The Effect of Service Quality and Corporate Image on Student Satisfaction and Loyalty in TVET Higher Learning Institutes (HLIS)

The 11th Malaysia Plan has emphasised that TVET HLIs is expected to increase the number of enrolment, improve quantity and quality of graduate to meet industry demand. This is not an easy task.  In a competitive higher learning sector, previous researches revealed that TVET institutes is facing challenges such as service quality and image issue which could have effect the level of student satisfaction and loyalty. Thus, the main objective of this research is to measure the linkages of service quality, corporate image, student satisfaction and loyalty in one framework for TVET HLIs. Stimulus- Organism- Response (SOR) model is adapted to conceptualise the relationship between the constructs. Six hypotheses have been developed. The scope of study is focus on student from TVET HLIs under higher education institutes of Council of Trust for the People (MARA). Since this study adapted quantitative method, a set of questionnaire was used for data collection. 398 data were collected and analysed using SPSS and PLS-SEM. The measurement model indicated that the measurement items are reliable and valid. The structural model indicates that there is a direct and significance effect between service quality, corporate image, student satisfaction and student loyalty. Thus, all hypotheses are supported. This research suggested that future research to investigate the mediating effect in the research framework and the scope of study to be extended to other TVET HLIs

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Efficacy of steroid injection versus physiotherapy treatment in work related trigger finger

Stenosing tenosynovitis or trigger finger is a common problem among patients seeking treatment in the orthopaedic clinic. Multiple approaches can be used to treat a patient with a trigger finger. This study to compare the functional outcome of steroid injection versus physiotherapy between service and professional workers with trigger finger. We use observational cohort study. Evaluating the functional outcome of treatment physiotherapy and steroid injection among professional and service workers for trigger finger grade I, II, and III. We also assess the recurrence of the affected finger. Malaysia Standard Classification of Occupation 2013 (MASCO) has been used to classify two working groups: professional and service worker. Michigan Hand Outcomes Questionnaire (MHQ) used for the finger assessment. The patient was observed with three separated visits; pre-treatment visits, six months and 12 months. The patient was divided into two groups of steroid injection and physiotherapy for evaluation of functional outcome and recurrence. The total number of patients recruited is 149 with 75 in the professional group and 74 in the service group. Out of the 149 patients, 80 were treated with physiotherapy and 69 were with steroid injection. There was no association between the occupation and the grading of trigger finger and the affected finger itself. Functional outcome using MHQ score for steroid group shows a good 12 months outcome (P values <0.01) comparing with physiotherapy group. Functional outcome in terms of physiotherapy was lower compared to steroid injection at six months and 12 months. The recurrence rate in physiotherapy was higher than in the steroid injection group. Single steroid injection had a better functional outcome after six months and 12 months post-intervention compared with physiotherapy. Physiotherapy treatment can be suggested to patients with grade 1, 2, and 3 of trigger finger who refused any steroid injection

Efficacy of steroid injection versus physiotherapy treatment in work related trigger finger

Introduction Stenosing tenosynovitis or trigger finger is a common problem among patients seeking treatment in the orthopaedic clinic. Trigger finger is characterized by locking or painful snapping when flexing the. Multiple approaches can be used to treat a patient with trigger finger. It can be divided into two major groups, either conservative or operative treatment. Conservative treatment varies in modalities. It includes non-steroidal anti-inflammatory drugs, ice packing, extension splint, physiotherapy, or corticosteroid injection. Operative treatment release the annular A1 pulley percutaneously or open. Objective This study to compare the functional outcome of steroid injection versus physiotherapy between service and professional workers. Method We are using observational cohort study. Michigan Hand Outcomes Questionnaire (MHQ) used for trigger finger grade I, II, and III. Patient was observed with pre-treatment visits, 6 months and 12 months. Patient was divided into two group steroid injection and physiotherapy for evaluation of functional outcome and recurrence rate. We used Malaysia Standard Classification of Occupation 2013 (MASCO) to identify 2 working group between professional and service & sales worker group. Result The total number of patients recruited is 149. It can be divided into 2 main groups, a professional group with a total number of patients of 75 and a service & sales worker with around 74 patients. Out of the 149 patients, 80 were treated with physiotherapy and 69 were treated with steroid injection. There was no association between the occupation and the grading of trigger finger and the trigger finger itself. Functional outcome using MHQ score for steroid group shows a good 12 months outcome (P values <0.01). Functional outcome in terms of physiotherapy was lower compared to steroid injection at 6 months and 12 months. The recurrence rate in physiotherapy was higher than in the steroid injection group. Conclusion Single steroid injection had better functional outcome after 6 months and 12 months post intervention compared with physiotherapy. Physiotherapy treatment can be suggested to patients with grade 1, 2, and 3 of trigger finger who refused any steroid injection

A compact triband microstrip antenna utilizing hexagonal CSRR for wireless communication systems

In this paper, a compact triband printed antenna with hexagonal complementary split-ring resonators (CSRRs) for 4G applications is proposed. The proposed multiband antenna is comprised of a rectangular patch antenna on the top plane, while on the ground plane, hexagonal CSRRs are etched for size miniaturization (at the lower bands) and multiband generation. Another effect of the CSRR is the shifting of the initial resonance of the patch antenna from 5.17 GHz to the higher band of 6.18 GHz. The triband of 180 MHz 2.4~2.59, 150 MHz 2.79~2.94 and 420 MHz 6.04~6.46 GHz bands acquired can cover WLAN/Wi-Fi and WiMAX operating bands adequately. This can be achieved by choosing the optimal size and position of the CSRR on the ground plane carefully. The design occupies a total size of 45 x 45 mm2 using the low-cost FR-4 substrate. Good agreements are obtained between the measured results and the simulated, which are discussed and presented

Biohydrogen Production by Antarctic Psychrotolerant Klebsiella sp. ABZ11

Lower temperature biohydrogen production has always been attractive, due to the lower energy requirements. However, the slow metabolic rate of psychrotolerant biohydrogen-producing bacteria is a common problem that affects their biohydrogen yield. This study reports on the improved substrate synthesis and biohydrogen productivity by the psychrotolerant Klebsiella sp. strain ABZ11, isolated from Antarctic seawater sample. The isolate was screened for biohydrogen production at 30°C, under facultative anaerobic condition. The isolate is able to ferment glucose, fructose and sucrose with biohydrogen production rate and yield of 0.8 mol/l/h and 3.8 mol/g, respectively at 10 g/l glucose concentration. It also showed 74% carbohydrate uptake and 95% oxygen uptake ability, and a wide growth temperature range with optimum at 37°C. Klebsiella sp. ABZ11 has a short biohydrogen production lag phase, fast substrate uptake and is able to tolerate the presence of oxygen in the culture medium. Thus, the isolate has a potential to be used for lower temperature biohydrogen production process

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London