Displaying publications 121 - 140 of 313 in total

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  1. 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
  2. Jahn Kassim PN, Alias F
    J Relig Health, 2016 Feb;55(1):119-34.
    PMID: 25576401 DOI: 10.1007/s10943-014-9995-z
    Religion and spirituality have always played a major and intervening role in a person's life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient's religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient's values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients' varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions.
    Matched MeSH terms: Clinical Decision-Making/ethics*
  3. Sreeramareddy CT, Rahman M, Harsha Kumar HN, Shah M, Hossain AM, Sayem MA, et al.
    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*
  4. Zeldin S, Krauss SE, Collura J, Lucchesi M, Sulaiman AH
    Am J Community Psychol, 2014 Dec;54(3-4):337-47.
    PMID: 25216734 DOI: 10.1007/s10464-014-9676-9
    Youth participation in program and community decision making is framed by scholars as an issue of social justice, a platform for positive youth development and effective citizenry, and a strategy for nation building. Recent literature reviews have consistently identified youth-adult partnership (Y-AP) as an effective type of youth participation across highly diverse contexts. These same reviews, however, note that indicators of Y-AP have not been conceptualized and validated for measurement purposes. The present study addresses this limitation by developing a brief measure of Y-AP that is explicitly grounded in current theory, research, and community practice. The measure was administered to youth in the United States, Malaysia, and Portugal (N = 610). Validation was assessed through factor analysis and tests of factorial, discriminant, and concurrent validity. Results confirmed the two predicted dimensions of the Y-AP measure: youth voice in decision making and supportive adult relationships. These two dimensions were also found to be distinct from other measures of program quality: safety and engagement. As predicted, they also significantly correlated with measures of agency and empowerment. It is concluded that the measure has the potential to support community efforts to maximize the quality of youth programs.
    Matched MeSH terms: Decision Making*
  5. Mohamed MS, Noor SN
    Sci Eng Ethics, 2015 Apr;21(2):429-40.
    PMID: 24664170 DOI: 10.1007/s11948-014-9534-z
    This article presents the Islamic bioethical deliberation on the issue of sex assignment surgery (SAS) for infants with disorders of sex development (DSD) or intersexed as a case study. The main objective of this study is to present a different approach in assessing a biomedical issue within the medium of the Maqasid al-Shari'ah. Within the framework of the maqasidic scheme of benefits and harms, any practice where benefits are substantial is considered permissible, while those promoting harms are prohibited. The concept of Maqasid al-Shari'ah which is the mechanistic interpretation of Qur'an and Hadith presents the holistic attention of Islam on many life activities, including healthcare. Indeed, this concept encompasses many aspects of worldly life, both for the human individual and collectively for the whole society. In healthcare, the practice of SAS on DSD newborns has presented an assortment of implications on the future livelihood of the affected individual. The process of decision-making seems to be very multifaceted since every element such as the determination of the 'correct' sex and the urgency of early surgery must consider the benefits and harms, as well as the child's rights and best interest. The application of the concept of Maqasid al-Shari'ah, would convey a pragmatic approach that is often disregarded in Western medicine. This approach considers the right of the individual to live life optimally, individually and socially and practice his faith, precisely, in accordance with the assigned gender.
    Matched MeSH terms: Decision Making/ethics*
  6. Abdullah A, Abdullah KL, Yip CH, Teo SH, Taib NA, Ng CJ
    Asian Pac J Cancer Prev, 2013;14(12):7143-7.
    PMID: 24460266
    BACKGROUND: The survival outcomes for women presenting with early breast cancer are influenced by treatment decisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early, many refuse treatment for complementary therapy.
    OBJECTIVE: This study aimed to explore the decision making experiences of women with early breast cancer.
    MATERIALS AND METHODS: A qualitative study using individual in-depth interviews was conducted to capture the decision making process of women with early breast cancer in Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eight participants consented and were interviewed using a semi-structured interview guide. These women were recruited from a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decision support framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribed and analysed using a thematic approach.
