A Non-decision-reaching Decision-making process

Decision-making processes are among the most important activities within human organizations. This dissertation is a case study of decision-making in the review of high school graduation standards in an urban school district. The review process lasted three years and was terminated before any decision was reached concerning graduation standards. The purpose of this study is to answer three questions: Why would a decision-making process be terminated before any results are achieved? Under what circumstances do decision makers choose to let the process die? What do such decision making processes reveal about the organization? This case study employs the rational choice model, the process model, and the organizational decision-making model. These three models are constructed within the theoretical frameworks of systems science, sociology, and political science, and also draw upon the literatures of education reform and organization theory. Define a NDR (non-decision-reaching) decision-making process as one which produces no outcome. The rational choice model suggests that the NDR outcome in this case was the best alternative under the circumstances. Two obstacles, insufficient resources and external uncertainties, were identified as important factors which led decision makers to choose the NDR outcome over other alternatives. The process model suggests that a decision outcome may not be necessary in many organizational decision-making processes, as the process itself is often significant and sufficient. The process accommodates, to some extent, the interests of the decision makers even without a definite outcome. The organizational decision-making model posits that organizational rules and procedures dictate decision-making processes, and that organizational interests will determine the nature and the outcome of such processes. In this model the NDR outcome is the result of organizational interests that no decision be reached. The conclusions of this case study indicate that a loose structural relationship among the decision makers was a major cause of the NDR outcome. In addition, the decision makers had never fully reconciled their differences regarding the nature of the decision problem. The changing environment of public education is also identified as a factor leading to the NDR outcome

Validation of CliEndomet as a diagnostic tool for endometriosis

Background: Endometriosis is one of the most common gynaecological disorders affecting the reproductive age group of women. The current gold standard in diagnosing this disease is via direct visualisation of endometriosis lesion intraoperatively and followed histological confirmation. Detection of non-invasive test is one of the priorities in endometriosis research. CliEndomet which was formulated by a group of researchers in Hospital Universiti Sains Malaysia using clinical manifestations, ultrasound findings and serum CA-125 had shown to be in substantial agreement with the intraoperative findings of endometriosis, but there is a need to validate the accuracy and reliability of CliEndomet using a more objective method i.e. histology confirmation. Objectives: The main objective of this study is to assess the accuracy of CliEndomet in the diagnosis of endometriosis with histopathology as the confirmation. It also serves to determine the accuracy of CliEndomet in staging the severity of endometriosis. Methodology: This was a cross sectional study that involving 94 patients who presented with symptoms of dysmenorrhea and chronic pelvic pain suggestive of endometriosis. Data regarding the symptoms, physical examination, scan findings and serum CA-125 were obtained preoperatively and scoring done according to CliEndomet into high possibility and low possibility group. Patients were then subjected to operation accordingly and the intraoperative findings were obtained regarding presence of endometriotic lesion. If endometriosis was clinically diagnosed, the disease was staged according to the revised American Society for Reproductive Medicine (ASRM) staging system. Regardless of the presence oftypical endometriotic lesion, tissue biopsy was taken during the operation for histopathology confirmation. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), positive likelihood ratio (PPV) , negative likelihood ratio (NPV), likelihood ratio positive (LR +) and likelihood ratio negative (LR-). The reliability for the diagnosis of endometriosis using CliEndomet was tested using Kappa coefficient. Results: A total of 94 patients were recruited into this study. Of the 94 patients, 56 were confirmed to have endometriosis by histology examination, and 50 were noted to have high risk for endometriosis using the CliEndomet scoring system. CliEndomet was shown to be 69.6% sensitive to diagnose endometriosis with positive predictive value of 78%. It has 71.1% of specificity and 61.4% negative predictive value. Its positive likelihood ratio was 2.41 and negative likelihood ratio of 0.43. CliEndomet was shown to have a fair agreement in diagnosing endometriosis (κ = 0,397 (95% CI, 0,21-0,58), p <0.005). During the surgery, 62 patients were found to have endometriosis. These patients were classified into having early stage endometriosis (AFS scoring system: minimal and mild endometriosis), and advanced stage disease (AFS scoring system: moderate and severe endometriosis). Of those who have early stage endometriosis, 5 patients had low risk and 2 had high risk of endometriosis according to the CliEndomet scoring system. Among those in the advanced stage disease, 12 patients were scored as low risk and 43 were scored as high risk. The sensitivity of CliEndomet to detect early stage endometriosis was 42% with positive predictive value of 29%. It is more capable to detect advanced stage disease (specificity 78%, negative predictive value of 96%).Conclusions: CliEndomet has a role to diagnose endometriosis in patients who refuse invasive diagnostic method. It is more accurate to predict the existence of advanced disease then early stage disease