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Fulltext A study on patient's decision-making process in deciding treatment strategies: an illustration of using grounded theory approach

LOW, LEE LAN, TONG, SENG FAH, LOW, WAH YUN

Malaysian Journal of Qualitative Research, 2019;5(1):28-40.
MyJurnal

The learning curve for doing a good qualitative study is steep because qualitative methodologies are often vague and lack explicit steps. We detail the formulation of the grounded theory approach in a study of patients with type 2 diabetes mellitus who made decisions while strategizing their treatment types. This undertaking is to demonstrate how this systematic and yet flexible methods contributed to the understanding of the issue we were investigating. The process from deciding on research objectives and research questions, follow with systematic process for data collection and analysis allows us to generate a substantive theoretical model. By paying critical attention to theoretical saturation, grounded theory approach enabled us to construct all possible explanatory concepts related to decision making in strategizing diabetes treatment. We also describe the challenges throughout the whole research journey, including getting permission to interview patients, gaining the trust of research participants and staying open to the participants’ views.

Matched MeSH terms: Decision Making
Fulltext A cross-sectional assessment of shared-decision making among patients visiting public healthcare institute of Quetta city, Pakistan

Waheed, Hira, Haider, Sajjad, Iqbal, Qaiser, Khalid, Adnan, Hassali, Mohamed Azmi, Bashaar, Mohammad, et al.

Malaysian Journal of Pharmaceutical Science, 2020;18(1):15-29.
MyJurnal

Shared-decision making (SDM), occasionally called “participatory governance” is the approach in healthcare to ensure that patients have the right to participate effectively in the decision-making (DM) process. The aim of this research was to discuss the external aspect of SDM and put forward applicable solutions to ensure SDM at both patient and physician levels. A standardised validated nine-item SDM questionnaire (patient version SDM-Q-9) was employed. SPSS version 25 was used to perform data analysis. Multiple tests such as Mann-Whitney U and Jonckheere-Terpstra were used. Kendall’s Tau coefficient was used for interpretation of the significant relationship among all items of SDM-Q-9 and education. A total of 465 chronically ill patients took part, where majority (63.4%) of patients was above the age of 47. The cohort was dominated by females (67.5%) with 92% of the sample was married. Majority (86.9%) of the patient reported not involved in any decision. During analysis, considerable association was reported between gender and all items of SDM-Q-9, where more men were involved in SDM when compared with women. Our findings did produce significant association between education and SDM-Q-9, which reveals that increase in education can improve the SDM. SDM should not be limited to chronic or emergency in practice. Specific and tailored shared medical DM programmes must be developed for low literacy population implementation. SDM is to be supported at policy and operation levels.

Matched MeSH terms: Decision Making
Vascular Access Choice, Complications, and Outcomes in Children on Maintenance Hemodialysis: Findings From the International Pediatric Hemodialysis Network (IPHN) Registry

Borzych-Duzalka D, Shroff R, Ariceta G, Yap YC, Paglialonga F, Xu H, et al.

Am J Kidney Dis, 2019 08;74(2):193-202.
PMID: 31010601 DOI: 10.1053/j.ajkd.2019.02.014