    RESULTS: We identified four phases in the decision-making process of women with early breast cancer: discovery (pre-diagnosis); confirmatory ('receiving bad news'); deliberation; and decision (making a decision). These phases ranged from when women first discovered abnormalities in their breasts to them making final surgical treatment decisions. Information was vital in guiding these women. Support from family members, friends, healthcare professionals as well as survivors also has an influencing role. However, the final say on treatment decision was from themselves.
    CONCLUSIONS: The treatment decision for women with early breast cancer in Malaysia is a result of information they gather on their decision making journey. This journey starts with diagnosis. The women's spouses, friends, family members and healthcare professionals play different roles as information providers and supporters at different stages of treatment decisions. However, the final treatment decision is influenced mainly by women's own experiences, knowledge and understanding.
    Study site: Breast surgical units, Klang Valley, Malaysia
    Matched MeSH terms: Decision Making*
  7. Phua KL, Hue JW
    Am J Disaster Med, 2013;8(4):243-52.
    PMID: 24481888 DOI: 10.5055/ajdm.2013.0130
    Scientists and policy makers issuing predictions and warnings of impending natural disaster are faced with two major challenges, that is, failure to warn and issuing a false alarm. The consequences of failure to warn can be serious for society overall, for example, significant economic losses, heavy infrastructure and environmental damage, large number of human casualties, and social disruption. Failure to warn can also have serious for specific individuals, for example, legal proceedings against disaster research scientists, as in the L'Aquila earthquake affair. The consequences of false alarms may be less serious. Nevertheless, false alarms may violate the principle of nonmaleficence (do no harm), affect individual autonomy (eg, mandatory evacuations), and may result in the "cry wolf" effect. Other ethical issues associated with natural disasters include the promotion of global justice through international predisaster technical assistance and postdisaster aid. Social justice within a particular country is promoted through greater postdisaster aid allocation to the less privileged.
    Matched MeSH terms: Decision Making/ethics
  8. Tong WT, Low WY, Wong YL, Choong SP, Jegasothy R
    Asia Pac J Public Health, 2014 Sep;26(5):536-45.
    PMID: 24368749 DOI: 10.1177/1010539513514434
    This study explores contraceptive practice and decision making of women who have experienced abortion in Malaysia. In-depth interviews were carried out with 31 women who had abortions. Women in this study did adopt some method of modern contraception prior their abortion episodes. However, challenges to use a method consistently were experiences and fear of side effects, contraceptive failure, partner's influence, lack of confidence, and cost. The decision to adopt contraception was theirs but the types of contraceptive methods to adopt were influenced by their spouses/partners. The women wanted to use modern contraception but were faced with challenges that hampered its use. More proactive contraceptive promotion is needed to educate people on the array of contraceptive methods available and made accessible to them, to correct misconceptions on safety of modern contraception, to increase men's involvement in contraceptive choices, and to encourage consistent contraceptive use to prevent unintended pregnancies.
    Matched MeSH terms: Decision Making*
  9. Krauss SE, Collura J, Zeldin S, Ortega A, Abdullah H, Sulaiman AH
    J Youth Adolesc, 2014 Sep;43(9):1550-62.
    PMID: 24122395
    Youth–adult partnership (Y–AP) has emerged as a key practice for enacting two features of effective developmental settings: supportive adult relationships and support for efficacy and mattering. Previous studies have shown that when youth, supported by adults, actively participate in organizational and community decision making they are likely to show greater confidence and agency, empowerment and critical consciousness, and community connections. Most of the extant research on Y–AP is limited to qualitative studies and the identification of organizational best practices. Almost all research focuses on Western sociocultural settings. To address these gaps, 299 youth, age 15 to 24, were sampled from established afterschool and community programs in Malaysia to explore the contribution of Y–AP (operationalized as having two components: youth voice in decision-making and supportive adult relationships) to empowerment, agency and community connections. As hypothesized, hierarchical regressions indicated that program quality (Y–AP, safe environment and program engagement) contributed to agency, empowerment and community connections beyond the contribution of family, school and religion. Additionally, the Y–AP measures contributed substantially more variance than the other measures of program quality on each outcome. Interaction effects indicated differences by age for empowerment and agency but not for community connections. The primary findings in this inquiry replicate those found in previous interview and observational-oriented studies. The data suggests fertile ground for future research while demonstrating that Y–AP may be an effective practice for positive youth development outside of Western settings.
