Integrated Decision Support Tool Research Articles

A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level.

Robust point-of-care methods are required to estimate anemia at the population level. The accurate methods are lab-based and cannot be used at the point of care. To address this caveat, a novel method based on pooled capillary blood and a portable autoanalyzer was developed for the estimation of Hb. Additionally, custom software was developed for near-real-time integration of the Hb values from the auto analyzer to the server. Moreover, a decision support tool that can immediately categorize the participants into different stages of anemia was developed. The decision support tool was designed based on the World Health Organization (WHO) cut-off for anemia at the population level and was available for all age and gender groups. This simple and user-friendly tool couldeasily be used by front-line health workers who have limited technical skills. Overall, the method developed couldbe used at the point of care and is accurate. This high-throughput method couldbe used for screening anemia at the population level for all age and gender groups.

Multi-facet assessment and ranking of alternatives for conceptualizing sustainable hybrid energy infrastructure in Pakistan based on evidential reasoning driven probabilistic tool

Developing a sustainable community is mainly contingent upon energy infrastructure driven by energy alternatives. It has been attempted to accomplish energy sustainability by just ranking energy alternatives. In the current work, an integrated decision support tool (IDST) and multi-level hierarchical structure (MLHS) are developed to instigate new notions for energy alternatives. The developed IDST is unique in dealing with two-dimensional assessment information and can also concurrently analyze hybrid information. The MLHS comprises eighteen attributes grouped into five sustainability aspects (operational, economic, technological, environmental, and social) to assess energy alternatives, including gas, coal, nuclear, solar, hydro, wind, and biomass. Firstly, the importance of attributes is calculated using the optimal weighting approach. Then, the ranking of alternatives is determined and validated. Lastly, the multi-facet performance of alternatives is assessed in terms of distributed performance and indexing using the probabilistic evidential reasoning algorithm, and the acceptability of alternatives is classified. The results revealed hydro is the most favorable energy alternative for achieving sustainability, followed by solar and wind, with a ‘very good’ index overall. The developed framework is useful for designing sustainable hybrid energy infrastructures and for intergovernmental organizations to draft long- and short-term policies for achieving the energy sustainability targets of SDG-7.

A Computer-Aided Design-Based Tolerance Analysis of Assemblies With Form Defects and Deformations of Nonrigid Parts

Abstract Product assemblability and functional behavior are affected by geometric deviations. These deviations consist of manufacturing errors and part deformation defects caused by external loads. Taking the sources of deviations into account in tolerance analysis yields not only to more precise and reliable results but also to more complex tasks. In this context, the modeling of assembly parts with defects in a Digital MockUp (DMU) is quite promising. In this article, an integrated decision support tool is proposed to consider the causes of multiple defects, such as tolerances and external mechanical loads, in the tolerancing process. The worst-case concept and the small displacement torsor (SDT) are used to model rigid parts with orientation and positional defects. To model the part with form defects, random positions of each toleranced face points are determined using the Gaussian perturbation method (GPM) and considering the tolerance zone limits. A computer-aided design (CAD) method based on the B-spline interpolation allows the reconstruction of realistic surfaces of parts with form defects. Realistic configurations of nonrigid components subjected to external mechanical loads are determined using the finite element analysis (FEA). The realistic assembly configurations are performed by updating the mating constraints between planar and cylindrical parts. The proposed method considers all tolerance types on CAD models (positional, orientation, and form defects) and part deformations. The tolerance analysis is performed to check the compliance with the functional requirement (FR) and to correct the initial tolerance values. An industrial case study is used to validate the steps of the proposed tolerancing method.

Maritime container shipping fleet deployment considering demand uncertainty

This paper investigates the integrated planning problem of fleet deployment considering demand uncertainty for container shipping liners. In the daily operation of container shipping networks with multiple routes, the demand of container transportation may exceed the capacity on some routes due to demand uncertainty. Shipping liners can apply temporary chartering and transshipment strategies to get extra capacity so that the excessive demand can be met. To formulate the problem, this paper develops a mixed-integer linear programming model to determine the fleet deployment, service scheduling, container routing and temporary chartering considering demand uncertainty. An improved particle swarm optimization algorithm is designed for solving this problem in large-scale cases. Numerical experiments show that the algorithm can solve the problem with high efficiency. This paper provides shipping liners with an integrated decision support tool for fleet deployment.

