New Strategies in Clinical Guideline Delivery: Randomized Trial of Online, Interactive Decision Support Versus Guidelines for Human Immunodeficiency Virus Treatment Selection by Trainees

Background Support for clinicians in human immunodeficiency virus (HIV) medicine is critical given national HIV-provider shortages. The US Department of Health and Human Services (DHHS) guidelines are comprehensive but complex to apply for antiretroviral therapy (ART) selection. Human immunodeficiency virus antiretroviral selection support and interactive search tool (HIV-ASSIST) (www.hivassist.com) is a free tool providing ART decision support that could augment implementation of clinical practice guidelines. Methods We conducted a randomized study of medical trainees at Johns Hopkins University, in which participants were asked to select an ART regimen for 10 HIV case scenarios through an electronic survey. Participants were randomized to receive either DHHS guidelines alone, or DHHS guidelines and HIV-ASSIST to support their decision making. ART selections were graded “appropriate” if consistent with DHHS guidelines, or concordant with regimens selected by HIV experts at 4 academic institutions. Results Among 118 trainees, participants randomized to receive HIV-ASSIST had a significantly higher percentage of appropriate ART selections compared to those receiving DHHS guidelines alone (percentage of appropriate responses in DHHS vs HIV-ASSIST arms: median [Q1, Q3], 40% [30%, 50%] vs 90% [80%, 100%]; P < .001). The effect was seen for all case types, but most pronounced for complex cases involving ART-experienced patients with ongoing viremia (DHHS vs HIV-ASSIST: median [Q1, Q3], 0% [0%, 33%] vs 100% [66%, 100%]). Conclusions Trainees using HIV-ASSIST were significantly more likely to choose appropriate ART regimens compared to those using guidelines alone. Interactive decision support tools may be important to ensure appropriate implementation of HIV guidelines. Clinical Trials Registration NCT04080765.

Geospatial Decision Support Systems

The chapter is on the geospatial decision support systems. Challenges arise when simple GIS is used to support complex problems encountered at higher level, strategic decision-making, and long-term development planning. In this case, SDI can be more valuable. The chapter presents the perspective of information systems for decision support taking into account the following: the levels of decisions and the process of decision making. Trends on the tools and framework for interactive decision support systems are discussed focusing on geospatial decision support systems based on GIS and SDI.

Interactive decision support system for planned student scheduling using same-time scheduling in timetable

Student scheduling takes place after the timetable is prepared. This is a very simple activity. This study is aimed at creating an interactive decision support system for planning related to student scheduling. This planning creates constraints at the pre-timetabling stage so that the complex part of student scheduling is easy at the post-timetabling stage. This study aims to address simultaneous study of backlog courses alongwith regular courses. Two methodologies are suggested to create these constraints which can be used to create different sets of courses scheduled at the same time. These methodologies employ assignment problem iteratively to arrive at courses to be scheduled at the same time. This research work has been tested with the real datasets of four semesters.