RATIONALE & OBJECTIVE: Arteriovenous fistulas (AVFs) have been recommended as the preferred vascular access for pediatric patients on maintenance hemodialysis (HD), but data comparing AVFs with other access types are scant. We studied vascular access choice, placement, complications, and outcomes in children.
STUDY DESIGN: Prospective observational cohort study.
SETTING & PARTICIPANTS: 552 children and adolescents from 27 countries on maintenance HD followed up prospectively by the International Pediatric HD Network (IPHN) Registry between 2012 and 2017.
PREDICTOR: Type of vascular access: AVF, central venous catheter (CVC), or arteriovenous graft.
OUTCOME: Infectious and noninfectious vascular access complication rates, dialysis performance, biochemical and hematologic parameters, and clinical outcomes.
ANALYTICAL APPROACH: Univariate and multivariable linear mixed models, generalized linear mixed models, and proportional hazards models; cumulative incidence functions.
RESULTS: During 314 cumulative patient-years, 628 CVCs, 225 AVFs, and 17 arteriovenous grafts were placed. One-third of the children with an AVF required a temporary CVC until fistula maturation. Vascular access choice was associated with age and expectations for early transplantation. There was a 3-fold higher living related transplantation rate and lower median time to transplantation of 14 (IQR, 6-23) versus 20 (IQR, 14-36) months with CVCs compared with AVFs. Higher blood flow rates and Kt/Vurea were achieved with AVFs than with CVCs. Infectious complications were reported only with CVCs (1.3/1,000 catheter-days) and required vascular access replacement in 47%. CVC dysfunction rates were 2.5/1,000 catheter-days compared to 1.2/1,000 fistula-days. CVCs required 82% more revisions and almost 3-fold more vascular access replacements to a different site than AVFs (P<0.001).
LIMITATIONS: Clinical rather than population-based data.
CONCLUSIONS: CVCs are the predominant vascular access choice in children receiving HD within the IPHN. Age-related anatomical limitations and expected early living related transplantation were associated with CVC use. CVCs were associated with poorer dialysis efficacy, higher complication rates, and more frequent need for vascular access replacement. Such findings call for a re-evaluation of pediatric CVC use and practices.

Matched MeSH terms: Clinical 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 An Automated Patient Self-Monitoring System to Reduce Health Care System Burden During the COVID-19 Pandemic in Malaysia: Development and Implementation Study

Lim HM, Teo CH, Ng CJ, Chiew TK, Ng WL, Abdullah A, et al.

JMIR Med Inform, 2021 Feb 26;9(2):e23427.
PMID: 33600345 DOI: 10.2196/23427

BACKGROUND: During the COVID-19 pandemic, there was an urgent need to develop an automated COVID-19 symptom monitoring system to reduce the burden on the health care system and to provide better self-monitoring at home.
OBJECTIVE: This paper aimed to describe the development process of the COVID-19 Symptom Monitoring System (CoSMoS), which consists of a self-monitoring, algorithm-based Telegram bot and a teleconsultation system. We describe all the essential steps from the clinical perspective and our technical approach in designing, developing, and integrating the system into clinical practice during the COVID-19 pandemic as well as lessons learned from this development process.
METHODS: CoSMoS was developed in three phases: (1) requirement formation to identify clinical problems and to draft the clinical algorithm, (2) development testing iteration using the agile software development method, and (3) integration into clinical practice to design an effective clinical workflow using repeated simulations and role-playing.
RESULTS: We completed the development of CoSMoS in 19 days. In Phase 1 (ie, requirement formation), we identified three main functions: a daily automated reminder system for patients to self-check their symptoms, a safe patient risk assessment to guide patients in clinical decision making, and an active telemonitoring system with real-time phone consultations. The system architecture of CoSMoS involved five components: Telegram instant messaging, a clinician dashboard, system administration (ie, back end), a database, and development and operations infrastructure. The integration of CoSMoS into clinical practice involved the consideration of COVID-19 infectivity and patient safety.
CONCLUSIONS: This study demonstrated that developing a COVID-19 symptom monitoring system within a short time during a pandemic is feasible using the agile development method. Time factors and communication between the technical and clinical teams were the main challenges in the development process. The development process and lessons learned from this study can guide the future development of digital monitoring systems during the next pandemic, especially in developing countries.

