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The effectiveness of the McIsaac clinical decision rule in the management of sore throat: an evaluation from a pediatrics ward

Thillaivanam S, Amin AM, Gopalakrishnan S, Ibrahim B

Pediatr Res, 2016 Oct;80(4):516-20.
PMID: 27331353 DOI: 10.1038/pr.2016.113

BACKGROUND: Sore throats may be due to either viral or group A beta hemolytic streptococcus (GABHS) infections; but diagnosis of the etiology of a sore throat is difficult, often leading to unnecessary antibiotic prescriptions and consequent increases in bacterial resistance. Scoring symptoms using the McIsaac clinical decision rule can help physicians to diagnose and manage streptococcal infections leading to sore throat and have been recommended by the Ministry of Health, Malaysia. In this paper, we offer the first assessment of the effectiveness of the McIsaac rule in a clinical setting in Malaysia.
METHOD: This study is a retrospective review of 116 pediatric patients presenting with sore throat. Group A comprised patients before the implementation of the McIsaac rule and Group B comprised patients after the implementation.
RESULTS: Unnecessary throat swab cultures were reduced by 40% (P = 0.003). Redundant antibiotic prescriptions were reduced by 26.5% (P = 0.003) and the overall use of antibiotics was reduced by 22.1% (P = 0.003). The pediatricians' compliance rate to McIsaac rule criteria was 45% before implementation of the McIsaac rule, but improved to 67.9% (P = 0.0005) after implementation.
DISCUSSION: The McIsaac rule is an effective tool for the management of sore throat in children in Malaysia.

Matched MeSH terms: Decision Making
Clinical clues for head injuries amongst Malaysian infants: accidental or non-accidental?

Thalayasingam M, Veerakumarasivam A, Kulanthayan S, Khairuddin F, Cheah IG

Injury, 2012 Dec;43(12):2083-7.
PMID: 22424957 DOI: 10.1016/j.injury.2012.02.010

Identifying the differences between infants with non-accidental head injuries (NAHI) and accidental head injuries (AHI) may help alert clinicians to recognize markers of abuse. A retrospective review of infants <1 year of age admitted to a tertiary referral centre in Malaysia over a two year period with a diagnosis of head injury or abnormal computed tomography head scans was conducted to identify the clinical features pointing towards a diagnosis of NAHI by comparing the socio-demographics, presenting complaints, clinical features and the extent of hospital investigations carried out. NAHI infants were more likely to be symptomatic, under a non-related caregiver's supervision, and presented with inconsistent or no known mechanism of injury. Subdural haemorrhages were more common in NAHI infants. The history, mechanism of injury, presenting signs and symptoms as well as the nature of the injuries sustained are all valuable clues as to whether a head injury sustained during infancy is likely to be accidental or not.

Matched MeSH terms: Decision Making
Factors affecting consumers' decisions on the use of nutraceuticals: a systematic review

Teoh SL, Ngorsuraches S, Lai NM, Bangpan M, Chaiyakunapruk N

Int J Food Sci Nutr, 2019 Jun;70(4):491-512.
PMID: 30634867 DOI: 10.1080/09637486.2018.1538326

There is a high and increasing global prevalence of nutraceuticals use. This study aims to systematically review and critically appraise all available evidence to identify the factors affecting consumers' decisions in taking nutraceuticals. Questionnaire, interview or focus group studies which directly reported factors affecting consumers' decisions in using nutraceuticals were included. A thematic synthesis method was employed to synthesis the findings from the included studies. Out of the 76 studies included, the key factors identified as the most important factors motivating consumers to take nutraceuticals were the perceived health benefits and safety of nutraceuticals, as well as the advice from healthcare professionals, friends and family. The identified barriers to take nutraceuticals were a lack of belief in the health benefit of nutraceuticals, the high cost of nutraceuticals and consumers' lack of knowledge about nutraceuticals. As a chief course of recommendation for the use of nutraceuticals, healthcare professionals should strive to utilise reliable information from clinical evidence to help consumers in making an informed decision in using nutraceuticals. Future studies should explore the possible ways to improve channelling clinical evidence information of nutraceuticals to the public.

