RESUMEN
PURPOSE: Previous studies show that the hospital environment and the behavior of health care personnel may predict patients' perceptions of care quality. The aim of the study was to explore changes in perceived care quality from the patients' perspective (QPP) when hospital services are relocated from an old to a new high-tech hospital and to describe what is important for patients in the high-tech hospital. PATIENTS AND METHODS: A comparative cross-sectional design was used. The questionnaire QPP, which is based on a theoretical model of the quality of care comprising four quality dimensions, was used. Data were collected in 2015 (old hospital) and 2016 (new hospital), with 253 and 324 respondents, respectively, by consecutive sampling. Comparative statistics was used to test differences between patients' care quality perceptions (perceived reality [PR] and subjective importance [SI]) (P≤0.05). RESULTS: The patients rated PR of all four quality dimensions (the care organization's physical-technical conditions and sociocultural approach and the caregivers' medical-technical competence and identity-oriented approach) higher in the new hospital. However, only the two quality dimensions concerning the care organization were rated significantly more highly. On an item level, five of the 27 items scored significantly higher on patients' SI than on patients' PR of the care in the new hospital, indicating a quality deficiency from the patients' perspective. This comprised receiving effective pain relief, receiving examination and treatment within an acceptable waiting time, receiving useful information on self-care, receiving useful information on which doctors were responsible for their medical care, and having a comfortable bed. CONCLUSION: The increase in care QPP was associated with improved environmental conditions, and no significant improvement in care quality was associated with the health care personnel. The results indicate that being in a high-tech environment does not improve patients' perceptions of care quality provided by health care personnel. The results gave valuable information for quality improvement in clinical practice, based on the patients' perspective.
RESUMEN
BACKGROUND: The endothelin axis has recently emerged as an important factor in tumour metastasis. The aim of this study was to investigate the endothelin axis and its downstream pathways related to metastasis in colon carcinoma. MATERIALS AND METHODS: mRNA expression of 36 genes associated with the endothelin axis in 18 non-metastatic and 20 metastatic colon carcinomas with individual-matched normal mucosa were evaluated using real-time reverse transcription polymerase chain reaction. RESULTS: Seventeen out of 36 genes, including endothelin A receptor, were significantly overexpressed in the tumour tissue compared to the individual-matched normal mucosa. Seven out of 36 genes, including endothelin B receptor, were significantly down-regulated in tumour tissue. Phosphatase and tensin homolog (PTEN) was significantly down-regulated in the metastatic patients compared to the non-metastatic patients. CONCLUSION: This study indicated that central genes in the endothelin axis are overexpressed when colon tissue becomes malignant. Down-regulation of PTEN may promote a progressive phenotype of colon carcinomas.
