2,946 research outputs found

    A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX‑EMD Study

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    Background The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) offers the potential to overcome the challenges associated with traditional decision-making tools. Objectives A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defined all of the criteria that could influence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was fitted by applying the backward elimination algorithm (relevant criteria: p value = 15 letters (p value < 0.001), effect duration per administration (p value = 0.008), retinal detachment (p value < 0.001), endophthalmitis (p value = 0.012), myocardial infarction (p value < 0.001), intravitreal hemorrhage (p value = 0.021), annual treatment cost per patient (p value = 0.001), health-related quality of life (HRQoL) (p value = 0.004), and disability level (p value = 0.021). Conclusions From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment effect duration. It should also contribute to system sustainability by being affordable, it should have a positive impact on HRQoL, and it should prevent disability

    Analysis of the potentials of multi criteria decision analysis methods to conduct sustainability assessment

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    Sustainability assessments require the management of a wide variety of information types, parameters and uncertainties. Multi criteria decision analysis (MCDA) has been regarded as a suitable set of methods to perform sustainability evaluations as a result of its flexibility and the possibility of facilitating the dialogue between stakeholders, analysts and scientists. However, it has been reported that researchers do not usually properly define the reasons for choosing a certain MCDA method instead of another. Familiarity and affinity with a certain approach seem to be the drivers for the choice of a certain procedure. This review paper presents the performance of five MCDA methods (i.e. MAUT, AHP, PROMETHEE, ELECTRE and DRSA) in respect to ten crucial criteria that sustainability assessments tools should satisfy, among which are a life cycle perspective, thresholds and uncertainty management, software support and ease of use. The review shows that MAUT and AHP are fairly simple to understand and have good software support, but they are cognitively demanding for the decision makers, and can only embrace a weak sustainability perspective as trade-offs are the norm. Mixed information and uncertainty can be managed by all the methods, while robust results can only be obtained with MAUT. ELECTRE, PROMETHEE and DRSA are non-compensatory approaches which consent to use a strong sustainability concept, accept a variety of thresholds, but suffer from rank reversal. DRSA is less demanding in terms of preference elicitation, is very easy to understand and provides a straightforward set of decision rules expressed in the form of elementary “if 
 then 
” conditions. Dedicated software is available for all the approaches with a medium to wide range of results capability representation. DRSA emerges as the easiest method, followed by AHP, PROMETHEE and MAUT, while ELECTRE is regarded as fairly difficult. Overall, the analysis has shown that most of the requirements are satisfied by the MCDA methods (although to different extents) with the exclusion of management of mixed data types and adoption of life cycle perspective which are covered by all the considered approaches

    An integrated MCDA software application for forest planning : a case study in southwestern Sweden

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    Forest planning in Sweden today translates not only into planning of timber production, but also for the provision of other functions and services. Multi-criteria decision analysis (MCDA) methods provide a way to take also non-monetary values into account in planning. The purpose of this study was to gain experience on how to use a forest decision support system combined with an MCDA tool in practical forestry. We used a new forest planning tool, PlanWise, which includes an integrated MCDA module, PlanEval. Using the software, the decision maker can compare different forest plans and evaluate them against his/her objectives in a structured and analytical manner. The analysis thus provides a ranking of the alternatives based on the individual preferences of the decision maker. PlanEval and the MCDA planning process are described in a case study, where the manager of a forest estate in southwestern Sweden used the program to compare different forest plans made for the estate. In the paper, we analyze possibilities and challenges of this approach and identify problems such as the adherence to formal requirements of MCDA techniques and the difficulty of comparing maps. Possibilities to expedite an MCDA planning process further are also discussed. The findings confirm that integration of an MCDA tool with a forest decision support system is valuable, but requires expert assistance to be successful

    Integrating multicriteria decision analysis and scenario planning : review and extension

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    Scenario planning and multiple criteria decision analysis (MCDA) are two key management science tools used in strategic planning. In this paper, we explore the integration of these two approaches in a coherent manner, recognizing that each adds value to the implementation of the other. Various approaches that have been adopted for such integration are reviewed, with a primary focus on the process of constructing preferences both within and between scenarios. Biases that may be introduced by inappropriate assumptions during such processes are identified, and used to motivate a framework for integrating MCDA and scenario thinking, based on applying MCDA concepts across a range of "metacriteria" (combinations of scenarios and primary criteria). Within this framework, preferences according to each primary criterion can be expressed in the context of different scenarios. The paper concludes with a hypothetical but non-trivial example of agricultural policy planning in a developing country

    A participatory approach for assessing alternative climate change adaptation responses to cope with flooding risk in the upper Brahmaputra and Danube river basins

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    This work illustrates the preliminary findings of a participatory research process aimed at identifying responses for sustainable water management in a climate change perspective, in two river basins in Europe and Asia. The paper describes the methodology implemented through local workshops, aimed at eliciting and evaluating possible responses to flooding risk. Participatory workshops allowed for the identification of four categories of possible responses and a set of nine evaluation criteria, three for each of the three pillars of sustainable development. The main result of such activities consists in the ranking of broad response categories, to contribute to the orientation of the Brahmatwinn research project towards the identification of Integrated Water Resource Management Strategies (IWRMS) well grounded upon the issues and preferences elicited from local experts. The mDSS tool was used to facilitate transparent and robust management of the information collected through Multi-Criteria Decision Analysis (MCDA) and the communication of the outputs.Participatory process, Climate Change, Flooding Risk, Decision Support System, MCDA

    Outsourcing: guidelines for a structured approach

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    Outsourcing is a management approach by which an organization delegates some noncore functions to specialized and efÂźcient service providers. In the era of ÂȘglobal marketÂș and ÂȘe-economyÂș, outsourcing is one of the main pillars of the new way to conceive the relationships among companies. Despite outsourcing large diffusion, huge business cases and big deals of documentation available on network or press, there is no structured procedure able to support the govern of the evolution of a generic outsourcing process. In accordance with the principles of total quality management, this paper describes a proposal of a new approach for managing outsourcing processes. The model, which can be easily adapted to different application Âźelds, has been conceived with the main aim of managing strategic decisions, economic factors and human resources. The approach is supported by different decision and analysis tools, such as benchmarking techniques, multiple criteria decision aiding (MCDA) methods, cost analysis, and other process-planning methodologies. An application of the method to a real case is also provide

    A Participatory Approach to Assess the Effectiveness of Responses to Cope With Flood Risk

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    This work illustrates the preliminary findings of a participatory research process aimed at identifying responses for sustainable water management in a climate change perspective, in two river basins in Europe and Asia. The paper describes the methodology implemented through local workshops, aimed at eliciting and evaluating possible responses to flood risk. Participatory workshops allowed for the identification of four categories of possible responses and a set of nine evaluation criteria, three for each of the three pillars of sustainable development. The main outcome of such activities consists in the ranking of broad response categories instrumental to the objective of the Brahmatwinn research project, i.e. the identification of Integrated Water Resource Management Strategies (IWRMS) based upon the issues and preferences elicited from local experts. The mDSS tool was used to facilitate transparent and robust management of the information collected through Multi-Criteria Decision Analysis (MCDA) and communication of the outputs.Participatory Process, Climate Change, Flood Risk, Decision Support System, Multi Criteria Analysis, MCA, Eliciting Responses, Evaluating Responses, Integrated Water Resources Management, IWRM, Mulino Decision Support System, mDSS
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