Matched MeSH terms: Decision Making*
Fulltext Factors influencing young men's decision to undergo health screening in Malaysia: a qualitative study

Teo CH, Ng CJ, White A

BMJ Open, 2017 03 10;7(3):e014364.
PMID: 28283491 DOI: 10.1136/bmjopen-2016-014364

OBJECTIVES: Uptake of health screening is low in men, particularly among those aged <40 years. This study aimed to explore factors that influence health screening behaviour in younger men.
DESIGN: This qualitative study employed an interpretive descriptive approach. Two trained researchers conducted in-depth interviews (IDIs) and focus group discussions (FGDs) using a semi-structured topic guide, which was developed based on literature review and behavioural theories. All IDIs and FGDs were audio-recorded and transcribed verbatim. Two researchers analysed the data independently using a thematic approach.
PARTICIPANTS AND SETTING: Men working in a banking institution in Kuala Lumpur were recruited to the study. They were purposively sampled according to their ethnicity, job position, age and screening status in order to achieve maximal variation.
RESULTS: Eight IDIs and five FGDs were conducted (n=31) and six themes emerged from the analysis. (1) Young men did not consider screening as part of prevention and had low risk perception. (2) The younger generation was more receptive to health screening due to their exposure to health information through the internet. (3) Health screening was not a priority in young men except for those who were married. (4) Young men had limited income and would rather invest in health insurance than screening. (5) Young men tended to follow doctors' advice when it comes to screening and preferred doctors of the same gender and ethnicity. (6) Medical overuse was also raised where young men wanted more screening tests while doctors tended to promote unnecessary screening tests to them.
CONCLUSIONS: This study identified important factors that influenced young men's screening behaviour. Health authorities should address young men's misperceptions, promote the importance of early detection and develop a reasonable health screening strategy for them. Appropriate measures must be put in place to reduce low value screening practices.

Matched MeSH terms: Decision Making*
Improving health screening uptake in men: a systematic review and meta-analysis

Teo CH, Ling CJ, Ng CJ

Am J Prev Med, 2018 Jan;54(1):133-143.
PMID: 29254551 DOI: 10.1016/j.amepre.2017.08.028

CONTEXT: Globally, uptake of health screening in men remains low and the effectiveness of interventions to promote screening uptake in men is not well established. This review aimed to determine the effectiveness of interventions in improving men's uptake of and intention to undergo screening, including interventions using information and communication technology and a male-sensitive approach.

EVIDENCE ACQUISITION: Studies were sourced from five electronic databases (October 2015), experts, and references of included studies. This study included RCTs or cluster RCTs that recruited men and reported uptake of or intention to undergo screening. Two researchers independently performed study selection, appraisal, and data extraction. The interventions were grouped into those that increase uptake and those that promote informed decision making. They were further sub-analyzed according to types of intervention, male-sensitive, and web- and video-based interventions. The analysis was completed in December 2016.

EVIDENCE SYNTHESIS: This review included 58 studies. Most studies were on prostate cancer (k=31) and HIV (k=11) screening. Most of the studies had low methodologic quality (79.3%) and after excluding them from the analysis, one study found that educational intervention (which was also male-sensitive) was effective in improving men's intention to screen (risk ratio=1.36, 95% CI=1.23, 1.50, k=1) and partner educational intervention increased men's screening uptake (risk ratio=1.77, 95% CI=1.48, 2.12, k=1). Video-based educational interventions reduced prostate cancer screening uptake (risk ratio=0.89, 95%CI=0.80, 0.99, k=1) but web-based interventions did not change men's screening intention or uptake.

CONCLUSIONS: This review highlights the need to conduct more robust studies to provide conclusive evidence on the effectiveness of different interventions to improve men's screening behavior.

Matched MeSH terms: Decision Making*
Fulltext Landscape analysis of health technology assessment (HTA): systems and practices in Asia

Teerawattananon Y, Rattanavipapong W, Lin LW, Dabak SV, Gibbons B, Isaranuwatchai W, et al.