Matched MeSH terms: Clinical Decision-Making
Fulltext Side chain similarity comparisons for integrated drug repositioning and potential toxicity assessments in epidemic response scenarios: The case for COVID-19

Ab Ghani NS, Emrizal R, Makmur H, Firdaus-Raih M

Comput Struct Biotechnol J, 2020;18:2931-2944.
PMID: 33101604 DOI: 10.1016/j.csbj.2020.10.013

Structures of protein-drug-complexes provide an atomic level profile of drug-target interactions. In this work, the three-dimensional arrangements of amino acid side chains in known drug binding sites (substructures) were used to search for similarly arranged sites in SARS-CoV-2 protein structures in the Protein Data Bank for the potential repositioning of approved compounds. We were able to identify 22 target sites for the repositioning of 16 approved drug compounds as potential therapeutics for COVID-19. Using the same approach, we were also able to investigate the potentially promiscuous binding of the 16 compounds to off-target sites that could be implicated in toxicity and side effects that had not been provided by any previous studies. The investigations of binding properties in disease-related proteins derived from the comparison of amino acid substructure arrangements allows for effective mechanism driven decision making to rank and select only the compounds with the highest potential for success and safety to be prioritized for clinical trials or treatments. The intention of this work is not to explicitly identify candidate compounds but to present how an integrated drug repositioning and potential toxicity pipeline using side chain similarity searching algorithms are of great utility in epidemic scenarios involving novel pathogens. In the case of the COVID-19 pandemic caused by the SARS-CoV-2 virus, we demonstrate that the pipeline can identify candidate compounds quickly and sustainably in combination with associated risk factors derived from the analysis of potential off-target site binding by the compounds to be repurposed.

Matched MeSH terms: Decision Making
Real-world data for health technology assessment for reimbursement decisions in Asia: current landscape and a way forward

Lou J, Kc S, Toh KY, Dabak S, Adler A, Ahn J, et al.

Int J Technol Assess Health Care, 2020 Oct;36(5):474-480.
PMID: 32928330 DOI: 10.1017/S0266462320000628

There is growing interest globally in using real-world data (RWD) and real-world evidence (RWE) for health technology assessment (HTA). Optimal collection, analysis, and use of RWD/RWE to inform HTA requires a conceptual framework to standardize processes and ensure consistency. However, such framework is currently lacking in Asia, a region that is likely to benefit from RWD/RWE for at least two reasons. First, there is often limited Asian representation in clinical trials unless specifically conducted in Asian populations, and RWD may help to fill the evidence gap. Second, in a few Asian health systems, reimbursement decisions are not made at market entry; thus, allowing RWD/RWE to be collected to give more certainty about the effectiveness of technologies in the local setting and inform their appropriate use. Furthermore, an alignment of RWD/RWE policies across Asia would equip decision makers with context-relevant evidence, and improve timely patient access to new technologies. Using data collected from eleven health systems in Asia, this paper provides a review of the current landscape of RWD/RWE in Asia to inform HTA and explores a way forward to align policies within the region. This paper concludes with a proposal to establish an international collaboration among academics and HTA agencies in the region: the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) working group, which seeks to develop a non-binding guidance document on the use of RWD/RWE to inform HTA for decision making in Asia.

Matched MeSH terms: Decision Making
Fulltext End-of-life attitudes in the Intensive Care Unit (ICU) amongst final year medical students at International Medical University, Malaysia

Sangeetha Poovaneswaran, Anuradha Poovaneswaran, Thiruselvi Subramaniam

International e-Journal of Science, Medicine & Education, 2014;8(1):32-33.
MyJurnal

With recent medical advances and the availability of newer sophisticated technologies, critically ill patients tend to survive longer. Thus, decisions to forgo life-sustaining medical treatment generate challenging issues that all doctors must face. The aim of this pilot study was to assess attitudes towards end-of-life care in ICU which included futile therapy (withholding and withdrawing therapy) among final year medical students who had received the same degree of clinical exposure and training in medical school. The results revealed varying attitudes and views towards end-of-life care in ICU suggesting other factors such as religion, ethnicity and culture may influence decision making.