A Site-Scale Tool for Performance-Based Design of Stormwater Best Management Practices

The objective of this research is to develop a module for the design of best management practices based on percent pollutant removal. The module is a part of the site-scale integrated decision support tool (i-DSTss) that was developed for stormwater management. The current i-DSTss tool allows for the design of best management practices based on flow reduction. The new water quality module extends the capability of the i-DSTss tool by adding new procedures for the design of best management practices based on treatment performance. The water quality module can be used to assess the treatment of colloid/total suspended solid and dissolved pollutants. We classify best management practices into storage-based (e.g., pond) and infiltration-based (e.g., bioretention and permeable pavement) practices for design purposes. Several of the more complex stormwater tools require expertise to build and operate. The i-DSTss and its component modules including the newly added water quality module are built on an accessible platform (Microsoft Excel VBA) and can be operated with a minimum skillset. Predictions from the water quality module were compared with observed data, and the goodness-of-fit was evaluated. For percent total suspended solid removal, both R2 and Nash–Sutcliffe efficiency values were greater than 0.7 and 0.6 for infiltration-based and storage-based best management practices, respectively, demonstrating a good fit for both types of best management practices. For percent total phosphorous and Escherichia. coli removal, R2 and Nash–Sutcliffe efficiency values demonstrated an acceptable fit. To enhance usability of the tool by a broad range of users, the tool is designed to be flexible allowing user interaction through a graphical user interface.

Resource nexus for sustainable development: Status quoand prospect

Sustainable Development Goals (SDGs) proposed by the United Nations Sustainable Development Summit in 2015 are a roadmap for action to promote coordinated development of economy, society, and the environment. Natural resources, including energy, water, biomass, minerals, and land, are key elements for the achievement of SDGs. Various dependence, substitution, competition, and complementation relationships exist among different kinds of natural resources. The idea of intrinsic interconnectivities of the world’s material basis, which states that the five basic elements of “gold, wood, water, fire, and earth” mutually enable and restrict one other, can be traced back to Wuxing theory in ancient Chinese culture. The research interest in understanding and managing such interconnections has inspired a large number of studies on “resource nexus” and its role in facilitating SDGs in the past decade. Bibliometric analysis showed that the number of publications on resource nexus increased rapidly after the Bonn 2011 Nexus Conference. Nexuses between water and other resources, especially energy, are commonly investigated issues. Transdisciplinary approaches have become an important research direction in recent years. Studies on resource nexus have been incorporated into SDG discussions after 2015. Methods and models used in resource nexus studies are generally classified into three categories, namely, accounting, simulation, and optimization. These widely used methods in the system analysis of single-resource elements have been extended to cover and focus on linkages among resources. A number of integrated decision support tools, such as CLEW, WEF Nexus Tool, WEAP-LEAP, and WEF Nexus Rapid Appraisal Tool, have also been developed for problem identification, scenario analysis, and policy design. Many research institutes and international organizations have compiled databases on resource extraction, production, consumption, and trade to facilitate academic studies and decision making. Effects of resource nexus on sustainable development can be summarized as follows: (1) Strengthened impacts of increasingly interconnected resource nexus on sustainable development, (2) global expansion of localized resource nexus, (3) resource nexus leads to both synergies and conflicts among SDGs, and (4) resource nexus has both promoting and restricting effects on sustainable socioeconomic transitions. Finally, future investigations can focus on the following directions: (1) Expand the research scope of resource nexus; (2) reveal mechanisms and influences of resource nexus; (3) build universal, open-source, and extendible data platforms; and (4) strengthen the decision support capability of resource nexus studies.

GDNDC: An integrated system to model water-nitrogen-crop processes for agricultural management at regional scales

Agroecosystem modelling has increasingly focused on the integration of soil biogeochemical processes and crop growth. However, few models are available that offer high computing efficiencies for region-scale simulations, integrated decision support tools, and a structure that allows for easy extension. This paper introduces a new modelling tool to fill this gap: the GDNDC (Gridded DNDC) system for gridded agro-biogeochemical simulations. Based on the established DeNitrification and DeComposition (DNDC) model version-95, its main advancements include (i) implementation of parallel computation to significantly reduce computation time across multiple scales; (ii) a built-in parameter optimization algorithm to improve the predictive accuracy, and (iii) several decision support tools. We demonstrate each of these for county-level maize growth simulations in Liaoning Province (China) and reveal the potential of this new modelling tool to guide both long-term policy decisions regarding optimal fertilizer application and near-term crop yield forecasting for reactive decisions required in times of drought.