Int J Technol Assess Health Care, 2019;35(6):416-421.
PMID: 31594553 DOI: 10.1017/S0266462319000667

This paper explores the characteristics of health technology assessment (HTA) systems and practices in Asia. Representatives from nine countries were surveyed to understand each step of the HTA pathway. The analysis finds that although there are similarities in the processes of HTA and its application to inform decision making, there is variation in the number of topics assessed and the stakeholders involved in each step of the process. There is limited availability of resources and technical capacity and countries adopt different means to overcome these challenges by accepting industry submissions or adapting findings from other regions. Inclusion of stakeholders in the process of selecting topics, generating evidence, and making funding recommendations is critical to ensure relevance of HTA to country priorities. Lessons from this analysis may be instructive to other countries implementing HTA processes and inform future research on the feasibility of implementing a harmonized HTA system in the region.

Matched MeSH terms: Decision Making
Selecting the optimal gridded climate dataset for Nigeria using advanced time series similarity algorithms

Tanimu B, Hamed MM, Bello AD, Abdullahi SA, Ajibike MA, Shahid S

Environ Sci Pollut Res Int, 2024 Feb;31(10):15986-16010.
PMID: 38308777 DOI: 10.1007/s11356-024-32128-0

Choosing a suitable gridded climate dataset is a significant challenge in hydro-climatic research, particularly in areas lacking long-term, reliable, and dense records. This study used the most common method (Perkins skill score (PSS)) with two advanced time series similarity algorithms, short time series distance (STS), and cross-correlation distance (CCD), for the first time to evaluate, compare, and rank five gridded climate datasets, namely, Climate Research Unit (CRU), TERRA Climate (TERRA), Climate Prediction Center (CPC), European Reanalysis V.5 (ERA5), and Climatologies at high resolution for Earth's land surface areas (CHELSA), according to their ability to replicate the in situ rainfall and temperature data in Nigeria. The performance of the methods was evaluated by comparing the ranking obtained using compromise programming (CP) based on four statistical criteria in replicating in situ rainfall, maximum temperature, and minimum temperature at 26 locations distributed over Nigeria. Both methods identified CRU as Nigeria's best-gridded climate dataset, followed by CHELSA, TERRA, ERA5, and CPC. The integrated STS values using the group decision-making method for CRU rainfall, maximum and minimum temperatures were 17, 10.1, and 20.8, respectively, while CDD values for those variables were 17.7, 11, and 12.2, respectively. The CP based on conventional statistical metrics supported the results obtained using STS and CCD. CRU's Pbias was between 0.5 and 1; KGE ranged from 0.5 to 0.9; NSE ranged from 0.3 to 0.8; and NRMSE between - 30 and 68.2, which were much better than the other products. The findings establish STS and CCD's ability to evaluate the performance of climate data by avoiding the complex and time-consuming multi-criteria decision algorithms based on multiple statistical metrics.

Matched MeSH terms: Decision Making
Fulltext Principlism and neonatology: utilising the principles of medical ethics in decision-making for neonates

Tan, Mark Kiak Min

Journal of Clinical and Health Sciences, 2018;3(2):5-12.
MyJurnal

Prematurity is the leading cause of infant mortality and one of the main reasons for newborn infants to be admitted to the Neonatal Intensive Care Unit (NICU). Advancements in medicine has made the NICU a maze of sophisticated modern technology and expensive to run. These advances in technology have also resulted in an added layer of complexity to many ethical dilemmas that are encountered in the NICU. In 1977, Beauchamp and Childress introduced the principles of biomedical ethics. These four principles of (1)respect for autonomy, (2)nonmaleficence, (3)beneficence and (4)justice, form a suitable starting point for the analysis of the moral challenges of medical innovation. This article explores how the four ethical principles relate to decision-making in the NICU, and how they can be applied to the treatment of sick newborn infants in clinical practice. It also highlights the reasons why healthcare personnel need to equip themselves with good communication skills and up to date knowledge of ethical considerations in the NICU in order to make quality decisions about care for their patients. This article also suggests that a Clinical Ethics Committee can play a vital role in ensuring that the best decisions are achieved for these patients.

