Malaysian Journal of Medical Sciences最新文献

{"title":"Prevalence and Associated Factors of Children Tuberculosis in Southeast Asia Countries: A Systematic Review.","authors":"Debri Rizki Faisal, Adistha Eka Noveyani, Yuni Purwatiningsih, Sinta Dewi Lestyoningrum, Wahyu Gito Putro, Muhammad Agus Mikrajab, Wahyu Pudji Nugraheni","doi":"10.21315/mjms2024.31.6.9","DOIUrl":"10.21315/mjms2024.31.6.9","url":null,"abstract":"<p><p>Southeast Asia (SEA) countries are characterised by a high burden of tuberculosis (TB). This research seeks to compile evidence of the prevalence and risk factors associated with TB among children in SEA countries. The searching of articles was conducted for four databases (PubMed, Scopus, Embase, and the Web of Science) published between 2013 and 2023 in the English language. The quality of articles was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Tool for Assessment of Risk Bias for Cross-Sectional studies. This research was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. Eight studies were included in the systematic review. The prevalence of paediatric TB in SEA countries varies between 1.50% and 38.10%. Risk factors associated with the occurrence of TB in children include the nutritional status, the Bacillus Calmette-Guérin (BCG) vaccine status, close contact with TB patients, parental smoking behaviour, unhealthy living conditions, and socioeconomic determinants. The continued high prevalence of TB in several SEA countries, particularly among children, remains a significant public health concern. The various risk factors summarised can serve as a basis for implementing interventions aimed at reducing cases and preventing the transmission of TB among children.</p>","PeriodicalId":47388,"journal":{"name":"Malaysian Journal of Medical Sciences","volume":"31 6","pages":"112-125"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving Away from the Blame Culture: The Way Forward to Manage Medical Errors.","authors":"Aimi Nadia Mohd Yusof, Hazdalila Yais Haji Razali","doi":"10.21315/mjms2024.31.6.10","DOIUrl":"10.21315/mjms2024.31.6.10","url":null,"abstract":"<p><p>When a medical error occurs, the instinct to blame healthcare professionals may seems like a way to ensure they learn from their mistakes. However, in today's healthcare landscape, the blame culture, coupled with the fear of litigation, proves detrimental to improving patient care. This culture fosters a reluctance among healthcare professionals to openly disclose mistakes, depriving them of valuable learning opportunities. These professionals, often referred to as second victims, deserve as much attention and support as the patients who are affected by the errors. Given that medical errors are inevitable, it becomes imperative to effectively manage the aftermath to ensure all parties involved are adequately supported and shielded from adverse consequences. This article delves into the ethical complexities of medical errors, advocating for a shift from a blame-centric culture to one that prioritises support for second victims. The aim of this article is to underscore the crucial importance of addressing medical errors within the healthcare sector by fostering an environment that promotes learning and growth post-error.</p>","PeriodicalId":47388,"journal":{"name":"Malaysian Journal of Medical Sciences","volume":"31 6","pages":"126-132"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Live Attenuated Bacterial Vectors as Vehicles for DNA Vaccine Delivery: A Mini Review.","authors":"Sze Wei Eng, Vilassini Muniandy, Lohshinni Punniamoorthy, Hui Xian Tew, Mohd Nor Norazmi, Manickam Ravichandran, Su Yin Lee","doi":"10.21315/mjms2024.31.6.2","DOIUrl":"10.21315/mjms2024.31.6.2","url":null,"abstract":"<p><p>DNA vaccines are third-generation vaccines composed of plasmids that encode vaccine antigens. Their advantages include fast development, safety, stability, and cost effectiveness, which make them an attractive vaccine platform for genetic and infectious diseases. However, the low transfection efficiency of DNA vaccines results in poor performance in both larger animals and humans, thereby limiting their clinical use. To overcome this issue, live attenuated bacterial vector (LABV) has been proposed as a DNA delivery vehicle. LABV is known to improve DNA vaccine transfection efficiency, thus enhancing the immune response. This article highlights recent advancements in the development of LABV DNA vaccines, the design of shuttle plasmids and adjuvants, and the potential applications of LABV candidates.