Investigating Tradeoffs of Green to Grey Stormwater Infrastructure Using a Planning-Level Decision Support Tool

Integrated decision support tools are needed to investigate the tradeoffs of stormwater control measures (SCMs) and determine the optimal suite of SCMs based on the needs of watersheds. In this study, an urbanized watershed undergoing infill development (the Berkeley neighborhood located in Denver, CO, USA) was modeled using a modified version of the U.S. Environmental Protection Agency’s (EPA) System for Urban Stormwater Treatment and Analysis IntegratioN (SUSTAIN). The primary goal was to compare the relative performance between green and grey SCMs, use optimizations and a planning-level approach to assist in decision-making, and discuss how stakeholder and community preferences can shift which SCMs are optimal for the watershed. Green and grey SCMs have variable hydrologic performance based on design and function, and both offer benefits that may be important to decision makers. Our results showed that infiltration trenches and underground infiltration were optimal for reducing flow volumes while vegetated swales and underground detention were optimal for pollutant concentration reduction. Stakeholders value both of these benefits and so the optimal stormwater solution in the Berkeley neighborhood included a mix of green and grey SCMs. Determining the optimal SCMs while considering tradeoffs in costs and associated benefits was complex and multifaceted. Modeling results such as those presented here are critical for informing stakeholders’ decision-making process.

Site-Scale Integrated Decision Support Tool (i-DSTss) for Stormwater Management

A site-scale integrated decision support tool (i-DSTss) is developed for selection and sizing of stormwater Best Management Practices (BMPs). The tool has several component modules—hydrology, BMP selection, BMP sizing, and life-cycle cost analysis (LCCA)—integrated into a single platform. The hydrology module predicts runoff from small catchment on event and continuous basis using the Green-Ampt and Curve Number methods. The module predicted runoff from a small residential area and a parking lot with R2 value of 0.77 and 0.74, respectively. The BMP selection module recommends a BMP type appropriate for a site based on economic, technical, social and environmental criteria using a multi-criteria optimization approach. The BMP sizing module includes sizing options for green roofs, infiltration-based BMPs, and storage-based BMPs. A mass balance approach is implemented for all types of BMPs. The tool predicted outflow rates from a permeable pavement with R2 value of 0.89. A cost module is included where capital, operation and maintenance, and rehabilitation costs are estimated based on BMP size obtained from the sizing module. The i-DSTss is built on an accessible platform (Microsoft Excel VBA) and can be operated with a basic skillset. The i-DSTss is intended for designers, regulators, and municipalities for quick analysis of scenarios involving interaction among several factors.

A Model for Sustaining and Investing in Immunization Information Systems: Authors.

In the past three years, Scientific Technologies Corporation electronically sent one-hundred fifty million retail pharmacy patient immunization events to state and community public health immunization information systems. Today, as a conservative estimate, over 85% of the U.S. population has an immunization record in an electronic health information system. Health technology, data exchange and increasing online patient health records offer consumers, providers and the immunization community new platforms to proactively identify vaccine coverage gaps. As the value of online immunization information increases, the cost to sustain and leverage these new technologies escalates. Online immunization records and integrated decision support tools are being used extensively from the pharmacy to the emergency room. They are moving from health data vaults with few users to more ubiquitous point of care services and direct consumer engagement. The data and the supporting technology infrastructure empower the community within the immunization ecosystem. To use this opportunity to reduce the impact of vaccine preventable disease on populations, investment in sustaining and modernizing existing immunization health technology systems suggest models to articulate their value and return on investment. This paper illustrates cost and technology drivers that impact sustainability and modernization of the immunization information system infrastructure. It provides a model to support investment priority decisions and estimate costs. It reviews the technical evolution of public health immunization registries and their current legacy state providing a pathway to migrate to opportunistic third generation technology platforms. It will answer: How much should be budgeted? What can this budget achieve over the next five years? What investments should be prioritized? Is there opportunity for public-private partnerships to support sustainment cost sharing? It shows that an investment of fifty million will modernize a quarter of the current second generation immunization systems and support the remainder over the next five years.