    Matched MeSH terms: Decision Making*
  10. Lee YK, Ng CJ, Lee PY, Khoo EM, Abdullah KL, Low WY, et al.
    PMID: 23378747 DOI: 10.2147/PPA.S36791
    BACKGROUND: Patients with type 2 diabetes often require insulin as the disease progresses. However, health care professionals frequently encounter challenges when managing patients who require insulin therapy. Understanding how health care professionals perceive the barriers faced by patients on insulin will facilitate care and treatment strategies.
    OBJECTIVE: This study explores the views of Malaysian health care professionals on the barriers faced by patients using insulin.
    METHODS: Semi-structured qualitative interviews and focus group discussions were conducted with health care professionals involved in diabetes care using insulin. Forty-one health care professionals participated in the study, consisting of primary care doctors (n = 20), family medicine specialists (n = 10), government policymakers (n = 5), diabetes educators (n = 3), endocrinologists (n = 2), and one pharmacist. We used a topic guide to facilitate the interviews, which were audio-recorded, transcribed verbatim, and analyzed using a thematic approach.
    RESULTS: FIVE THEMES WERE IDENTIFIED AS BARRIERS: side effects, patient education, negative perceptions, blood glucose monitoring, and patient adherence to treatment and follow-up. Patients perceive that insulin therapy causes numerous negative side effects. There is a lack of patient education on proper glucose monitoring and how to optimize insulin therapy. Cost of treatment and patient ignorance are highlighted when discussing patient self-monitoring of blood glucose. Finally, health care professionals identified a lack of a follow-up system, especially for patients who do not keep to regular appointments.
    CONCLUSION: This study identifies five substantial barriers to optimizing insulin therapy. Health care professionals who successfully identify and address these issues will empower patients to achieve effective self-management. System barriers require government agency in establishing insulin follow-up programs, multidisciplinary diabetes care teams, and subsidies for glucometers and test strips.
    KEYWORDS: diabetes; focus groups; insulin; noncommunicable disease; primary care; qualitative study
    Matched MeSH terms: Decision Making*
  11. Martinez AM, Partridge JC, Yu V, Wee Tan K, Yeung CY, Lu JH, et al.
    J Paediatr Child Health, 2005 Apr;41(4):209-14.
    PMID: 15813876
    This study was undertaken to evaluate physician counselling practices and resuscitation decisions for extremely preterm infants in countries of the Pacific Rim. We sought to determine the degree to which physician beliefs, parents' opinion and medical resources influence decision-making for infants at the margin of viability.
    Matched MeSH terms: Decision Making*
  12. Kassim PN, Alias F
    J Law Med, 2015 Jun;22(4):934-50.
    PMID: 26349388
    End-of-life decision-making is an area of medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. Decisions are no longer confined to clinical assessments; rather, they involve wider considerations such as a patient's religious and cultural beliefs, financial constraints, and the wishes and needs of family members. These decisions affect everyone concerned, including members of the community as a whole. Therefore it is imperative that clear ethical codes and legal standards are developed to help guide the medical profession on the best possible course of action for patients. This article considers the relevant ethical, codes and legal provisions in Malaysia governing certain aspects of end-of-life decision-making. It highlights the lack of judicial decisions in this area as well as the limitations with the Malaysian regulatory system. The article recommends the development of comprehensive ethical codes and legal standards to guide end-of-life decision-making in Malaysia.
    Matched MeSH terms: Decision Making*
  13. Tumin M, Mohd Satar NH, Zakaria RH, Raja Ariffin RN, Soo-Kun L, Kok-Peng N, et al.
    Urol J, 2015 Sep 04;12(4):2245-50.
    PMID: 26341766
    PURPOSE: This study explores the factors affecting the willingness of dialysis patients' family members to become involved in living and deceased organ donation.