</p>","PeriodicalId":47388,"journal":{"name":"Malaysian Journal of Medical Sciences","volume":"31 6","pages":"6-20"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forging the Future: B Cell Activating Factor's Impact on Nephrotic Syndrome.","authors":"Astrid Kristina Kardani, Loeki Enggar Fitri, Nur Samsu, Krisni Subandiyah","doi":"10.21315/mjms2024.31.6.5","DOIUrl":"10.21315/mjms2024.31.6.5","url":null,"abstract":"<p><p>Nephrotic syndrome is the most common glomerular disease in children. While the exact pathogenesis of nephrotic syndrome is not fully understood, recent research has shed light on some of the underlying mechanisms involved in it. Improvement by B cell depletion therapy using antiCD20 in nephrotic syndrome has led to a paradigm shift from immunoinflammatory disease influenced by T cell dysregulation to B cell involvement in the pathogenesis of nephrotic syndrome. The expression of the B cell activating factor (BAFF), an essential cytokine for the maturation and differentiation of B lymphocytes, in the podocytes of paediatric patients with nephrotic syndrome is known to be associated with worse renal outcomes. The pro-inflammatory cytokines and pathogenic antibodies produced by B cells allegedly cause podocyte injury leading to proteinuria due to effacement of foot processes. Considering the role of the BAFF in B cell proliferation and antibody production, BAFF signalling is a potential target for development as targeted therapy in nephrotic syndrome. Nevertheless, there is limited research regarding the role of BAFF in nephrotic syndrome, and the exact mechanism of BAFF involvement in the pathogenesis of nephrotic syndrome is still unknown. This review discusses the role of the BAFF in the pathogenesis of nephrotic syndrome and highlights the gap of knowledge for future research.</p>","PeriodicalId":47388,"journal":{"name":"Malaysian Journal of Medical Sciences","volume":"31 6","pages":"57-64"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Health Insurance Role in Hospital Utilisation in Disadvantaged Areas: Evidence from Indonesia.","authors":"Ratna Dwi Wulandari, Leny Latifah, Agung Dwi Laksono, Wahyu Pudji Nugraheni, Tati Suryati, Tety Rachmawati, Diah Yunitawati, Rofingatul Mubasyiroh, Irfan Ardani, Asep Kusnali","doi":"10.21315/mjms2024.31.6.16","DOIUrl":"10.21315/mjms2024.31.6.16","url":null,"abstract":"<p><strong>Background: </strong>The Indonesian government policy regarding obtaining universal coverage through National Health Insurance (NHI) is expected to increase public access to health service facilities, including in disadvantaged areas. This study analysed the role of NHI in hospital utilisation in underprivileged areas of Indonesia.</p><p><strong>Methods: </strong>Data from the 2023 National Socioeconomic Survey were used in this cross-sectional study that included 130,331 participants. Hospital utilisation was the dependent variable and NHI membership was the independent variable. Residence, age, sex, marital status, education, occupation, and wealth status were control factors. A multinomial logistic regression was employed in the final stage for data evaluation.</p><p><strong>Results: </strong>In 2023, the hospital utilisation rate in Indonesia's disadvantaged regions was 1.5% and the percentage of NHI members was 74.5%. People with an NHI membership were 3.01 times more likely to utilise the hospital than those without [95% confidence interval (CI) 2.58-3.50]. Seven control variables related to hospital utilisation were identified, namely, residence type, age, sex, marital status, education level, employment status, and wealth status.</p><p><strong>Conclusion: </strong>This study concluded that NHI membership influenced hospital utilisation in disadvantaged areas of Indonesia. Individuals with NHI membership were three times more likely to visit hospitals.</p>","PeriodicalId":47388,"journal":{"name":"Malaysian Journal of Medical Sciences","volume":"31 6","pages":"205-216"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Antibody-Detection Tests for Human Melioidosis: A Systematic Review and Meta-analysis.","authors":"Kasturi Selvam, Mohamad Ahmad Najib, Muhammad Fazli Khalid, Azian Harun, Ismail Aziah","doi":"10.21315/mjms2024.31.6.4","DOIUrl":"10.21315/mjms2024.31.6.4","url":null,"abstract":"<p><p>Melioidosis is a life-threatening infectious disease caused by the bacterium <i>Burkholderia pseudomallei</i>. Although culture is the gold standard for diagnosing melioidosis, it is time-consuming and delays timely treatment. Non-culture-based diagnostic techniques are interesting alternatives for the rapid detection of melioidosis. This systematic review provides an overview of the performance of antibody-detection tests for melioidosis. A thorough literature search was conducted in two databases to identify relevant studies published until 31 December 2023. Among the 453 studies identified, 29 were included for further analysis. Various antibody-detection methods have been developed, primarily enzyme-linked immunosorbent assays (ELISAs). Recombinant outer membrane protein A-(OmpA)-specific immunoglobulin G (IgG), immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin D (IgD) exhibited the highest accuracy, with a sensitivity of 95.0% and a specificity of 98.0% in ELISA. Furthermore, immunochromatographic testing has emerged as a promising rapid diagnostic test (RDT), with haemolysin co-regulated protein 1 (Hcp1) demonstrating significant accuracy, a sensitivity of 88.3%, and a specificity of 91.6%. Additionally, IgG against <i>Burkholderia</i> invasion protein D (BipD) showed excellent accuracy, with a sensitivity of 100.0% and a specificity of 100.0% in surface plasmon resonance assay. Combining multiple antigens or employing different detection techniques can enhance the accuracy of melioidosis diagnosis.