Perceived service quality, customer satisfaction and behavioural intentions towards hospitals in Sabah

Health system in Malaysia including hospitals, clinic and community health agencies can be very different from other work environments. Healthcare systems are complex and there are many things we need to know about types of hospital systems, patient care, insurance, healthcare providers and legal issues. This study aimed to examine the relationship among perceived service quality, customer satisfaction and behavioural intentions in the context of hospitals in Sabah, Malaysia. Information from 208 respondents were used through questionnaires for the purposed statistical data analysis using SmartPLS. The result showed only tangibles and empathy supports behavioural intentions in relations to health service providers in Sabah. This study tested relationships of tangibles, assurance and empathy with customer satisfactions respectively were shown to be significantly positive as well. Positive relationship between customer satisfaction and behavioural intentions was also observed in this study. As for the mediation analysis, the outcome indicated that tangibles, assurance and empathy respectively have indirect relationship with behavioural intentions mediated by customer satisfaction. Additional findings also showed that, while the direct effects of empathy on behavioural intentions was significant, the indirect impact was noted to be greater for behavioural intentions in connection with customer satisfaction as mediation. The result also showed that relative to other perceived service quality, empathy has the most impact on customer satisfaction as well as behavioural intentions respectively. The findings from this study significant to this industry which contribute to policy makers, service providers and other stakeholders

Bucket of nails: foreign body ingestion in a young adult

Foreign body (FB) ingestion is a potentially serious health problem. Majority of the cases are seen in pediatric populations; when encountered in adults, they are usually due to underlying mental health disturbances, edentulous state or alcohol intoxication. Most ingested FBs pass spontaneously. However, 10%–20% of cases require endoscopic intervention, while 1% or less require surgical procedures due to complications such as bowel perforation or obstruction. Medical history obtained from the patient is highly critical in the diagnosis of FB ingestion. Patients can present with a wide array of symptoms and signs such as dysphagia, non-specific abdominal pain, atypical chest pain, choking, gastrointestinal (GI) obstruction, GI bleeding as well as GI perforation. Presentations, clinical findings and management are distinct and based on the anatomical region where the FB is located

Single-stage inferior vena caval intravenous leiomyomatosis excision

Intravascular tumour extension can occur in many different types of cancer. Those with the highest tendency include renal cell carcinoma, adrenal cortical carcinoma and hepatocellular carcinoma. Inferior vena cava (IVC) tumour thrombus in gynaecological malignancy is rarely reported. We present a report on a female patient with extensive IVC tumour thrombus (intravenous leiomyomatosis) with concurrent intrauterine leiomyomatosis. She underwent a single-stage procedure, involving laparotomy and a sternotomy to remove her pelvic tumour, as well as the intracaval and intracardiac thrombus. The clinical presentation and management of this rare tumour will be detailed in this case report

Recurrent Femoral Artery Pseudoaneurysm: anticoagulant no more a life savior

Femoral artery pseudoaneurysm is a devastating complication after arterial access. It may thrombose spontaneously with conservative management. Failure to thrombose is multifactorial. We present a case of iatrogenic femoral artery pseudoaneurysm, developed recurrence after consumption of anticoagulant, which was surgically treated using traditional open repai

Appendiceal Goblet Cell Carcinoid: An Unexpected Histology Following Simple Appendicectomy

Goblet cell carcinoid (GCC) is an enigmatic and rare tumour involving the appendix almost exclusively. It is a rare, aggressive subtype of appendiceal tumours with neuroendocrine features, and controversy exists with regards to therapeutic strategy. We herein highlight a 56-year-old lady with GCC whom she presented initially with a typical presentation of acute appendicitis. The histologic hallmark of this entity is the presence of clusters of goblet cells in the lamina propria or submucosa stain for various neuroendocrine markers, though the intensity is often patchy. GCC of the appendix is rare and challenging. In advanced form, it can present with carcinoid symptoms but occasionally mimics classical presentations of acute appendicitis. A tumour measuring less than 1 cm and located at the tip of the appendix is sufficient for a simple appendicectomy which warrants a promising prognosis