    MATERIALS AND METHODS: We utilize cross sectional data on 350 family members of dialysis patients collected through self-administered survey from June to October 2013. The factors affecting willingness to become deceased and living organ donors among respondents were identified by running logistic regressions.

    RESULTS: The findings reveal that ethnicity, education and role in family are significant factors explaining will­ingness for living donation, while ethnicity, knowledge of organ donation and donor age drive willingness for deceased donation. We also find that the reasons of respondents being unwilling to donate center on the lack of information and family objections for deceased donation, while being medically unfit, scared of surgery and family objections are the reasons for unwillingness to donate living organs.

    CONCLUSION: In light of our findings, educational efforts are suggested to decrease the reluctance to become in­volved in living and deceased donation.

    Matched MeSH terms: Decision Making*
  14. Damas S, Wilkinson C, Kahana T, Veselovskaya E, Abramov A, Jankauskas R, et al.
    Forensic Sci Int, 2015 Dec;257:504-508.
    PMID: 26482539 DOI: 10.1016/j.forsciint.2015.07.045
    Craniofacial superimposition, although existing for one century, is still a controversial technique within the scientific community. Objective and unbiased validation studies over a significant number of cases are required to establish a more solid picture on the reliability. However, there is lack of protocols and standards in the application of the technique leading to contradictory information concerning reliability. Instead of following a uniform methodology, every expert tends to apply his own approach to the problem, based on the available technology and deep knowledge on human craniofacial anatomy, soft tissues, and their relationships. The aim of this study was to assess the reliability of different craniofacial superimposition methodologies and the corresponding technical approaches to this type of identification. With all the data generated, some of the most representative experts in craniofacial identification joined in a discussion intended to identify and agree on the most important issues that have to be considered to properly employ the craniofacial superimposition technique. As a consequence, the consortium has produced the current manuscript, which can be considered the first standard in the field; including good and bad practices, sources of error and uncertainties, technological requirements and desirable features, and finally a common scale for the craniofacial matching evaluation. Such a document is intended to be part of a more complete framework for craniofacial superimposition, to be developed during the FP7-founded project MEPROCS, which will favour and standardize its proper application.
    Matched MeSH terms: Decision Making*
  15. Ibáñez O, Vicente R, Navega DS, Wilkinson C, Jayaprakash PT, Huete MI, et al.
    Forensic Sci Int, 2015 Dec;257:496-503.
    PMID: 26060056 DOI: 10.1016/j.forsciint.2015.05.030
    As part of the scientific tasks coordinated throughout The 'New Methodologies and Protocols of Forensic Identification by Craniofacial Superimposition (MEPROCS)' project, the current study aims to analyse the performance of a diverse set of CFS methodologies and the corresponding technical approaches when dealing with a common dataset of real-world cases. Thus, a multiple-lab study on craniofacial superimposition has been carried out for the first time. In particular, 26 participants from 17 different institutions in 13 countries were asked to deal with 14 identification scenarios, some of them involving the comparison of multiple candidates and unknown skulls. In total, 60 craniofacial superimposition problems divided in two set of females and males. Each participant follow her/his own methodology and employed her/his particular technological means. For each single case they were asked to report the final identification decision (either positive or negative) along with the rationale supporting the decision and at least one image illustrating the overlay/superimposition outcome. This study is expected to provide important insights to better understand the most convenient characteristics of every method included in this study.
    Matched MeSH terms: Decision Making*
  16. Lee PY, Khoo EM, Low WY, Lee YK, Abdullah KL, Azmi SA, et al.
    Health Expect, 2016 Apr;19(2):427-36.
    PMID: 25857694 DOI: 10.1111/hex.12366
    BACKGROUND: Malaysia is an Asian country with population of diverse culture and health perceptions. Patient decision aid (PDA) is a new tool in Malaysia. Patients' and health-care professionals' (HCPs) expectation of a PDA is unknown.
    AIM: We aimed to explore patients' and health-care professionals'(HCPs) views on the information needed in a patient decision aid (PDA) on insulin initiation developed for patients with type 2 diabetes mellitus (T2DM).
    DESIGN: We used a qualitative design and thematic approach.
    SETTING: Three main primary health-care settings in Malaysia: public university-based primary care clinics, public health-care clinics and private general practices.
    METHOD: We conducted focus groups and one-to-one interviews with a purposive sample of health professionals and patients with type 2 diabetes.
    RESULTS: We interviewed 18 patients and 13 HCPs. Patients viewed the content of the PDA as simple and clear. However, HCPs felt the PDA might be difficult for patients with low literacy to understand. HCPs thought the PDA was too lengthy. Nevertheless, patients would prefer more information. HCPs tended to focus on benefits of insulin, while patients wanted to know the impact of insulin on their quality of life and practical issues regarding insulin and its side-effects. Patients preferred numbers to weigh the risks and benefits of treatment options. HCPs' views that presenting numbers in a PDA would be too complex for patients to understand.
    CONCLUSION: It is important to consider including issues related to psycho-social impact of treatment to patients when developing a patient decision aid.
    Matched MeSH terms: Decision Making*
  17. Chattopadhyay A
    Gender Issues, 2000;18(2):29-47.