</p>","PeriodicalId":47388,"journal":{"name":"Malaysian Journal of Medical Sciences","volume":"31 6","pages":"34-56"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Psychosocial Functioning Among Long-stay Schizophrenia Patients in a Malaysian Mental Institution.","authors":"Pey Fang Teo, Eugene Boon Yau Koh, Seng Choi Chong","doi":"10.21315/mjms2024.31.6.14","DOIUrl":"10.21315/mjms2024.31.6.14","url":null,"abstract":"<p><strong>Background: </strong>A considerable number of schizophrenia patients still require long-term hospital care despite psychiatric deinstitutionalisation, especially in developing nations. Prolonged hospitalisation is associated with greater impairment in psychosocial functioning. This study aimed to determine the level of psychosocial functioning and its predictors among long-stay schizophrenia patients in a Malaysian mental institution.</p><p><strong>Methods: </strong>This cross-sectional study included 138 patients selected through universal sampling. Data on socio-demographics, illness characteristics such as psychopathology and illness severity [measured using the Brief Psychiatric Rating Scale (BPRS)], and cognitive function [assessed using the Montreal Cognitive Assessment (MoCA)] were collected. The Personal and Social Performance (PSP) scale was used to evaluate psychosocial functioning. Pearson correlation coefficients and multiple linear regression analyses were applied to identify the correlates and predictors of psychosocial functioning.</p><p><strong>Results: </strong>This study found that 47.8% and 16.7% of the patients had moderate and severe cognitive impairments, respectively. The mean PSP score was 69.68 (standard deviation (SD) = 15.48). Female gender, previous unemployment and more severe cognitive impairments were significantly associated with poorer psychosocial functioning. Meanwhile, negative symptoms and age of onset were negatively correlated with psychosocial functioning. By contrast, the duration of illness was positively correlated with psychosocial functioning. The regression model indicated that being female (β = -7.32, <i>p</i> < 0.001), previously unemployed (β = -3.67, <i>p</i> < 0.047), having negative symptoms (β = -4.18, <i>p</i> < 0.001), experiencing a longer illness duration (β = -0.60, <i>p</i> = 0.004), and the presence of severe cognitive impairment (β = -9.80, <i>p</i> < 0.001) significantly predicted poorer psychosocial functioning.</p><p><strong>Conclusion: </strong>Long-stay schizophrenia patients experience substantial difficulties in psychosocial functioning. Factors such as gender, last employment status, negative symptoms, illness duration, and cognitive function affect psychosocial functioning.</p>","PeriodicalId":47388,"journal":{"name":"Malaysian Journal of Medical Sciences","volume":"31 6","pages":"178-193"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Factors Associated with a High Risk of Malnutrition among Older Adults in the East Coast of Peninsular Malaysia.","authors":"Asma Amaran, Nani Draman, Nur Suhaila Idris, Sakinah Harith","doi":"10.21315/mjms2024.31.6.15","DOIUrl":"10.21315/mjms2024.31.6.15","url":null,"abstract":"<p><strong>Background: </strong>Older people are more susceptible to malnutrition. Malnutrition is defined as imbalances and deficiencies of nutrients that result in diminished function. However, malnutrition identification through nutrition screening is not routinely performed at Malaysian health clinics or hospitals. Our study aimed to determine the proportion of older people at high risk of malnutrition and its associated factors.</p><p><strong>Methods: </strong>This was a cross-sectional study conducted among older persons aged ≥ 60 years, and the exclusion criteria were older persons with known cases of dementia or the inability to stand and have hand problems that limit the ability to hold the dynamometer. Sociodemographic data and anthropometry assessment were conducted. Malnutrition risk screening tool-hospital, modified Barthel Index and the Elderly Cognitive Assessment Questionnaire were used in this study. The data were analysed using descriptive statistics and multiple logistic regression.</p><p><strong>Results: </strong>A total of 200 older persons participated in the study, and the proportion of the high risk of malnutrition was 27 (13.5%). Poor handgrip strength odd ratio (OR) = 3.56, 95% confidence interval (CI) = 1.41, 8.98; <i>p</i> = 0.007) and living arrangements (OR = 4.6, 95% CI = 1.31, 16.1; <i>p</i> = 0.017) were significantly associated with a high risk of malnutrition in older persons.</p><p><strong>Conclusions: </strong>The proportion of older persons at high risk of malnutrition was low (13.5%). Poor handgrip strength and living arrangements are significant factors associated with a high risk of malnutrition among older persons. Nutrition screening can help identify the cause and other factors of malnutrition. The role of healthcare personnel should be emphasised in nutrition screening, as they are commonly the first point of contact for patients seeking medical advice.