Exploring Consumers' Negative Electronic Word-of-Mouth of 5 Military Hospitals in Taiwan Through SERVQUAL and Flower of Services: Web Scraping Analysis.

BACKGROUND: In recent years, with the widespread use of the internet, the influence of electronic word-of-mouth (eWOM) has been increasingly recognized, particularly the significance of negative eWOM, which has surpassed positive eWOM in importance. Such reviews play a pivotal role in research related to service industry management, particularly in intangible service sectors such as hospitals, where they have become a reference point for improving service quality. OBJECTIVE: This study comprehensively collected negative eWOM from 5 military hospitals in Taiwan that were at or above the level of regional teaching hospitals. It aimed to investigate service quality issues before and after the pandemic. The findings provide important references for formulating strategies to improve service quality. METHODS: In this study, we used web scraping techniques to gather 1259 valid negative eWOM, covering the period from the inception of the first review to December 31, 2022. These reviews were categorized using content analysis based on the modified Parasuraman, Zeithaml, and Berry service quality (PZB SERVQUAL) scale and Flower of Services. Statistical data analysis was conducted to investigate the performance of service quality. RESULTS: The annual count of negative reviews for each hospital has exhibited a consistent upward trajectory over the years, with a more pronounced increase following the onset of the pandemic. In the analysis, among the 5 dimensions of PZB SERVQUAL framework, the "Assurance" dimension yielded the least favorable results, registering a negative review rate as high as 58.3%. Closely trailing, the "Responsiveness" dimension recorded a negative review rate of 34.2%. When evaluating the service process, the subitem "In Service: Diagnosis/Examination/Medical/Hospitalization" exhibited the least satisfactory performance, with a negative review rate of 46.2%. This was followed by the subitem "In Service: Pre-diagnosis Waiting," which had a negative review rate of 20.2%. To evaluate the average scores of negative reviews before and during the onset of the COVID-19 pandemic, independent sample t tests (2-tailed) were used. The analysis revealed statistically significant differences (P<.001). Furthermore, an ANOVA was conducted to investigate whether the length of the negative reviews impacted their ratings, which also showed significant differences (P=.01). CONCLUSIONS: Before and during the pandemic, there were significant differences in evaluating hospital services, and a higher word count in negative reviews indicated greater dissatisfaction with the service. Therefore, it is recommended that hospitals establish more comprehensive service quality management mechanisms, carefully respond to negative reviews, and categorize significant service deficiencies as critical events to prevent a decrease in overall service quality. Furthermore, during the service process, customers are particularly concerned about the attitude and responsiveness of health care personnel in the treatment process. Therefore, hospitals should enhance training and management in this area.

A comparative study of positive and negative electronic word-of-mouth on the SERVQUAL scale during the COVID-19 epidemic - taking a regional teaching hospital in Taiwan as an example.

BACKGROUND: In recent years, studies have shown that electronic WOM (eWOM) directly reflects consumers' post-purchase psychological perception and directly affects repurchase behavior. This information is valued by institutions in various fields. Within the scope of the evaluation of service characteristics, medical service is the least visible and most difficult service attribute to evaluate. Service organizations must have high trust attributes. Therefore, an eWOM review significantly influences people's decision-making process when choosing a healthcare provider. The purpose of this research is to combine eWOM reviews with the SERVQUAL scale in a comparative study of positive and negative eWOM reviews of a regional teaching hospital in Taiwan. METHODS: This research obtained data from publicly available eWOM reviews on Google Maps of a regional teaching hospital in Taiwan over the past 10 years (from June 24, 2011, to December 31, 2021) using website scraping technology. The semantic content analysis method was used in this study to classify eWOM reviews according to the revised PZB SERVQUAL scale. RESULTS: Statistical analysis was conducted. During the COVID-19 pandemic, positive reviews showed a downward trend. Among the five determinants of the SERVQUAL of PZB, positive eWOM reviews performed best in "assurance" with a positive review rate of 60.00%, followed by 42.11% for "reliability". For negative eWOM reviews, "assurance" performed the worst with a positive rate of 72.34%, followed by "responsiveness" at 28.37% and "reliability" at 26.95%. CONCLUSION: Since the onset of COVID-19 in 2020, negative eWOM has increased significantly and exceeded the amount of positive eWOM. Regardless of positive and negative reviews, what patients care most about is "assurance" of the professional attitude and skills of medical staff, which urgently needs to be strengthened. In addition, good "reliability" will help to develop positive eWOM. However, "responsiveness" as indicated by poor service waiting time can easily lead to the spread of negative eWOM. Hospital management should focus on these service-oriented qualities.

The choice of Taiwanese college students to vaccinate against severe special infectious pneumonia COVID-19 based on the integrated theory of planning behavior.