From Molecule to Patient and Ways to Get the Dose Precisely Right

From Molecule to Patient and Ways to Get the Dose Precisely Right

Productivity Improvement Through Multi-Objective Simulation Optimization—A Case Study

To maximize profitability and meet customers’ expectations, assembly plants strive to enhance operations and minimize costs. Using discrete-event system simulation and optimization, this paper investigates different scenarios to enhance operations efficiency and presents a decision support tool to aid operational decision making in an air conditioner assembly plant. Specifically, simulation is used to evaluate the system-wide impact of an optimal sequencing rule at a bottleneck station; in addition, a multi-objective simulation optimization problem is solved to enable manufacturers to evaluate their time/cost tradeoffs. Using actual data from a previous month, the simulation study illustrates possible savings throughout the evaluated alternatives. To sustain the study outcomes, we combine mathematical programming and simulation into an integrated decision support tool. Overall, this study illustrates the benefits of the solution approach to a real-life system.

A BIM-WMS integrated decision support tool for supply chain management in construction

Abstract Selection of construction material sources is an important issue in construction supply chain management. This affects not only the shipping cost and schedule of a construction project, but also its environmental impact. However, material delivery cost and time from the source location to the job site concerning sustainability may not be easily estimated. In this paper, a decision support tool that integrates building information modeling (BIM) and web map service (WMS) for the source selection of sustainable construction materials is presented. The BIM-WMS integrated decision support tool is developed in a form of a BIM-integrated plugin, which can help select sustainable construction material sources through evaluating the final cost and delivery time of the material, as well as calculate location-related credits in some green building standards, such as LEED. The developed plugin will make the selection of sustainable construction material and the calculation of location-related credits in green building certification an easy task, with the goal of minimizing environmental impact.

IDST: An integrated decision support tool for treatment and beneficial use of non-traditional water supplies – Part II. Marcellus and Barnett Shale case studies

Development of unconventional gas resources is currently one of the most rapidly growing trends in the oil and natural gas industry. Exploration of shale gas requires significant quantities of water for hydraulic fracturing. Meanwhile, large volumes of produced water are generated during gas production. Treatment and beneficial use of hydraulic fracturing flowback and produced water provides opportunities for sustainable unconventional gas operations while minimizing impacts to environment, local water resources, and public health. Considering the broad variety of treatment technologies and the wide spectrum of flowback and produced water qualities, selecting appropriate treatment and management options involves a complex decision-making process that requires understanding of treatment technologies, water quality, reuse requirements, and consideration of multiple criteria, constraints, and objectives. This study presents an integrated decision support tool (iDST) to assist in selection of treatment technologies and evaluation of the feasibility of potential water reuse options. The Marcellus Shale in Pennsylvania and the Barnett Shale in Texas were selected as case studies to demonstrate produced water treatment technologies and beneficial reuse options considering realistic site-specific conditions, assumptions, and future projections such as well numbers and locations, water demands, flowback and produced water quality and quantity, disposal availability, and costs. The iDST provides an interactive user interface to select suitable technologies for produced water treatment and reuse based on user preference, target water quality, and current disposal options.

IDST: An integrated decision support tool for treatment and beneficial use of non-traditional water supplies – Part I. Methodology

The treatment and use of non-traditional water supplies such as saline water, domestic wastewater, and produced water from the oil and gas industry has been recognized as a viable solution to address water scarcity. A Visual Basic for Applications (VBA) based integrated decision support tool (iDST) was developed to select a combination of treatment technologies or treatment trains for different types of alternative water and beneficial use options, such as potable use, crop irrigation, livestock watering, hydraulic fracturing, well drilling, environmental restoration, and other industrial applications. The tool integrates costs and treatment capacities of a broad range of treatment technologies from pretreatment, conventional to advanced technologies, and post-treatment. The iDST is fully automated and selects treatment trains based on input data such as feed water quality, target water quality requirements, and treatment selection criteria including technical, energy demand, and economic criteria. The iDST starts with a comprehensive water quality database, then selects the most effective treatment trains that could meet water quality requirement for user selected beneficial use options with respect to multiple technical and economic criteria. The iDST was evaluated based on four case studies, including municipal wastewater for potable reuse and irrigation, and geothermal water for surface discharge and power plant cooling. The iDST selected cost-effective treatment trains capable of producing the water quality required for end uses given site-specific conditions and feed water quality. The iDST provides a comprehensive tool to evaluate potential water treatment and end-use options with consideration of multiple criteria, functions, objectives, and constraints.