Matched MeSH terms: Decision Making
Fulltext Multi-Objective Optimization of Friction Stir Welding Process Parameters of AA6061-T6 and AA7075-T6 Using a Biogeography Based Optimization Algorithm

Tamjidy M, Baharudin BTHT, Paslar S, Matori KA, Sulaiman S, Fadaeifard F

Materials (Basel), 2017 May 15;10(5).
PMID: 28772893 DOI: 10.3390/ma10050533

The development of Friction Stir Welding (FSW) has provided an alternative approach for producing high-quality welds, in a fast and reliable manner. This study focuses on the mechanical properties of the dissimilar friction stir welding of AA6061-T6 and AA7075-T6 aluminum alloys. The FSW process parameters such as tool rotational speed, tool traverse speed, tilt angle, and tool offset influence the mechanical properties of the friction stir welded joints significantly. A mathematical regression model is developed to determine the empirical relationship between the FSW process parameters and mechanical properties, and the results are validated. In order to obtain the optimal values of process parameters that simultaneously optimize the ultimate tensile strength, elongation, and minimum hardness in the heat affected zone (HAZ), a metaheuristic, multi objective algorithm based on biogeography based optimization is proposed. The Pareto optimal frontiers for triple and dual objective functions are obtained and the best optimal solution is selected through using two different decision making techniques, technique for order of preference by similarity to ideal solution (TOPSIS) and Shannon's entropy.

Matched MeSH terms: Decision Making
Fulltext Proposal of a Clinical Decision Tree Algorithm Using Factors Associated with Severe Dengue Infection

Tamibmaniam J, Hussin N, Cheah WK, Ng KS, Muninathan P

PLoS One, 2016;11(8):e0161696.
PMID: 27551776 DOI: 10.1371/journal.pone.0161696

BACKGROUND: WHO's new classification in 2009: dengue with or without warning signs and severe dengue, has necessitated large numbers of admissions to hospitals of dengue patients which in turn has been imposing a huge economical and physical burden on many hospitals around the globe, particularly South East Asia and Malaysia where the disease has seen a rapid surge in numbers in recent years. Lack of a simple tool to differentiate mild from life threatening infection has led to unnecessary hospitalization of dengue patients.

METHODS: We conducted a single-centre, retrospective study involving serologically confirmed dengue fever patients, admitted in a single ward, in Hospital Kuala Lumpur, Malaysia. Data was collected for 4 months from February to May 2014. Socio demography, co-morbidity, days of illness before admission, symptoms, warning signs, vital signs and laboratory result were all recorded. Descriptive statistics was tabulated and simple and multiple logistic regression analysis was done to determine significant risk factors associated with severe dengue.

RESULTS: 657 patients with confirmed dengue were analysed, of which 59 (9.0%) had severe dengue. Overall, the commonest warning sign were vomiting (36.1%) and abdominal pain (32.1%). Previous co-morbid, vomiting, diarrhoea, pleural effusion, low systolic blood pressure, high haematocrit, low albumin and high urea were found as significant risk factors for severe dengue using simple logistic regression. However the significant risk factors for severe dengue with multiple logistic regressions were only vomiting, pleural effusion, and low systolic blood pressure. Using those 3 risk factors, we plotted an algorithm for predicting severe dengue. When compared to the classification of severe dengue based on the WHO criteria, the decision tree algorithm had a sensitivity of 0.81, specificity of 0.54, positive predictive value of 0.16 and negative predictive of 0.96.

CONCLUSION: The decision tree algorithm proposed in this study showed high sensitivity and NPV in predicting patients with severe dengue that may warrant admission. This tool upon further validation study can be used to help clinicians decide on further managing a patient upon first encounter. It also will have a substantial impact on health resources as low risk patients can be managed as outpatients hence reserving the scarce hospital beds and medical resources for other patients in need.

Study site: single ward, in Hospital Kuala Lumpur, Malaysia

Matched MeSH terms: Clinical Decision-Making*
A grounded explanation of why women present with advanced breast cancer

Taib NA, Yip CH, Low WY

World J Surg, 2014 Jul;38(7):1676-84.
PMID: 24280975 DOI: 10.1007/s00268-013-2339-4

Advanced breast cancer presentation remains a large obstacle in lowering mortality rates in low- and middle-resource countries. This study aims to explore the reasons why women present with breast cancer at an advanced stage.

