Data envelopment analysis (DEA) is a mathematical programming for evaluating the relative efficiency of decision making units (DMUs). The first DEA model (CCR model) assumed for exact data, later some authors introduced the applications of DEA which the data was imprecise. In imprecise data envelopment analysis (IDEA) the data can be ordinal, interval and fuzzy. Data envelopment analysis also can be used for the future programming of organizations and the response of the different policies, which is related to the target setting and resource allocation. The existing target model that conveys performance based targets in line with the policy making scenarios was defined for exact data. In this paper we improved the model for imprecise data such as fuzzy, ordinal and interval data. To deal with imprecise data we first established an interval DEA model. We used one of the methods to convert fuzzy and ordinal data into the interval data. A numerical experiment is used to illustrate the application to our interval model.
BACKGROUND: Although prevalent in primary care settings, men's health issues are rarely discussed. Yet, primary care doctors (PCDs) are well positioned to offer health check-ups during consultations.
OBJECTIVES: This study aims to develop a substantive theory to explain the process of decision making by which PCDs engage men in discussing health check-ups.
METHODS: Grounded theory method was adopted. Data source was from 14 in-depth interviews and 8 focus group discussions conducted with a semi-structured guide. Interviews were recorded and transcribed verbatim for analysis. Initial open coding captured the concepts of processes from the data, followed by selective and theoretical coding to saturate the core category. Constant comparative method was used throughout the process to allow emergence of the theory.
RESULTS: Fifty-two PCDs from private and public settings were interviewed. PCDs engaged male patients in health check-ups when they associated high medical importance with the relevant issues. The decision to engage men also depended on perceived chances of success in negotiations about health check-ups. A high chance of success, associated with minimal negotiation effort, is associated with men being most receptive to health check-ups. When doctors feel the importance of a particular health issue, they place less emphasis on their perceived men's receptivity to discuss that health issue in their intention to engage them in discussing it.
CONCLUSIONS: Engaging male patients in appropriate health check-up activities requires a series of actions and decisions by the PCDs. The decision to engage the patient depends on the perceived balance between the receptivity of male patients and the medical importance of the issues in mind.
Medical ethics issues encountered in rehabilitation medicine differ from those in an acute care setting due to the complex relationships among the parties involved in rehabilitative care. The study examined the attitudes of Malaysian rehabilitation doctors toward medical ethics issues commonly encountered during patient care.
This cross-sectional study determined the appreciation of the learning environment and development of higher-order learning skills among students attending the Medical Curriculum at the International Medical University, Malaysia which provides traditional and e-learning resources with an emphasis on problem based learning (PBL) and self-directed learning. Of the 708 participants, the majority preferred traditional to e-resources. Students who highly appreciated PBL demonstrated a higher appreciation of e-resources. Appreciation of PBL is positively and significantly correlated with higher-order learning skills, reflecting the inculcation of self-directed learning traits. Implementers must be sensitive to the progress of learners adapting to the higher education environment and innovations, and to address limitations as relevant.
This paper raises issues about the role of family members in providing support for breast cancer survivors. Data were collected from 400 breast cancer survivors in Peninsular Malaysia through a custom-designed questionnaire fielded at hospitals and support group meetings. The data were analyzed using descriptive statistics. The analyses show that all family members could be supportive, especially in decision making and help with emotional issues. The spouse was the main support provider among the family members (others were children, parents, siblings and more distant relatives). The results also indicated that a significant percentage practiced collaborative decision-making. Breast cancer survivors needed their family members' support for information on survivorship strategies such as managing emotions, health, life style and dietary practice. The family members' supportive role may be linked to the Malaysian strong family relationship culture. For family members to contribute more adequately to cancer survivorship, it is suggested that appropriate educational intervention also be provided to them.