Taiwan's coronavirus (COVID-19) vaccine procurement was delayed until October 2021. With the vaccine's introduction in Taiwan, the public will have an opportunity to choose vaccination. Choosing to vaccinate involves considerations regarding the trade-off between the protective power of the vaccine and its side effects, which is a planned behavior. College students have considered high-risk objects for COVID-19 outbreaks given their lifestyle, and their efficient vaccination may help reduce mutual infection between college students and the general public. This study obtained 707 valid questionnaires from Taiwan college students (20 years old and above). We investigated several factors during our college students' survey regarding vaccination. Among this integrated TPB model, "Attitude," "Subjective Norm," "Perceived Behavioral Control," and "COVID-19 Information Asymmetry" had a positive impact on vaccination "Behavioral Intention." COVID-19 information asymmetry positively and significantly affected behavioral intention through perceived behavioral control, while perceived behavioral control had a mediating effect. To promote the behavioral intention of college students to choose COVID-19 vaccination, public and private departments for epidemic prevention must aim to overcome the self-efficacy barriers of perceived behavioral control and promote the primary group influence effect of subjective norm and the self-interest factor of attitude. Governments and NGOs should also ensure prompt and accurate transmission of epidemic and vaccine information and actively investigate and prohibit misleading details from unknown sources and no scientific basis. Such a policy will generate trust, effectively increasing the vaccination rate and reducing cluster infection.

Transdermal Delivery Systems of Natural Products Applied to Skin Therapy and Care.

Natural products are favored because of their non-toxicity, low irritants, and market reacceptance. We collected examples, according to ancient wisdom, of natural products to be applied in transdermal delivery. A transdermal delivery system, including different types of agents, such as ointments, patches, and gels, has long been used for skin concerns. In recent years, many novel transdermal applications, such as nanoemulsions, liposomes, lipid nanoparticles, and microneedles, have been reported. Nanosized drug delivery systems are widely applied in natural product deliveries. Nanosized materials notably enhance bioavailability and solubility, and are reported to improve the transdermal permeation of many substances compared with conventional topical formulations. Natural products have been made into nanosized biomaterials in order to enhance the penetration effect. Before introducing the novel transdermal applications of natural products, we present traditional methods within this article. The descriptions of novel transdermal applications are classified into three parts: liposomes, emulsions, and lipid nanoparticles. Each section describes cases that are related to promising natural product transdermal use. Finally, we summarize the outcomes of various studies on novel transdermal agents applied to skin treatments.

Inhibition of LPS-Induced Oxidative Damages and Potential Anti-Inflammatory Effects of Phyllanthus emblica Extract via Down-Regulating NF-κB, COX-2, and iNOS in RAW 264.7 Cells.

Phyllanthus emblica is an edible nutraceutical and functional food in the Asia area with medicinal and nutritive importance. The fruit extract of P. emblica is currently considered to be one of the effective functional foods for flesh maintenance and disease treatments because of its antioxidative and immunomodulatory properties. We examined the antioxidant abilities of the fruit extract powder by carrying out 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging, iron reducing power, and metal chelating activity analysis and showed excellent antioxidative results. In 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, the result showed that the samples had no cytotoxic effect on RAW 264.7 cells even at a high concentration of 2 mg/mL. To investigate its immunomodulatory function, our estimation was to treat it with lipopolysaccharide (LPS) in RAW 264.7 cells to present anti-inflammatory capacities. The extract decreased reactive oxygen species (ROS) production levels in a dose-dependent manner measured by flow cytometry. We also examined various inflammatory mRNAs and proteins, including nuclear factor-κB (NF-κB), inducible nitric oxide synthases (iNOS), and cyclooxygenase-2 (COX-2). In quantitative reverse transcription polymerase chain reaction (qRT-PCR) and western blotting assay, all three targets were decreased by the extract, also in a dose-dependent manner. In conclusion, P. emblica fruit extract powder not only lessened antioxidative stress damages, but also inhibited inflammatory reactions.

Direct glucose detection in whole blood by colorimetric assay based on glucose oxidase-conjugated graphene oxide/MnO2 nanozymes.

We herein report a facile approach for the preparation of horseradish peroxidase (HRP)-mimic glucose oxidase-conjugated graphene oxide/MnO2 (GOD-GO/MnO2) as new nanozyme to detect the glucose concentration in whole blood. The nano-sized of MnO2 nanoparticles embedded in bovine serum albumin (BSA)-coated GO by in situ growth were evaluated focusing on the principle of HRP-mimic activity catalyzing the oxidation of 3,3',5,5'-tetramethylbenzidine (TMB) in the presence of hydrogen peroxide. Furthermore, we constructed dual sensing platforms based on the combination of a plasma separation pad and GOD-GO/MnO2 for direct detection of glucose concentration in whole blood by colorimetric assay without blood sample pretreatment. As a proof-of-concept, a limit of detection of 3.1 mg dL-1 for glucose was obtained with a wide linear quantification range from 25 mg dL-1 to 300 mg dL-1 through visual observation and quantitative analysis, suggesting potential clinical applications in blood glucose monitoring for diabetic patients.

Spontaneous pneumothorax after steroid treatment in a patient with bronchiolitis obliterans organizing pneumonia.

Bronchiolitis obliterans organizing pneumonia (BOOP) is an uncommon pulmonary disorder which is a clinicopathologic syndrome. The typical symptoms include cough, fever and dyspnea. Corticosteroid therapy is effective. Death from progressive disease is infrequent. We report a case of BOOP in a 41-year-old male non-smoker, proved by pathologic findings. After steroid therapy (prednisolone 30 mg daily) for 10 days, he developed spontaneous pneumothorax of bilateral lung fields. Responses to steroid and chest tube thoracostomy were excellent. BOOP may be complicated with spontaneous pneumothorax which may adversely affect prognosis. BOOP should be included in the differential diagnosis of patients presenting with secondary spontaneous pneumothorax.