    PMID: 12296212 DOI: 10.1007/s12147-000-0009-y
    In this article the author examines gender differences in the effect of family migration on socioeconomic attainment in Malaysia. The analysis discerns the relative importance of gender roles in household migration decisions, compared to gender stratification in the labor market. The Malaysian economy has undergone rapid industrialization and great structural changes which have opened up new economic opportunities, particularly for women. Despite the somewhat advantaged position of women compared to men in the Malaysian labor market, the author finds that men experience much greater socioeconomic gains than women from family migration. Hence indicating that family migration decisions in Malaysia, rather than optimizing family gains, compensate for the gender effect in the labor market. However, the gains of Malaysian men are more assured when they move alone. Data for the study come from the second round of the Malaysian Family Life Survey.
    Matched MeSH terms: Decision Making*
  18. Lim CP, Harrison RF, Kennedy RL
    Artif Intell Med, 1997 Nov;11(3):215-39.
    PMID: 9413607
    This paper presents a study of the application of autonomously learning multiple neural network systems to medical pattern classification tasks. In our earlier work, a hybrid neural network architecture has been developed for on-line learning and probability estimation tasks. The network has been shown to be capable of asymptotically achieving the Bayes optimal classification rates, on-line, in a number of benchmark classification experiments. In the context of pattern classification, however, the concept of multiple classifier systems has been proposed to improve the performance of a single classifier. Thus, three decision combination algorithms have been implemented to produce a multiple neural network classifier system. Here the applicability of the system is assessed using patient records in two medical domains. The first task is the prognosis of patients admitted to coronary care units; whereas the second is the prediction of survival in trauma patients. The results are compared with those from logistic regression models, and implications of the system as a useful clinical diagnostic tool are discussed.
    Matched MeSH terms: Decision Making, Computer-Assisted*
  19. Balakrishnan B, Tochinai F, Kanemitsu H
    Sci Eng Ethics, 2019 08;25(4):1069-1083.
    PMID: 29569171 DOI: 10.1007/s11948-018-0051-3
    This paper reports the findings of a comparative study in which students' perceived attainment of the objectives of an engineering ethics education and their attitude towards engineering ethics were investigated and compared. The investigation was carried out in Japan and Malaysia, involving 163 and 108 engineering undergraduates respectively. The research method used was based on a survey in which respondents were sent a questionnaire to elicit relevant data. Both descriptive and inferential statistical analyses were performed on the data. The results of the analyses showed that the attainment of the objectives of engineering ethics education and students' attitude towards socio-ethical issues in engineering were significantly higher and positive among Japanese engineering students compared to Malaysian engineering students. Such findings suggest that a well-structured, integrated, and innovative pedagogy for teaching ethics will have an impact on the students' attainment of ethics education objectives and their attitude towards engineering ethics. As such, the research findings serve as a cornerstone to which the current practice of teaching and learning of engineering ethics education can be examined more critically, such that further improvements can be made to the existing curriculum that can help produce engineers that have strong moral and ethical characters.
    Matched MeSH terms: Decision Making/ethics
  20. Chew KS, van Merrienboer JJG, Durning SJ
    BMC Med Educ, 2019 Jan 10;19(1):18.
    PMID: 30630472 DOI: 10.1186/s12909-018-1451-4
    BACKGROUND: Establishing a diagnosis is a complex, iterative process involving patient data gathering, integration and interpretation. Premature closure is a fallacious cognitive tendency of closing the diagnostic process before sufficient data have been gathered. A proposed strategy to minimize premature closure is the use of a checklist to trigger metacognition (the process of monitoring one's own thinking). A number of studies have suggested the effectiveness of this strategy in classroom settings. This qualitative study examined the perception of usability of a metacognitive mnemonic checklist called TWED checklist (where the letter "T = Threat", "W = What if I am wrong? What else?", "E = Evidence" and "D = Dispositional influence") in a real clinical setting.

    METHOD: Two categories of participants, i.e., medical doctors (n = 11) and final year medical students (Group 1, n = 5; Group 2, n = 10) participated in four separate focus group discussions. Nielsen's 5 dimensions of usability (i.e. learnability, effectiveness, memorability, errors, and satisfaction) and Pentland's narrative network were adapted as the framework to study the usability and the implementation of the checklist in a real clinical setting respectively.

    RESULTS: Both categories (medical doctors and medical students) of participants found that the TWED checklist was easy to learn and effective in promoting metacognition. For medical student participants, items "T" and "W" were believed to be the two most useful aspects of the checklist, whereas for the doctor participants, it was item "D". Regarding its implementation, item "T" was applied iteratively, items "W" and "E" were applied when the outcomes did not turn out as expected, and item "D" was applied infrequently. The one checkpoint where all four items were applied was after the initial history taking and physical examination had been performed to generate the initial clinical impression.

    CONCLUSION: A metacognitive checklist aimed to check cognitive errors may be a useful tool that can be implemented in the real clinical setting.

    Matched MeSH terms: Clinical Decision-Making/methods*
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