Interconnection between Scales for Friendly and Affordable Sustainable Urban Districts Retrofitting

The EU FP7 project FASUDIR (Friendly and Affordable Sustainable Urban Districts Retrofitting) supports the mobilization of the building retrofitting market towards 2020-2050 EU-targets through an Integrated Decision Support Tool (IDST), a software based on a new methodology that will help decision makers identify the best energy retrofitting strategy to increase the sustainability of the whole district. Improving the sustainability of urban environments is a interscalar problem, addressed through a multiscalar and multidirectional approach. A comprehensive urban scale strategy considers the working scale, but the measures at building scale have to be coherent with the global objectives at district and city scale. The FASUDIR IDST and methodology interconnect and visualize information across scales, ensuring comprehensive diagnoses and proper implementation of strategies. Due to the complexity of urban sustainability, interscalarity and multiscalarity, first it has been necessary to identify the possible scales of analysis, to capture various themes and to highlight the horizontal and vertical interconnections between different components. Multiscalarity and Interscalarity affect the three phases of the sustainable retrofitting cycle: diagnosis, decision making and management. The identification of the impact of district solutions on buildings (and vice versa) and their compatibility across scales has been addressed through interconnected building and district Key Performance Iindicators (KPIs). The intervention phases at building level generate new information about specific buildings, enabling more accurate decision making at district level. The methodology articulates the structure of the new information and the feedback generated during the process. To allow information interconnection a strategic information management is key. A multiscale information model based on CityGML, a standard data model issued by the OGC (Open Geospatial Consortium), will be the baseline structure for all the district-scale information (geometric and semantic) that is necessary for decision making and management, organized into a single interoperable data model that will integrate information from different fields and at different levels of detail.The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007- 2013) under grant agreement n̊ 609222.

A Novel Integrated Decision Support Tool for Sustainable Water Resources Management in Singapore: Synergies Between System Dynamics and Analytic Hierarchy Process

In order to alleviate the risks of urban flooding and diversify Singapore’s sources of water supply, an innovative idea of underground reservoirs was proposed. This infrastructure could have significant long-term impacts on the water resources system in Singapore. In addition, among various alternatives to augment water supply, decision makers need to know which ones are the more sustainable plans to pursue. This research proposes a novel integrated decision support tool that synergizes System Dynamics (SD) and a multi-criteria decision-making method called Analytic Hierarchy Process (AHP). First, a SD model takes in real-world data and simulates the consequences of different alternative plans under various scenarios of future population growth. Second, AHP is applied to compare different alternatives based on their performance as revealed by the SD simulation and the judgment of decision makers. Through the SD modeling we found that the proposed underground water storage system is not going to have a profound impact on Singapore’s adequacy and self-sufficiency in water, mainly because of its limited capacity and long construction time. Decision analysis through AHP reveals that if the population increases rapidly or mildly, then the order of priorities are: 1) seawater desalination; 2) NEWater (brand name for reclaimed water); 3) local water catchments; 4) underground water storage; 5) status quo. This novel integrated decision support tool, together with real-world data, could be applied to many other similar situations around the world in which policy makers need to make critical decisions with significant long-term implications, both in water systems and beyond.

Landscape Dynamics in Northwestern Amazonia: An Assessment of Pastures, Fire and Illicit Crops as Drivers of Tropical Deforestation

Many studies have identified drivers of deforestation throughout the tropics and, in most cases, have recognised differences in the level of threat. However, only a few have also looked at the temporal and spatial dynamics by which those drivers act, which is critical for assessing the conservation of biodiversity as well as for landscape planning. In this study, we analyse land cover change between 2000 and 2009 in north-western Colombian Amazonia to identify the interactions between the use of fire, cultivation of illicit crops and establishment of pastures, and their impacts on the loss of forest in the region. Yearly analyses were undertaken at randomly selected sample areas to quantify the average areas of transition of land cover types under different landscape compositions: forest-dominated mosaics, pasture mosaics, fire mosaics, and illicit crop mosaics. Our results indicate that despite the fact that forest areas were well-preserved, deforestation occurred at a low annual rate (0.06%). Conversion to pasture was the main factor responsible for forest loss (the area of pastures tripled within forest mosaics over 8 years), and this process was independent of the landscape matrix in which the forests were located. In fire mosaics, burning is a common tool for forest clearing and conversion to pasture. Thus, forests in fire mosaics were highly disturbed and frequently transformed from primary to secondary forests. The use of fire for illicit cropping was not detected, partly due to the small size of common illicit crops. Forest regeneration from pastures and secondary vegetation was observed in areas with large amounts of natural forest. Overall, assuming the continuation of the observed pasture conversion trend and the use of forest fire, we suggest that our results should be incorporated into a spatially explicit and integrated decision support tool to target and focus land-planning activities and policies.