Matched MeSH terms: Decision Making
A hybrid method for evaluating enterprise architecture implementation

Nikpay F, Ahmad R, Yin Kia C

Eval Program Plann, 2017 02;60:1-16.
PMID: 27665066 DOI: 10.1016/j.evalprogplan.2016.09.001

Enterprise Architecture (EA) implementation evaluation provides a set of methods and practices for evaluating the EA implementation artefacts within an EA implementation project. There are insufficient practices in existing EA evaluation models in terms of considering all EA functions and processes, using structured methods in developing EA implementation, employing matured practices, and using appropriate metrics to achieve proper evaluation. The aim of this research is to develop a hybrid evaluation method that supports achieving the objectives of EA implementation. To attain this aim, the first step is to identify EA implementation evaluation practices. To this end, a Systematic Literature Review (SLR) was conducted. Second, the proposed hybrid method was developed based on the foundation and information extracted from the SLR, semi-structured interviews with EA practitioners, program theory evaluation and Information Systems (ISs) evaluation. Finally, the proposed method was validated by means of a case study and expert reviews. This research provides a suitable foundation for researchers who wish to extend and continue this research topic with further analysis and exploration, and for practitioners who would like to employ an effective and lightweight evaluation method for EA projects.

Matched MeSH terms: Decision Making
Fulltext Understanding the decision-delivery interval in cesarean births

Naseem, Rashid, Nalliah, Sivalingam

International e-Journal of Science, Medicine & Education, 2007;1(2):61-68.
MyJurnal

Avoiding the adverse neonatal effects of perinatal asphyxia has been one of the common indications for cesarean deliveries in current obstetric practice. Expeditious delivery is dependent on decision to perform cesarean delivery and time lines achieved. A decision-delivery interval of 30 minutes, a concept initiated by the American College of Obstetricians and Gynecologists has open to debate as controversy reins about neonatal outcome when this time interval is considered in isolation. Time lines alone are probably not the only criteria to be employed, and may contribute to errors in interpretation by professional regulatory bodies and the society at large. Procedures prior to decision making like trial of labour, fetal scalp sampling and readily available resources for instituting emergent cesarean delivery invariably need to be considered. Though decision to delivery time is an integral component of critical conduct intervals in the acutely compromised fetus, a more pragmatic approach needs to be taken considering potential and known logistical and obstetric factors in line with good obstetric practice.

Matched MeSH terms: Decision Making
Fulltext Employee satisfaction of various aspects of human resource management and work environment in a health district office in Perak

Adlina, S., Narimah, A.H.H., Hakimi, Z.A., N Adilah, H., N Syuhada, Y.

Malaysian Journal of Public Health Medicine, 2006;6(2):26-30.
MyJurnal

Employee satnfaction surveys can provide the information needed to improved levek of productivity, job and loyalty. Management can identify the factors of job issues and provide solutions to improve the working environment. A cross sectional descriptive study on employee satisfaction among a health care district office’s staff was conducted in Perak in March - April 2006. A total of 19 staff were randomly picked and interviewed in the data collection process. Almost all understand the objectives of the administration unit (94%) and were satisfied with the management leadership’s style (78%- l 00%) . Majority agreed that their relationship with immediate superior and within the group was harmonious and professional (89%) and they preferred an open problem solving method in handling conflict (72 %). The most common type of incentive rewarded by the administration to express gratitude to their staff was certificate (56%); bonus and medal (33%); and informal gesture (28%). Majority (83%) were also satisfied by the method used to disseminate the information in their units. Majority agreed that the working environment in the administration unit were conducive (72%), their ideas were equally considered during decision making sessions (89%) and training opportunities were similarly given to them by the management (72%). This study revealed that employee satisfaction was determined by several factors such as management leadership's style, opportunity to contribute skills and idea; reward and incentive; and conducive king environment.