Acute appendicitis is one of the most common differential diagnoses for acute abdominal pain made by emergency doctors. Suspected cases require surgical referral for observation or definitive intervention to prevent complications. A high index of suspicion and good clinical skills with the aid of scoring systems allows early decision making, which includes optimal pain control. The objective of this study was to identify the pain score and is relationship to the cut-off points of the Alvarado scoring system so that justifies early surgical referral or discharge for suspected acute appendicitis from the Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a cross sectional study of acute abdominal pain from June 2007 to September 2008. All patients who fulfilled the criteria and consented to the study were assessed for Alvarado score, verbal numerical pain score (VNRS) and their subsequent management. Patients with an Alvarado score of ≥7 were likely to have acute appendicitis (80.1% sensitivity and 52.63% specificity) and those with the score of ≤3 were unlikely to have acute appendicitis. The median pain score was 7.00 (IQR: 5.00-8.50) but 72.5% did not receive any analgesia. There was no direct relationship between the pain score with Alvarado score. Oligoanalgesia in patients with acute appendicitis still exist in Emergency Department of UKMMC.
This article sought to describe the health-care data situation in six selected economies in the Asia-Pacific region. Authors from Thailand, China mainland, South Korea, Taiwan, Japan, and Malaysia present their analyses in three parts. The first part of the article describes the data-collection process and the sources of data. The second part of the article presents issues around policies of data sharing with the stakeholders. The third and final part of the article focuses on the extent of health-care data use for policy reform in these different economies. Even though these economies differ in their economic structure and population size, they share some similarities on issues related to health-care data. There are two main institutions that collect and manage the health-care data in these economies. In Thailand, China mainland, Taiwan, and Malaysia, the Ministry of Health is responsible through its various agencies for collecting and managing the health-care data. On the other hand, health insurance is the main institution that collects and stores health-care data in South Korea and Japan. In all economies, sharing of and access to data is an issue. The reasons for limited access to some data are privacy protection, fragmented health-care system, poor quality of routinely collected data, unclear policies and procedures to access the data, and control on the freedom on publication. The primary objective of collecting health-care data in these economies is to aid the policymakers and researchers in policy decision making as well as create an awareness on health-care issues for the general public. The usage of data in monitoring the performance of the heath system is still in the process of development. In conclusion, for the region under discussion, health-care data collection is under the responsibility of the Ministry of Health and health insurance agencies. Data are collected from health-care providers mainly from the public sector. Routinely collected data are supplemented by national surveys. Accessibility to the data is a major issue in most of the economies under discussion. Accurate health-care data are required mainly to support policy making and evidence-based decisions.
Fatigue-related crashes have long been the topic of discussion and study worldwide. The relationship between fatigue-related crashes and time of day is well documented. In Malaysia, the possibility of banning express buses from operating during the early-hours of the morning has emerged as an important consideration for passenger safety. This paper highlights the findings of an impact assessment study. The study was conducted to determine all possible impacts prior to the government making any decision on the proposed banning. This study is an example of a simple and inexpensive approach that may influence future policy-making process. The impact assessment comprised two major steps. The first step involved profiling existing operation scenarios, gathering information on crashes involving public express buses and stakeholders' views. The second step involved a qualitative impact assessment analysis using all information gathered during the profiling stage to describe the possible impacts. Based on the assessment, the move to ban early-hour operations could possibly result in further negative impacts on the overall road safety agenda. These negative impacts may occur if the fundamental issues, such as driving and working hours, and the need for rest and sleep facilities for drivers, are not addressed. In addition, a safer and more accessible public transportation system as an alternative for those who choose to travel at night would be required. The proposed banning of early-hour operations is also not a feasible solution for sustainability of express bus operations in Malaysia, especially for those operating long journeys. The paper concludes by highlighting the need to design a more holistic approach for preventing fatigue-related crashes involving express buses in Malaysia.
A cross-sectional study was conducted to explore clincians' baseline knowledge, practice beliefs and acceptance of intravenous (IV)-to-oral antibiotic switching practice in Hospital Pulau Pinang. The factors most highly rated for antibiotic conversion were the ability to maintain oral intake (85.6%) and microbiology etiology (85.0%). Majority of the clinicians (76%) agreed with the traditional clinical rule that "patient should be afebrile for 24 hours before IV-to-oral switch". Specialists and consultants had the highest knowledge score among the clinicians. However, they were generally less positive about a guideline being integrated into practice.
