• Journal of Korean Academy of Nursing Administration
• /
• v.2 no.1
• /
• pp.97-114
• /
• 1996

INSTRODUCTION Service quality is, unlike goods quality, an abstract and elusive constuct. Service quality and its requirements are not easily understood by consumers, and also present some critical research problems. However, quality is very important to marketers and consumers in that it has many strategic benefits in contributing to profitability of marketing activities and consumers' problem-solving activities. Moreover, despite the phenomenal growth of medical service sector, few researchers have attempted to define and model medical service quality. Especially, little research has focused on the evaluation of medical service quality and patient satisfaction from the perspectives of both the provider and the patient. As competition intensifies and patients are demanding higher quality of medical service, medical service quality and patient satisfaction has emerged as a critical research topic. The major purpose of this article is to explore the concept of medical service quality and its evaluation from both nurse and patient perspectives. This article attempts to achieve its purpose by (1)classfying critical service attibutes into threecategories(satisfiers, hygiene factors, and performance factors). (2)measuring the relative importance of need criteria, (3)evaluating SERVPERF model and SERVQUAL model in medical service sector, and (4)identifying the relationship between perceived quality and overall patient satisfaction. METHOD Data were gathered from a sample of 217 patients and 179 nurses in Seoul-area general hospitals. From the review of previous literature, 50 survey items representing various facets of the medical service quality were developed to form a questionnaire. A five-point scale ranging from "Strongly Agree"(5) to "Strongly Disagree"(1) accompanied each statement(expectation statements, perception statements, and importance statements). To measure overall satisfaction, a seven-point scale was used, ranging from "Very Satisfied"(7) to "Very Dissatisfied"(1) with no verbal labels for scale points 2 through 6 RESULTS In explaining the relationship between perceived performance and overall satisfaction, only 31 variables out of original 50 survey items were proven to be statistically significant. Hence, a penalty-reward analysis was performed on theses 31 critical attributes to find out 17 satisfiers, 8 hygiene factors, and 4 performance factors in patient perspective. The role(category) of each service quality attribute in relation to patient satisfaction was com pared across two groups, that is, patients and nurses. They were little overlapped, suggesting that two groups had different sets of 'perceived quality' attributes. Principal components factor analyses of the patients' and nurses' responses were performed to identify the underlying dimensions for the set of performance(experience) statements. 28 variables were analyzed by using a varimax rotation after deleting three obscure variables. The number of factors to be extracted was determined by evaluating the eigenvalue scores. Six factors wereextracted, accounting for 57.1% of the total variance. Reliability analysis was performed to refine the factors further. Using coefficient alpha, scores of .84 to .65 were obtained. Individual-item analysis indicated that all statements in each of the factors should remain. On 26 attributes of 31 critical service quality attributes, there were gaps between actual patient's importance of need criteria and nurse perceptions of them. Those critical attributes could be classified into four categories based on the relative importance of need criteria and perceived performance from the perspective of patient. This analysis is useful in developing strategic plans for performance improvement. (1) top priorities(high importance and low performance) (in this study)- more health-related information -accuracy in billing - quality of food - appointments at my convenience - information about tests and treatments - prompt service of business office -adequacy of accommodations(elevators, etc) (2) current strengths(high importance and high performance) (3)unnecessary strengths(low importance and high performance) (4) low priorities(low importance and low performance) While 26 service quality attributes of SERPERF model were significantly related to patient satisfation, only 13 attributes of SERVQUAL model were significantly related. This result suggested that only experience-based norms(SERVPERF model) were more appropriate than expectations to serve as a benchmark against which service experiences were compared(SERVQUAL model). However, it must be noted that the degree of association to overall satisfaction was not consistent. There were some gaps between nurse percetions and patient perception of medical service performance. From the patient's viewpoint, "personal likability", "technical skill/trust", and "cares about me" were most significant positioning factors that contributed patient satisfaction. DISCUSSION This study shows that there are inconsistencies between nurse perceptions and patient perceptions of medical service attributes. Also, for service quality improvement, it is most important for nurses to understand what satisfiers, hygiene factors, and performance factors are through two-way communications. Patient satisfaction should be measured, and problems identified should be resolved for survival in intense competitive market conditions. Hence, patient satisfaction monitoring is now becoming a standard marketing tool for healthcare providers and its role is expected to increase.

• The Korean Society of Law and Medicine
• /
• v.23 no.4
• /
• pp.29-74
• /
• 2022