Matched MeSH terms: Decision Making
Consent for lumbar puncture -factors that influence the decision

Malik, A.S.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):35-41.
MyJurnal

Lumbar puncture (LP) is an important procedure both for diagnostic and therapeutic purposes. In Kelantan, Malaysia, on many occasions consent for this procedure is not granted by patients or guardians. The aim of this study was to find out the factors that influence the decision to grant or refuse the consent for LP. This was a cross-sectional study in which 86 parents (who agreed or refused to give consent for LP on their child) were interviewed by using a standard questionnaire. A scoring system was used to assess their knowledge about the purpose and technique of the procedure. Consent for LP was granted in 23 and refused in 27 children. The refusal rate was significantly higher when family members other than parents made the decision. The factors which did not play a statistically significant role in decision-making included: age of the child and parents; gender of the patient; number of children in the family; patient's birth order among the siblings; place of residence; monthly income of the family; parents' level of education; and number of days after admission when LP was requested. The factors that positively influenced the decision to give consent included knowledge about the purpose of LP and underlying disease. In order to receive positive consent for LP it is concluded that the parents/guardians and other family members who may influence the decision-making should be explained the role of LP in (1) making diagnosis and (2) choosing right antibiotics for treatment. They should also be informed about the side-effects of antibiotics, which may be used unnecessarily in unconfirmed cases of central nervous system infections.

Matched MeSH terms: Decision Making
Fulltext Termination of pregnancy for a Muslim rape victim and dilemma in Malaysian setting: a case report

Umi Adzlin, S., Azizul, A., Uma, V., Nor’Izam, A.

Malaysian Journal of Psychiatry, 2012;21(2):0-0.
MyJurnal

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.

Matched MeSH terms: Decision Making
Fulltext The relationship between alvarado score and pain score in managing adult acute appendicitis in the Emergency Department

Ahmad, K.I., Shamsul, A.S., Ismail, M.S.

Journal of Surgical Academia, 2011;1(1):15-24.
MyJurnal

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.

Matched MeSH terms: Decision Making
Fulltext The clinical impact of using complex molecular profiling strategies in routine oncology practice

Laes JF, Aftimos P, Barthelemy P, Bellmunt J, Berchem G, Camps C, et al.

Oncotarget, 2018 Apr 17;9(29):20282-20293.
PMID: 29755651 DOI: 10.18632/oncotarget.24757

Molecular profiling and functional assessment of signalling pathways of advanced solid tumours are becoming increasingly available. However, their clinical utility in guiding patients' treatment remains unknown. Here, we assessed whether molecular profiling helps physicians in therapeutic decision making by analysing the molecular profiles of 1057 advanced cancer patient samples after failing at least one standard of care treatment using a combination of next-generation sequencing (NGS), immunohistochemistry (IHC) and other specific tests. The resulting information was interpreted and personalized treatments for each patient were suggested. Our data showed that NGS alone provided the oncologist with useful information in 10-50% of cases (depending on cancer type), whereas the addition of IHC/other tests increased extensively the usefulness of the information provided. Using internet surveys, we investigated how therapy recommendations influenced treatment choice of the oncologist. For patients who were still alive after the provision of the molecular information (76.8%), 60.4% of their oncologists followed report recommendations. Most treatment decisions (93.4%) were made based on the combination of NGS and IHC/other tests, and an approved drug- rather than clinical trial enrolment- was the main treatment choice. Most common reasons given by physicians to explain the non-adherence to recommendations were drug availability and cost, which remain barriers to personalised precision medicine. Finally, we observed that 27% of patients treated with the suggested therapies had an overall survival > 12 months. Our study demonstrates that the combination of NGS and IHC/other tests provides the most useful information in aiding treatment decisions by oncologists in routine clinical practice.

Matched MeSH terms: Decision Making
Value of Information in Asia: Concepts, Current Use, and Future Directions

Dilokthornsakul P, McQueen RB, Chaiyakunapruk N, Spackman E, Watanabe JH, Campbell JD

Value Health Reg Issues, 2016 May;9:99-104.
PMID: 27881269 DOI: 10.1016/j.vhri.2015.12.003