The current study sought to evaluate Malaysian oncology patients' decision making about the use of Complementary and Alternative Medicine (CAM) for the management of their care. Patients were interviewed across three major Malaysian ethnic groups, Malay, Chinese and Indian. Thematic content analysis identified four central themes: Conceptualizing CAM, the decision making process; rationale given for selecting or rejecting CAM and barriers to CAM use. Participants generally used the term 'traditional medicine', referred to locally as 'ubat kampung', meaning medicine derived from 'local traditions'. Mixed reactions were shown concerning the effectiveness of CAM to cure cancer and the slow progression of CAM results and treatment costs were cited as major barriers to CAM use. Concerns regarding safety and efficacy of CAM in ameliorating cancer as well as potential interactions with conventional therapies highlighted the importance of patients' knowledge about cancer treatments.
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.
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.
Clinical pathways have been implemented in many healthcare systems with mix results in improving the quality of care and controlling the cost. CP is a methodology used for mutual decision making and organization of care for a well-defined group of patients within a well-defined period. In developing the CPs for a medical centre, several meetings had been carried out involving expert teams which consist of physicians, nurses, pharmacists and physiotherapists. The steps used to develop the pathway were divided into 5 phases. Phase 1: the introduction and team development, Phase II: determining the cases and information gathering, Phase III: establishing the draft of CP, Phase IV: is implementing and monitoring the effectiveness of CP while Phase V: evaluating, improving and redesigning of the CP. Four CPs had been developed: Total Knee Replacement (TKR), ST Elevation Myocardial Infarction (AMI), Chronic Obstructive Airways Diseases (COAD) and elective Lower Segment Caesarean Section (LSCS). The implementation of these CPs had supported the evidence-based medicine, improved the multidisciplinary communication, teamwork and care planning. However, the rotation of posts had resulted in lack of document ownership, lack of direction and guidance from senior clinical staff, and problem of providing CPs prior to admission. The development and implementation of CPs in the medical centre improved the intra and inter departmental communication, improved patient outcomes, promote patient safety and increased patient satisfaction. However, accountability and understanding of the CPs must be given more attention.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Plurality voter is one of the commonest voting methods for decision making in highly-reliable applications in which the reliability and safety of the system is critical. To resolve the problem associated with sequential plurality voter in dealing with large number of inputs, this paper introduces a new generation of plurality voter based on parallel algorithms. Since parallel algorithms normally have high processing speed and are especially appropriate for large scale systems, they are therefore used to achieve a new parallel plurality voting algorithm by using (n/log n) processors on EREW shared-memory PRAM. The asymptotic analysis of the new proposed algorithm has demonstrated that it has a time complexity of O(log n) which is less than time complexity of sequential plurality algorithm, i.e. O (n log n).
This case report highlights on the dilemma in making a decision for termination of pregnancy (TOP) for a muslim rape victim in Malaysian setting. We report a case of 17 year-old student at 7 weeks of pregnancy after being gang-raped, who, together with her parents, had requested for a TOP. Psychiatric assessment showed that the patient suffered from a major depressive disorder and post-traumatic stress disorder which justified termination of pregnancy on a psychological and clinical basis. However the available Malaysian Islamic fatwa had caused some uncertainties on the final decision making. This case demonstrated on the needs to understand the relevant issues beyond clinical judgment in relation to TOP in our setting which encompasses the legal provision, ethical obligation as well as the needs for a clear religious understanding and stand to support the medical decision.
