The Delivery Model of Perceived Medical Service Quality Based on Donabedian's Framework.

ABSTRACT: The implementation of the National Health Insurance has transformed the medical care landscape in Taiwan, rendering perceived medical service quality (PMSQ) and patient satisfaction significant focal points in medical care management. Past studies mostly focused on the technical aspects of medical care services, while overlooking the patients' perception of services and the delivery process of PMSQ in the medical care experience. This study integrated the theoretical framework of the Donabedian SPO model and the SERVQUAL questionnaire. The survey was conducted among the outpatients of three types of medical institutions in northern Taiwan: academic medical centers, metropolitan hospitals, and local community hospitals. A total of 400 questionnaires were collected, and 315 valid questionnaires remained after eliminating the incomplete ones. This study established a PMSQ delivery model to explore patients' perceptions of medical service quality. It was found that the variable, Assurance, could deliver the PMSQ and enhance the Medical outcome (MO), while improving the variable, Tangible, in medical institutions could not significantly enhance the MO. These findings emphasize the importance of healthcare institutions prioritizing the professional background, demeanor of their healthcare staff, treatment methods, and processes over tangible elements.

Ultrasound imaging of extensive peripheral macrocysts in chronic total combined rhegmatogenous-traction retinal detachment.

Purpose: To report a case of a 42-year-old male with proliferative diabetic retinopathy (PDR) complicated by tractional retinal detachments (TRD) bilaterally with a rare finding on B-scan ultrasonography. Observations: On B-scan ultrasound, a total combined rhegmatogenous-TRD was observed, accompanied by extensive retinal macrocysts that appeared nearly confluent for 360°. Conclusions and Importance: Retinal macrocysts are rare but important clinical entities that help drive management, as their presence typically suggests a chronic retinal detachment.

Thyroid Eye Disease With Divergence Insufficiency Causing Recurrent Falls in an Elderly Patient.

Recurrent falls are a common cause of morbidity in the elderly population, as more than one-third of individuals aged 65 years or older experience falls each year. Falls remain a multifactorial phenomenon that can potentially result in devastating debilitation and hence require proper medical attention and management. In an elderly patient presenting with recurrent falls, the workup for differential diagnoses remains wide with various causes such as postural hypotension, syncope, seizures, arrhythmia, medication-induced, and cognitive impairment. In this report, we discuss an interesting case of recurrent falls in an elderly woman with hyperthyroidism who was repeatedly found to have unremarkable lab results and negative imaging studies. She was later diagnosed with divergence insufficiency with intermittent esotropia secondary to thyroid ophthalmopathy, which was the cause of her underlying horizontal diplopia contributing to her falls. This can cause blurry vision at further distances, which is observed especially in individuals older than 50 years. Treatment typically involves prism therapy, surgery in refractory patients, and, currently, novel therapy using teprotumumab infusion. The patient was referred to see a strabismus specialist for prism prescription and possible surgical intervention. In elderly patients with a history of recurrent falls, a comprehensive visual exam should be strongly considered, especially for individuals with repeated negative workups, to prevent further testing or procedures.

YY1 and HDAC9c transcriptionally regulate p38-mediated mesenchymal stem cell differentiation into osteoblasts.

Mesenchymal stem cells (MSCs) have a high self-renewal potential and can differentiate into various types of cells, including adipocytes, osteoblasts, and chondrocytes. Previously, we reported that the enhancer of zeste homolog 2 (EZH2), the catalytic component of the Polycomb-repressive complex 2, and HDAC9c mediate the osteogenesis and adipogenesis of MSCs. In the current study, we identify the role of p38 in osteogenic differentiation from a MAPK antibody array screen and investigate the mechanisms underlying its transcriptional regulation. Our data show that YY1, a ubiquitously expressed transcription factor, and HDAC9c coordinate p38 transcriptional activity to promote its expression to facilitate the osteogenic potential of MSCs. Our results show that p38 mediates osteogenic differentiation, and this has significant implications in bone-related diseases, bone tissue engineering, and regenerative medicine.

Targeted expression of BikDD combined with metronomic doxorubicin induces synergistic antitumor effect through Bax activation in hepatocellular carcinoma.

Conventional chemotherapy is commonly used to treat advanced non-resectable hepatocellular carcinoma (HCC) but this treatment modality has not demonstrated convincing survival benefit in HCC patients. Our previous studies indicated that targeted expression of therapeutic BikDD driven by a liver cancer-specific α-fetoprotein promoter/enhancer (eAFP) in the VISA backbone (eAFP-VISA-BikDD) significantly and specifically kills HCC cells in multiple orthotopic animal models. To enhance its therapeutic efficacy, we combined eAFP-VISA-BikDD with chemotherapeutic agents and found that eAFP-VISA-BikDD plus doxorubicin (Dox) or 5-fluorouracil (5-FU) demonstrated synergistic cytotoxicity in HCC cells. Specifically, the combination of eAFP-VISA-BikDD plus Dox markedly induced apoptosis via increased Bax mitochondrial translocation and cytoplasmic cytochrome c release. Compared with either agent alone, a low dose of Dox combined with eAFP-VISA-BikDD induced better antitumor effect and prolonged longer survival of mice in two orthotopic liver cancer xenograft models. Our findings provide strong preclinical support for evaluating the combined therapy of eAFP-VISA-BikDD and Dox in a clinical setting as a treatment option for HCC.