Health technology assessment is a form of health policy research that provides policymakers with information relevant to decisions about policy alternatives. Findings from cost-effectiveness analysis (CEA) are one of the important aspects of health technology assessment. Nevertheless, the more advanced method of value of information (VOI), which is recommended by the International Society for Pharmacoeconomics and Outcomes Research and Society for Medical Decision Making Modeling Good Research Practices Task Force, has rarely been applied in CEA studies in Asia. The lack of VOI in Asian CEA studies may be due to limited understanding of VOI methods and what VOI can and cannot help policy decision makers accomplish. This concept article offers audiences a practical primer in understanding the calculation, presentation, and policy implications of VOI. In addition, it provides a rapid survey of health technology assessment guidelines and literature related to VOI in Asia and discusses the future directions of VOI use in Asia and its potential barriers. This article will enable health economists, outcomes researchers, and policymakers in Asia to better understand the importance of VOI analysis and its implications, leading to the appropriate use of VOI in Asia.

Matched MeSH terms: Clinical Decision-Making
Fulltext Geographical information system (GIS) application in tuberculosis spatial clustering studies: a systematic review

Norazman Mohd Rosli, Shamsul Azhar Shah, Mohd Ihsani Mahmood

Malaysian Journal of Public Health Medicine, 2018;18(1):0-0.
MyJurnal

Tuberculosis (TB) is known as a disease that prone to spatial clustering. Recent development has seen a sharp rise in the number of epidemiologic studies employing Geographical Information System (GIS), particularly in identifying TB clusters and evidences of etiologic factors. The aim of this systematic review is to determine evidence of TB clustering, type of spatial analysis commonly used and the application of GIS in TB surveillance and control. A literature search of articles published in English language between 2000 and November 2015 was performed using MEDLINE and Science Direct using relevant search terms related to spatial analysis in studies of TB cluster. The search strategy was adapted and developed for each database using appropriate subject headings and keywords. The literature reviewed showed strong evidence of TB clustering occurred in high risk areas in both developed and developing countries. Spatial scan statistics were the most commonly used analysis and proved useful in TB surveillance through detection of outbreak, early warning and identifying area of increased TB transmission. Among others are targeted screening and assessment of TB program using GIS technology. However there were limitations on suitability of utilizing aggregated data such as national cencus that were pre-collected in explaining the present spatial distribution among population at risk. Spatial boundaries determined by zip code may be too large for metropolitan area or too small for country. Nevertheless, GIS is a powerful tool in aiding TB control and prevention in developing countries and should be used for real-time surveillance and decision making.

Matched MeSH terms: Decision Making
Health Technology Assessment and Its Use in Drug Policy in Malaysia

Shafie AA, Chandriah H, Yong YV, Wan Puteh SE

Value Health Reg Issues, 2019 May;18:145-150.
PMID: 31082794 DOI: 10.1016/j.vhri.2019.03.003

OBJECTIVE: To describe the process and role of health technology assessment (HTA) in the context of drug policy in Malaysia.
METHODS: We summarized the HTA process through review of documents and reports available in the public domain combined with the authors' experience.
RESULTS: Health technology assessment plays an integral part in prioritizing treatment in public health facilities in Malaysia, particularly for the Ministry of Health Medicines Formulary (MOHMF). The MOHMF is the reference list of drugs allowed to be prescribed in the Ministry of Health (MOH) facilities. There are 2 organizations within the MOH that conduct HTA as their core activities, namely the Malaysian Health Technology Assessment Section and the Formulary Management Branch of Pharmacy Practice & Development Division. The assessment of pharmaceuticals for the purpose of listing medicines into the MOHMF is under the purview of the Formulary Management Branch. The evidence-based assessment focuses on safety, efficacy, effectiveness, and budget impact of the drug. Cost-effectiveness evidence is currently not mandatory but is of interest to the decision makers. The assessment outcomes are considered by the MOH Medicines List Review Panel for formulary decisions.
CONCLUSIONS: Health technology assessment has supported formulary decisions in MOH. Evidence generation needs to progress beyond efficacy or effectiveness, safety, and budget impact to incorporate cost-effectiveness. Nevertheless, there are challenges to be met to achieve this. The impact of the HTA process is currently unknown and is yet to be evaluated formally.