This quasi-experimental study examined the effectiveness of SET pedagogical style training that combined teaching style E (Inclusion style) from Mosston Spectrum of Teaching Styles (Mosston & Ashworth, 2002) with Teaching Games for Understanding (TGfU), in hockey. A total of n=25, Form One low-skilled students (LSS) secondary school boys were involved in this study using Physical Education class for the duration of nine weeks. The effectiveness of the SET pedagogical style of training on LSS in hockey was measured using speed and accuracy executing general hockey skills, acquisition of declarative and procedural hockey knowledge as well as ball control, decision making (passing, tackling, dribbling and scoring) and skill execution (passing, tackling, dribbling and scoring) in 3 vs 3 game play. The data was analysed using MANCOVA together with other two training styles, which was not disclosed in this article. Findings indicated there were significant improvements in speed and accuracy executing hockey general skills, declarative and procedural knowledge using SET pedagogical style of training. Findings too revealed the SET style was able to develop significantly game components of ball control, decision makng and skill execution in 3 vs 3 game plays at posttest among LSS group. Conclusion, further research has to be done to validate the SET pedagogical style of training across many invasion games.
INTRODUCTION: Achieving target door-needle times for ST elevation myocardial infarction remains challenging. Data on emergency department (ED) doctor-led thrombolysis in developing countries and factors causing delay are limited.
OBJECTIVES: To assess the effect on door-needle times by transferring responsibility for thrombolysis to the ED doctors and to identify predictors of prolonged door-needle times.
METHODOLOGY: Data on medical on-call team-led thrombolysis at a tertiary Asian hospital were prospectively collected from May 2007 to Aug 2008 (1st study period). In September 2008, ED doctors were empowered to perform thrombolysis. The practice change was accompanied by new guidelines, tick chart implementation, and training sessions. Data were then consecutively collected from September 2008 to May 2009 (2nd study period). Door-to-needle times for the 1st and 2nd study periods were compared. All cases were analysed for factors of delay by multiple logistic regression.
RESULTS: 297 patients were thrombolysed, 169 by the medical on-call team during the 1st study period and 128 by the ED doctors during the 2nd study period. Median door-needle times were 54 and 48 min, respectively (p=0.76). Significant delays were predicted by 'incorrect initial ECG interpretation' (adjusted OR (aOR) 14.3), 'inappropriate triage' (aOR 10.4) and 'multiple referrals' (aOR 5.9). No cases of inappropriate thrombolysis were recorded.
CONCLUSIONS: Transfer of responsibility for thrombolysis to the ED doctors did not improve door-needle times despite measures introduced to facilitate this change. Key causative factors for this failure were identified.
KEYWORDS: Accident & Emergency Medicine; Quality improvement
Study site: Emergency department, University Malaya Medical Centre, Kuala Lumpur
Family planning has been cited as essential to the achievement of Millennium Development Goals (MDG). Family planning has a direct impact on women's health and consequence of each pregnancy. The use of modern contraception among Asian women is less than global average. In Asia a majority of unintended pregnancies are due to using traditional contraceptive or no methods which lead to induced unsafe abortion. Cultural attitudes, lack of knowledge of methods and reproduction, socio demographic factors, and health service barriers are the main obstacles to modern contraceptive practice among Asian women. Culturally sensitive family planning program, reforming health system, and reproductive health education through mass media to create awareness of the benefits of planned parenthood are effective strategies to improve modern contraceptive practice among Asian women.
The aim of this study was to investigate the use of a newly developed design game called BLOCKS to stimulate awareness of ethical responsibilities amongst engineering students. The design game was played by seventeen teams of chemical engineering students, with each team having to arrange pieces of colored paper to produce two letters each. Before the end of the game, additional constraints were introduced to the teams such that they faced similar ambiguity in the technical facts that the engineers involved in the Challenger disaster had faced prior to the space shuttle launch. At this stage, the teams had to decide whether to continue with their original design or to develop alternative solutions. After the teams had made their decisions, a video of the Challenger explosion was shown followed by a post-game discussion. The students' opinion on five Statements on ethics was tracked via a Five-Item Likert survey which was administered three times, before and after the ethical scenario was introduced, and after the video and post-game discussion. The results from this study indicated that the combination of the game and the real-life incident from the video had generally strengthened the students' opinions of the Statements.