Environmental Impacts of Short Rotation Coppice (SRC) Grown for Biomass on Agricultural Land

This issue of BioEnergy Research highlights the activitieswithin a European Union research project funded by ERA-NET Bioenergy, “Reducing environmental impact of SRCthrough evidence-based integrated decision support tools”(RATING-SRC). The project goal was to provide scientificevidence for evaluatingthe impacts —positiveandnegative—of short rotation coppice (SRC) plantations on soil, water,biodiversity, and landscape issues and also to propose waysto mitigate the negative and increase the positive impacts.Commercial SRC plantations are currently grown at limit-edscaleinsomecountries(e.g.,Sweden),buttheareaofSRCplantationshastoincreasedramaticallyinthefutureiftheyareto contribute significantly to the replacement of fossil energysources. Thus, a rapid increase of agricultural land dedicatedto SRC with willow (Salix spp.) or poplar (Populus spp.) forproduction of biomass for heat and/or electricity is projectedin the short-term in many regions of the world. A large-scaleshift from “conventional” arable crops to SRC will haveimplications on a range of environmental issues, and large-scale implementation of those crops for bio-energy purposemakes sense only if they prove to reduce negative effects onthe environment, especially when compared with other alter-natives for reduction of fossil energy sources. As a perennialcrop,SRCdiffersfrommostarablecropsinphysicaltraitsandmanagement practices. Results so far imply many positiveenvironmental benefits due to SRC implementation, but theeffects that SRC will have on the environment depend on theexisting or previous land use, the scale of planting and themanagement practices applied. In addition, SRC is a newproduction system for most regions in which it might begrown in future, and many uncertainties exist with respect tothe environmental impacts of those plantations on soil, water,biodiversity, and landscape issues.This special issue contains sevenpaperscoveringthetopicareasofSRCeffectsonissuesofwaterandsoil(twopapersbyDimitriou et al., Schmidt-Walter and Lamersdorf), biodiver-sity (Baum et al.), and the overall impact that these planta-tions may have on the environment and sustainability(Busch, Englund et al., Langeveld et al.). The paper on soilissues by Dimitriou et al. highlights the results for pH,organic carbon (C), and trace element concentrations in thesoil of 14 long-term (10–20 years) commercial willow SRCfields in Sweden when compared with those in adjacent,conventionally managed arable soils. The paper on waterissues by Dimitriou et al. reports the effects of SRC on waterquality by determining differences in leaching of nitrogenand phosphorus to groundwater of 16 commercial SRCstands in Sweden compared to adjacent arable fields grownwith “ordinary” crops. Schmidt-Walter and Lamersdorfdescribe effects on groundwater quality, specifically the po-tential effects of SRC grown under different managementregimes on groundwater recharge. Based on flora inventoriesin eight landscapes located in two European regions(Germany and Sweden), the paper by Baum et al. focus-es on the diversity of higher plants as an indicator ofbiodiversity in willow and poplar SRC, including variousscales ranging from habitat to landscape level diversity.The contribution by Busch is an attempt to assess theimpact of SRC on various landscape functions with thehelp of GIS-based tools. Englund et al. focus on thepotential effects of sustainability requirements within theEU Renewable Energy Directive (RED) on different stake-holders along SRC bioenergy supply chains, assessing theirusefulness in ensuring that SRC bioenergy is produced with

Clinical practice guidelines and patient decision aids. An inevitable relationship

As health professionals and patients are moving toward shared models of decision making, there is a growing need for integrated decision support tools that facilitate uptake of best evidence in routine clinical practice in a patient-centered manner. This article charts the landscape of clinical practice guidelines (CPGs) and patient decision aids.Decision support tools for medical practice can be mapped on two dimensions. (1) The target user and his or her level of decision making; either for groups of patients or for an individual patient and (2) the level of uncertainty: either supporting more directive decision making (behavior support) in the case of strong recommendations with a single best option or supporting dialog (deliberation support) on the pros and cons of different options in the case of conditional (or weak) recommendations.We conclude that it is important to establish closer links between CPGs and patient decision aids, through collaborative development of both. Such collaboration will encourage the design of decision support tools for professionals and patients who share the same evidence and the aim to increase the quality of decision making between doctor and patient. This could facilitate the implementation of CPGs and shared decision making in clinical practice.