Matched MeSH terms: Decision Making
Fulltext Modelling the prognostic effect of glucose and lipid profiles on stroke recurrence in Malaysia: an event-history analysis

Chen XW, Nazri Shafei M, Abdul Aziz Z, Nazifah Sidek N, Imran Musa K

PeerJ, 2020;8:e8378.
PMID: 32095319 DOI: 10.7717/peerj.8378

Background: Diabetes and dyslipidemia are significantly associated with stroke recurrence, yet the evidence for this relationship is conflicting. Consequently, the parameters in the glucose and lipid profiles may inform us regarding their relationship with stroke recurrence, thus enhancing the physicians' clinical decision-making.
Aim: This study sought to investigate whether glucose and lipid profiles could prognosticate stroke recurrence in Malaysia.
Methods: We conducted a retrospective hospital-based study where we analyzed the first-ever stroke cases regarding about which the Malaysia National Stroke Registry was informed between 2009 and 2017, that fulfilled this study's criteria, and that were followed for stroke recurrence. Using the Cox proportional hazard regression analysis, we estimated the adjusted hazard ratios (HRs), which reflected the prognostic effect of the primary variables (i.e., glucose and lipid profiles on the first-stroke admission) on stroke recurrence.
Results: Among the 8,576 first-ever stroke patients, 394 (4.6%) experienced a subsequent first stroke recurrence event. The prognostic effect measured by univariable Cox regression showed that, when unadjusted, ten variables have prognostic value with regards to stroke recurrence. A multivariable regression analysis revealed that glucose was not a significant prognostic factor (adjusted HR 1.28; 95% CI [1.00-1.65]), while triglyceride level was the only parameter in the lipid profile found to have an independent prognostication concerning stroke recurrence (adjusted HR: 1.28 to 1.36).
Conclusions: Triglyceride could independently prognosticate stroke recurrence, which suggests the role of physicians in intervening hypertriglyceridemia. In line with previous recommendations, we call for further investigations in first-ever stroke patients with impaired glucose and lipid profiles and suggest a need for interventions in these patients.

Matched MeSH terms: Clinical Decision-Making
Fulltext Knowledge, attitudes, and barriers towards evidence-based practice among physiotherapists in Malaysia

Yahui HC, Swaminathan N

Hong Kong physiotherapy journal : official publication of the Hong Kong Physiotherapy Association Limited = Wu li chih liao, 2017 Dec;37:10-18.
PMID: 30931041 DOI: 10.1016/j.hkpj.2016.12.002

Background: Recently, there has been an increased need for all healthcare disciplines to provide interventions that are effective and evidence based. This has led to more implementation of evidence-based practice (EBP) in clinical settings. Following this, research regarding EBP gained attention to determine its uptake into the physiotherapy profession. Although there are numerous studies to determine the attitudes and barriers of physiotherapists towards EBP, most of them were done in developed nations. As for Malaysia, little research has been carried out, much less among physiotherapists.
Purpose: The purpose of this study was to identify the knowledge, attitude, and barriers towards the implementation of EBP among physiotherapists in Malaysia.
Methods: A survey was conducted among the members of the Malaysian Physiotherapy Association and other practicing therapists in Malaysia. One hundred and two responses were collected throughout a span of 2 months.
Results: Respondents agreed that EBP is necessary to practice and that it helps in decision making as well as improving patient care. Eighty-one percent of the respondents either agreed or strongly agreed that they had received formal training in EBP. However, 61% of the respondents reported that strong evidence is lacking to support their interventions. Thirty percent of the respondents reported reading <2 articles per month, with 57% stating that they read two to five articles in a typical month. This study also found time constraints, limited access to search engines, and lack of generalizability of research evidence as the top three barriers to implementing EBP.
Conclusion: Physiotherapists in Malaysia had a positive attitude towards EBP and are inclined towards implementing evidence into their clinical practice. They are interested in attending courses to improve their knowledge and skills in EBP.

Matched MeSH terms: Decision Making

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