Matched MeSH terms: Decision Making*
Recognizing pitfalls in breast cancer follow-up: a necessity--reply

Taib NA

World J Surg, 2015 Feb;39(2):548-9.
PMID: 25446473 DOI: 10.1007/s00268-014-2872-9
Matched MeSH terms: Decision Making*
Fulltext Using a patient decision aid for insulin initiation in patients with type 2 diabetes: a qualitative analysis of doctor-patient conversations in primary care consultations in Malaysia

Syed A, Mohd Don Z, Ng CJ, Lee YK, Khoo EM, Lee PY, et al.

BMJ Open, 2017 05 09;7(5):e014260.
PMID: 28490553 DOI: 10.1136/bmjopen-2016-014260

OBJECTIVE: To investigate whether the use of apatient decision aid (PDA) for insulin initiation fulfils its purpose of facilitating patient-centred decision-making through identifying how doctors and patients interact when using the PDA during primary care consultations.
DESIGN: Conversation analysis of seven single cases of audio-recorded/video-recorded consultations between doctors and patients with type 2 diabetes, using a PDA on starting insulin.
SETTING: Primary care in three healthcare settings: (1) one private clinic; (2) two public community clinics and (3) one primary care clinic in a public university hospital, in Negeri Sembilan and the Klang Valley in Malaysia.
PARTICIPANTS: Clinicians and seven patients with type 2 diabetes to whom insulin had been recommended. Purposive sampling was used to select a sample high in variance across healthcare settings, participant demographics and perspectives on insulin.
PRIMARY OUTCOME MEASURES: Interaction between doctors and patients in a clinical consultation involving the use of a PDA about starting insulin.
RESULTS: Doctors brought the PDA into the conversation mainly by asking information-focused 'yes/no' questions, and used the PDA for information exchange only if patients said they had not read it. While their contributions were limited by doctors' questions, some patients disclosed issues or concerns. Although doctors' PDA-related questions acted as a presequence to deliberation on starting insulin, their interactional practices raised questions on whether patients were informed and their preferences prioritised.
CONCLUSIONS: Interactional practices can hinder effective PDA implementation, with habits from ordinary conversation potentially influencing doctors' practices and complicating their implementation of patient-centred decision-making. Effective interaction should therefore be emphasised in the design and delivery of PDAs and in training clinicians to use them.

Matched MeSH terms: Decision Making
Excellent Survival Outcomes of Pediatric Patients With Acute Myeloid Leukemia Treated With the MASPORE 2006 Protocol

Sutiman N, Nwe MS, Ni Lai EE, Lee DK, Chan MY, Eng-Juh Yeoh A, et al.

Clin Lymphoma Myeloma Leuk, 2021 03;21(3):e290-e300.
PMID: 33384264 DOI: 10.1016/j.clml.2020.11.016

PURPOSE: To determine the prognostic factors in pediatric patients with acute myeloid leukemia (AML) and to assess whether their outcomes have improved over time.
PATIENTS AND METHODS: Sixty-two patients with AML excluding acute promyelocytic leukemia were retrospectively analyzed. Patients in the earlier cohort (n = 36) were treated on the Medical Research Council (MRC) AML12 protocol, whereas those in the recent cohort (n = 26) were treated on the Malaysia-Singapore AML protocol (MASPORE 2006), which differed in terms of risk group stratification, cumulative anthracycline dose, and timing of hematopoietic stem-cell transplantation for high-risk patients.
RESULTS: Significant improvements in 10-year overall survival and event-free survival were observed in patients treated with the recent MASPORE 2006 protocol compared to the earlier MRC AML12 protocol (overall survival: 88.0% ± 6.5% vs 50.1% ± 8.6%, P = .002; event-free survival: 72.1% ± 9.0 vs 50.1% ± 8.6%, P = .045). In univariate analysis, patients in the recent cohort had significantly lower intensive care unit admission rate (11.5% vs 47.2%, P = .005) and numerically lower relapse rate (26.9% vs 50.0%, P = .068) compared to the earlier cohort. Multivariate analysis showed that treatment protocol was the only independent predictive factor for overall survival (hazard ratio = 0.21; 95% confidence interval, 0.06-0.73, P = .014).
CONCLUSION: Outcomes of pediatric AML patients have improved over time. The more recent MASPORE 2006 protocol led to significant improvement in long-term survival rates and reduction in intensive care unit admission rate.

