell in X-Windows. GRDSS include options such as Import /Export of different data formats, Display, Digital Image processing, Map editing, Raster Analysis, Vector Analysis, Point Analysis, Spatial Query, which are required for regional planning such as watershed Analysis, Landscape Analysis etc. This is customised to Indian context with an option to extract individual band from the IRS (Indian Remote Sensing Satellites) data, which is in BIL (Band Interleaved by Lines) format. The integration of PostgreSQL (a freeware) in GRDSS aids as an efficient database management system.

WEPA: Wind energy potential assessment-spatial decision support system

Spatial Decision Support System (SDSS) assist in strategic decision-making activities considering spatial and temporal variables, which help in Regional planning. WEPA is a SDSS designed for assessment of wind potential spatially. A wind energy system transforms the kinetic energy of the wind into mechanical or electrical energy that can be harnessed for practical use. Wind energy can diversify the economies of rural communities, adding to the tax base and providing new types of income. Wind turbines can add a new source of property value in rural areas that have a hard time attracting new industry. Wind speed is extremely important parameter for assessing the amount of energy a wind turbine can convert to electricity: The energy content of the wind varies with the cube (the third power) of the average wind speed. Estimation of the wind power potential for a site is the most important requirement for selecting a site for the installation of a wind electric generator and evaluating projects in economic terms. It is based on data of the wind frequency distribution at the site, which are collected from a meteorological mast consisting of wind anemometer and a wind vane and spatial parameters (like area available for setting up wind farm, landscape, etc.). The wind resource is governed by the climatology of the region concerned and has large variability with reference to space (spatial expanse) and time (season) at any fixed location. Hence the need to conduct wind resource surveys and spatial analysis constitute vital components in programs for exploiting wind energy. SDSS for assessing wind potential of a region / location is designed with user friendly GUI’s (Graphic User Interface) using VB as front end with MS Access database (backend). Validation and pilot testing of WEPA SDSS has been done with the data collected for 45 locations in Karnataka based on primary data at selected locations and data collected from the meteorological observatories of the India Meteorological Department (IMD). Wind energy and its characteristics have been analysed for these locations to generate user-friendly reports and spatial maps. Energy Pattern Factor (EPF) and Power Densities are computed for sites with hourly wind data. With the knowledge of EPF and mean wind speed, mean power density is computed for the locations with only monthly data. Wind energy conversion systems would be most effective in these locations during May to August. The analyses show that coastal and dry arid zones in Karnataka have good wind potential, which if exploited would help local industries, coconut and areca plantations, and agriculture. Pre-monsoon availability of wind energy would help in irrigating these orchards, making wind energy a desirable alternative.