</p>","PeriodicalId":47388,"journal":{"name":"Malaysian Journal of Medical Sciences","volume":"31 6","pages":"194-204"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Morbidity and Mortality of COVID-19 Patients During the Period of June 2020-September 2021 in Sulianti Saroso Infectious Disease Hospital, Indonesia.","authors":"Pompini Agustina Sitompul, Nina Mariana, Siti Maemun, Aninda Dinar Widiantari, Farida Murtiani, Rosamarlina Rosamarlina, Adria Rusli, Titi Sundari, Tri Bayu Purnama","doi":"10.21315/mjms2024.31.5.15","DOIUrl":"https://doi.org/10.21315/mjms2024.31.5.15","url":null,"abstract":"<p><strong>Objectives: </strong>The increasing mortality rate of COVID-19 has remained an international public health concern. Limited studies on clinical treatment and morbidity in hospital settings are available in Indonesia. This present study aims to analyse demographic characteristics, clinical signs and treatment in COVID-19 patients and their association to the mortality case in Sulianti Saroso Infectious Disease Hospital.</p><p><strong>Methods: </strong>The study applied a retrospective cohort approach to all COVID-19 inpatients confirmed by polymerase chain reaction (PCR) testing in Sulianti Saroso Infectious Disease Hospital from 1 June 2020 to 30 September 2021. Overall survival rates until the end of the study were calculated using the Kaplan-Meier method and compared using the log-rank test. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors.</p><p><strong>Results: </strong>We collected 1,970 inpatient data that met our inclusion and exclusion criteria. Most of them were 19 years old-59 years old (73.2%) and male (52.6%), and 966 (49%) patients had comorbidities. Approximately 63.9%, 89.2%, 89.8%, 82%, and 14.1% of the patients had ferritin levels ≤ 800, received antiviral treatment, were treated in non-intensive wards, had a moderate or mild clinical stage and did not survive, respectively. In the adjusted analysis, mortality was associated with sex (hazard ratio [HR]: 1.12; 95% CI: 1.02, 1.23), presence of comorbidity (HR: 1.19; 95% CI: 1.08, 1.30) and favipiravir (FPV) plus azithromycin treatment (HR: 1.21; 95% CI: 1.06,1.39). FPV treatment (HR: 1.35; 95% CI: 1.04, 1.75) was associated with higher mortality.</p><p><strong>Conclusion: </strong>Tailored approaches to treatment, considering individual risk factors and comorbidities, are crucial in improving patient outcomes.</p>","PeriodicalId":47388,"journal":{"name":"Malaysian Journal of Medical Sciences","volume":"31 5","pages":"215-230"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11477462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the New Norm Elements in Emergency Departments in Malaysia During a Pandemic: A Fuzzy Delphi Method.","authors":"Jivanya Raj Selvaraju, Nik Ab Rahman Nik Hisamuddin","doi":"10.21315/mjms2024.31.5.17","DOIUrl":"https://doi.org/10.21315/mjms2024.31.5.17","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) have had to cope with various pandemics, such as HIN1, Ebola and the currently ongoing COVID-19. This study aimed to determine the elements of the new norm that has introduced changes into healthcare systems, particularly EDs, during the COVID-19 pandemic and to obtain consensus from the experts, the Emergency physicians in EDs across Malaysia. No previous study has been conducted on this topic.</p><p><strong>Methods: </strong>This study used the fuzzy Delphi method (FDM) to acquire expert consensus. There were two phases in this study. The first involved extracting the elements to be assessed by the selected experts from a literature review. Three major domains were considered: infrastructure, governance and human resources. A total of 35 items were identified and divided into the three domains. In the second phase, the selected items were sent to a group of 15 ED physicians, who were asked to rate the items on a Likert-type scale. The data were then analysed using FDM.</p><p><strong>Results: </strong>A total of 35 items were identified as possible new norms from a literature search for the three domains (governance, infrastructure and human resources). The first step of the FDM analysis showed that 9 out of the 35 items did not fulfil the initial requirement of the FDM, since the threshold value (<i>d</i>) must be lower than 0.2 (<i>d</i> </ 0.2). In meeting the second condition for the FDM, 25 out of the 35 items had an expert consensus of > 75%. Regarding the third requirement for FDM, only 1 out of the 35 items did not meet the criteria of an average fuzzy number (<i>A</i> value) of > 0.5. Finally, 25 items fulfilled all three requirements of FDM, so these were retained and the remaining 10 items were discarded.</p><p><strong>Conclusion: </strong>The FDM used in this study had identified 25 items achieved the required level of agreement by the chosen experts. The results of this study can be used to guide EDs in Malaysia to utilise the new norms items in mitigating major outbreak affecting the ED services.</p>","PeriodicalId":47388,"journal":{"name":"Malaysian Journal of Medical Sciences","volume":"31 5","pages":"241-255"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11477466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}