Matched MeSH terms: Clinical Decision-Making
Fulltext Psychosocial impact of perinatal loss among Muslim women

Sutan R, Miskam HM

BMC Womens Health, 2012;12:15.
PMID: 22708998 DOI: 10.1186/1472-6874-12-15

Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women.

Matched MeSH terms: Decision Making
Fulltext Does mental fatigue affect skilled performance in athletes? A systematic review

Sun H, Soh KG, Roslan S, Wazir MRWN, Soh KL

PLoS One, 2021;16(10):e0258307.
PMID: 34648555 DOI: 10.1371/journal.pone.0258307

BACKGROUND: Mental fatigue is a psychobiological state induced by a prolonged duration of demanding cognitive tasks. The effects of mental fatigue on physical performance have been well investigated in the literature. However, the effect of mental fatigue on skilled performance in sports remains unclear.
OBJECTIVE: This study aimed to report a comprehensive systematic review investigating the carryover effects of mental fatigue on skilled performance among athletes.
METHODS: A thorough search was conducted on PubMed, Web of Science, EBSCOhost (CENTRAL, SPORTDicus), and Scopus to select relevant literature, as well as on Google Scholar and sources of reference for grey literature. The selected literatures are centred on a mental fatigue protocol in which cognitive tasks are performed prior to athletic tasks. Only studies that used an experimental design to test two conditions, namely mental fatigue and non-mental fatigue, were selected.
RESULTS: Eleven articles were chosen based on the selection criteria. Mental fatigue affects skilled performance in three sports: soccer, basketball, and table tennis. A decline in skilled performance (decreased accuracy, increased performing time etc) is relevant to impaired executive functions. Seven studies focus on offensive skills, whereas only two studies are associated with defensive skills.
CONCLUSION: Mental fatigue has a negative effect on various sports skills of high-level athletes, including their technical and decision-making skills; however, the impact is greater on offensive skills than that of defensive skills in terms of the role of athletes. Impaired executive functions may be responsible for the negative effects of mental fatigue on skilled performance.

Matched MeSH terms: Decision Making
Determination of potential fishing grounds of Rastrelliger kanagurta using satellite remote sensing and GIS Technique

Suhartono Nurdin, Muzzneena Ahmad Mustapha, Tukimat Lihan, Mazlan Abd Ghaffar

Sains Malaysiana, 2015;44:225-232.

Analysis of relationship between sea surface temperature (SST) and Chlorophyll-a (chl-a) improves our understanding on the variability and productivity of the marine environment, which is important for exploring fishery resources. Monthly level 3 and daily level 1 images of Moderate Resolution Imaging Spectroradiometer Satellite (MODIS) derived SST and chl-a from July 2002 to June 2011 around the archipelagic waters of Spermonde Indonesia were used to investigate the relationship between SST and chl-a and to forecast the potential fishing ground of Rastrelliger kanagurta. The results indicated that there was positive correlation between SST and chl-a (R=0.3, p<0.05). Positive correlation was also found between SST and chl-a with the catch of R. kanagurta (R=0.7, p<0.05). The potential fishing grounds of R. kanagurta were found located along the coast (at accuracy of 76.9%). This study indicated that, with the integration of remote sensing technology, statistical modeling and geographic information systems (GIS) technique were able to determine the relationship between SST and chl-a and also able to forecast aggregation of R. kanagurta. This may contribute in decision making and reducing search hunting time and cost in fishing activities.

Matched MeSH terms: Decision Making
Fulltext Intuitive weights of harm for therapeutic decision making in smear-negative pulmonary Tuberculosis: an interview study of physicians in India, Pakistan and Bangladesh

Sreeramareddy CT, Rahman M, Harsha Kumar HN, Shah M, Hossain AM, Sayem MA, et al.