Merendino procedure as an alternative to total gastrectomy in the treatment of gastrointestinal stromal tumors of the gastroesophageal junction: A case series

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the alimentary canal and are postulated to have originated from the interstitial cells of Cajal. We present three patients with an age range from 43 to 63 years old diagnosed with GIST of the gastroesophageal junction (GEJ). All patients were noted to have submucosal lesions through gastroscopy, in which the largest was 5 cm × 7 cm in size. All of them underwent emergent surgery due to various reasons, and the Merendino procedure was performed as the surgery of choice. All of them recovered well and were discharged on days 10–12. The histopathological examination demonstrated a GIST. Merendino procedure can improve patients’ digestive functions and nutritional status, leading to a better quality of life after surgery with a reduction in postoperative complications. This case series demonstrated proximal gastrectomy with Merendino procedure reconstruction as a safe, efficient, and feasible approach in treating gastric GISTs at the GEJ

Infected omental cyst complicated with subacute intestinal obstruction and ileal erosion in a 2-year-old boy: a case report

An omental cyst is a rare intraabdominal pathology that can cause acute abdomen and intestinal obstruction among children. A 2-year-old boy presented with fever, bilious vomiting, abdomen distension and loose stool of acute onset. The chest and abdominal radiographs showed right pleural effusion and prominent small bowels with thickening walls respectively. Ultrasonography revealed a gastrointestinal duplication cyst. An exploratory laparotomy was done and found a 5x5 cm infected omental cyst, severely adhered to and eroded into the ileum causing a small perforation. Omental cyst excision and ileal primary repair were done. The final diagnosis was a benign omental cyst. Omental cyst is usually asymptomatic; however, symptomatic omental cyst should be cautious for bleeding, intestinal obstruction, infection, torsion and rupture

Breast Cancer with Isolated Metastatic Temporomandibular Joint: A Surgeon’s Challenge

Breast cancer is the number one malignancy in women worldwide. It tends to metastasize distantly via lymphatic and haematogenous route. Skeletal metastases are frequent with more than three quarter of cases in all malignant bone tumours. Breast cancer can infiltrate the axial bone especially spine, but rarely affect the temporomandibular joint. In view of its rarity and the significance of early detection, the diagnosis is always challenging and shall be considered in the differential diagnosis. We endeavour to highlight this unfortunate 37-year-old lady who had just undergone left mastectomy and axillary dissection but was complicated with left temporomandibular joint metastasis

Primary neuroendocrine tumor of the liver: A diagnostic dilemma in the management of liver mass in pregnancy

Neuroendocrine tumor (NET) commonly occurs in the gastrointestinal tract, however primary NET of the liver is rare, especially during pregnancy. We present a 34-year-old pregnant woman gravida 3 para 2 at 16 weeks period of gestation with primary liver NET discovered incidentally during the antenatal check-up. She has no risk factors for hepatocellular carcinoma. Her serum alpha-fetoprotein was elevated. A plain magnetic resonance imaging (MRI) of the liver delineating a large well-defined exophytic liver mass at segment V/VI measuring 7.1 × 7.4 × 7.8 cm. Given inconclusive MRI findings coupled with low-risk factors of HCC, we had decided to follow up her liver mass with imaging 6 weekly. She then underwent a right hepatectomy with a caesarean delivery at 32 weeks of gestation in the same setting. The histopathological formal report revealed a neuroendocrine tumor, grade 2 with a Ki-67 index of 3% with negative lymphovascular and perineural invasion, but positive for porta hepatis lymph nodes metastasis. A follow up after 1 year shows both patient and her infant are healthy. Antenatal discovery of liver masses poses a diagnostic and management dilemma to clinicians. A multidisciplinary approach and collective decision making are crucial to determine the best approach tailored to the maternal and fetal benefit. In cases of inconclusive non-contrast MRI in pregnancy with low-risk factors and lack of clinical evidence of HCC, follow-up with imaging modalities aiming to intervene at the third trimester can offer safer, and promising outcomes