BMC Med Inform Decis Mak, 2014;14:67.
PMID: 25104297 DOI: 10.1186/1472-6947-14-67

BACKGROUND: To estimate the amount of regret and weights of harm by omission and commission during therapeutic decisions for smear-negative pulmonary Tuberculosis.
METHODS: An interviewer-administered survey was done among young physicians in India, Pakistan and Bangladesh with a previously used questionnaire. The physicians were asked to estimate probabilities of morbidity and mortality related with disease and treatment and intuitive weights of omission and commission for treatment of suspected pulmonary Tuberculosis. A comparison with weights based on literature data was made.
RESULTS: A total of 242 physicians completed the interview. Their mean age was 28 years, 158 (65.3%) were males. Median probability (%) of mortality and morbidity of disease was estimated at 65% (inter quartile range [IQR] 50-75) and 20% (IQR 8-30) respectively. Median probability of morbidity and mortality in case of occurrence of side effects was 15% (IQR 10-30) and 8% (IQR 5-20) respectively. Probability of absolute treatment mortality was 0.7% which was nearly eight times higher than 0.09% reported in the literature data. The omission vs. commission harm ratios based on intuitive weights, weights calculated with literature data, weights calculated with intuitive estimates of determinants adjusted without and with regret were 3.0 (1.4-5.0), 16 (11-26), 33 (11-98) and 48 (11-132) respectively. Thresholds based on pure regret and hybrid model (clinicians' intuitive estimates and regret) were 25 (16.7-41.7), and 2(0.75-7.5) respectively but utility-based thresholds for clinicians' estimates and literature data were 2.9 (1-8.3) and 5.9 (3.7-7.7) respectively.
CONCLUSION: Intuitive weight of harm related to false-negatives was estimated higher than that to false-positives. The mortality related to treatment was eightfold overestimated. Adjusting expected utility thresholds for subjective regret had little effect.

Matched MeSH terms: Decision Making*
Legal sanctions and information about drugs as influences upon the decision by adolescents whether to use illicit drugs

Spencer C, Navaratnam V

Drug Alcohol Depend, 1980 Nov;6(5):315-22.
PMID: 7460763

Although those Malaysian secondary schoolchildren who have never used drugs are consistent in their support for legal and social sanctions against drug use, it is argued that such sanctions are a relatively unimportant factor in the decision whether or not to use drugs. Non-drug users inhabit a social world separated from their drug-using contemporaries; they rely on information from public rather than direct social sources, and claim to have been little interested in information received. However, there is evidence that, for a minority of the drug-using sub-sample, public information campaigns have made them more rather than less interested in experimenting with drug substances.

Matched MeSH terms: Decision Making*
Fulltext Focus group discussions on female genital cutting

Siti Nur Afiqah Zahari, Yufu Iguchi, Abdul Rashid

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):18-18.
MyJurnal

Introduction: Female Genital Cutting (FGC) is a sensitive issue as this topic is always associated with religion and culture in Malaysia. In the past, FGC is performed by the traditional midwives. However, this practice has been med-icalized nowadays. This study aimed to understand the reasons of performing FGC, the decision making, the practice and the future of FGC among rural community in Northern Malaysia. Methods: Focus group discussions (FGD) were conducted on three groups of young women aged 18-45, older women aged 45 and above and a group of married adult men. All of them were Malay Muslims who were conveniently selected from a rural village in Northern Malay-sia. A semi-structured interview guide was used to conduct the FGD focusing on the reasons, decision making, the practice and the future of FGC. Data was collected until saturation of information was achieved. These participants were chosen based on their willingness to take part in the discussion and also based on their personality of being talkative and able to give feedback to the questions. Results: The result of the interviews revealed that religion is the reason of practicing FGC. All of the participants from each FGD prefer to go to the doctor in the clinic compared to the traditional midwives. The men in this FGD mentioned that they rarely involved in the decision making of the FGC and only the mother or the grandmother to take the responsibility to decide. Conclusion: Generally, majority Malay Muslims community from the rural areas in Northern Malaysia believed that FGC is compulsory in Islam and they prefer to go to the doctors to perform FGC.

Matched MeSH terms: Decision Making

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