As social disasters occur under the Disaster Management Act, which can damage the people's "life, body, and property" due to the rapid spread and spread of unexpected COVID-19 infectious diseases in 2020, information collected through inspection and reporting of infectious disease pathogens (Article 11), epidemiological investigation (Article 18), epidemiological investigation for vaccination (Article 29), artificial technology, and prevention policy Decision), (3) It was used as an important basis for decision-making in the context of an infectious disease crisis, such as promoting vaccination and understanding the current status of damage. In addition, medical policy decisions using infectious disease data contribute to quarantine policy decisions, information provision, drug development, and research technology development, and interest in the legal scope and limitations of using infectious disease data has increased worldwide. The use of infectious disease data can be classified for the purpose of spreading and blocking infectious diseases, prevention, management, and treatment of infectious diseases, and the use of information will be more widely made in the context of an infectious disease crisis. In particular, as the serious stage of the Disaster Management Act continues, the processing of personal identification information and sensitive information becomes an important issue. Information on "medical records, vaccination drugs, vaccination, underlying diseases, health rankings, long-term care recognition grades, pregnancy, etc." needs to be interpreted. In the case of "prevention, management, and treatment of infectious diseases", it is difficult to clearly define the concept of medical practicesThe types of actions are judged based on "legislative purposes, academic principles, expertise, and social norms," but the balance of legal interests should be based on the need for data use in quarantine policies and urgent judgment in public health crises. Specifically, the speed and degree of transmission of infectious diseases in a crisis, whether the purpose can be achieved without processing sensitive information, whether it unfairly violates the interests of third parties or information subjects, and the effectiveness of introducing quarantine policies through processing sensitive information can be used as major evaluation factors. On the other hand, the collection, provision, and use of infectious disease data for research purposes will be used through pseudonym processing under the Personal Information Protection Act, consent under the Bioethics Act and deliberation by the Institutional Bioethics Committee, and data provision deliberation committee. Therefore, the use of research purposes is recognized as long as procedural validity is secured as it is reviewed by the pseudonym processing and data review committee, the consent of the information subject, and the institutional bioethics review committee. However, the burden on research managers should be reduced by clarifying the pseudonymization or anonymization procedures, the introduction or consent procedures of the comprehensive consent system and the opt-out system should be clearly prepared, and the procedure for re-identifying or securing security that may arise from technological development should be clearly defined.

• Journal of Environmental Health Sciences
• /
• v.34 no.3
• /
• pp.188-198
• /
• 2008

Since 2003, the National Institute of Environmental Research (NIER) of Korea has been conducting "The monitoring study on exposure level and biomarkers of environmental pollutants" in the Ulsan industrial complex with the goals to establish a surveillance system for residents, to evaluate the health effects associated with chronic exposure to environmental pollutants and to develop the environmental health indicators in Ulsan industrial complex. This program consists of three phases an initial or foundation phase in which the program is developed, made operational and extended to the community, followed by an evaluation and accountability assessment of the surveillance system and finally an improvement in the quality of life and the maintenance of good health for Ulsan residents. In the period 2003 to 2008, the study program developed the surveillance system which will be used for the full-length survey. All participants in this study were contacted at a presentation meeting for residents, introduced to the objectives and protocols of the survey, and asked to participate. Informed consent was obtained from each participant. The study is now underway and includes questionnaires, health examinations and the analysis/collection/banking of bio-sample such as blood and urine. To date 828 subjects have participated and already 588 subjects have been followed up. We are committed to complete health examinations and to arrange storage of biosample for all participants. During the current year, we will analyze metals (Pb in blood and Cd, inorganic As and Hg in urine) in 1,972 samples and VOCs (11 species) and PARs (18 species) in 300 samples (blood sample). Moreover, the summary of the first step and the further preparation of the second step are currently underway. In this article, we introduce the study and its protocols and the distribution and size of the study participants. In conclusion, this survey will be continuously conducted on the established cohort and will enable the identification of relationship between environmental pollutant exposures and the health status of residents in Ulsan industrial complex.

• Journal of Pharmaceutical Investigation
• /
• v.37 no.3
• /
• pp.137-148
• /
• 2007

Using a strain-controlled rheometer [Rheometrics Dynamic Analyzer (RDA II)], the steady shear flow properties of a semi-solid ointment base (vaseline) have been measured over a wide range of shear rates at temperature range of $25{\sim}60^{\circ}C$. In this article, the steady shear flow properties (shear stress, steady shear viscosity and yield stress) were reported from the experimentally obtained data and the effects of shear rate as well as temperature on these properties were discussed in detail. In addition, several inelastic-viscoplastic flow models including a yield stress parameter were employed to make a quantitative evaluation of the steady shear flow behavior, and then the applicability of these models was examined by calculating the various material parameters (yield stress, consistency index and flow behavior index). Main findings obtained from this study can be summarized as follows : (1) At temperature range lower than $40^{\circ}C$, vaseline is regarded as a viscoplastic material having a finite magnitude of yield stress and its flow behavior beyond a yield stress shows a shear-thinning (or pseudo-plastic) feature, indicating a decrease in steady shear viscosity as an increase in shear rate. At this temperature range, the flow curve of vaseline has two inflection points and the first inflection point occurring at relatively lower shear rate corresponds to a static yield stress. The static yield stress of vaseline is decreased with increasing temperature and takes place at a lower shear rate, due to a progressive breakdown of three dimensional network structure. (2) At temperature range higher than $45^{\circ}C$, vaseline becomes a viscous liquid with no yield stress and its flow character exhibits a Newtonian behavior, demonstrating a constant steady shear viscosity regardless of an increase in shear rate. With increasing temperature, vaseline begins to show a Newtonian behavior at a lower shear rate range, indicating that the microcrystalline structure is completely destroyed due to a synergic effect of high temperature and shear deformation. (3) Over a whole range of temperatures tested, the Herschel-Bulkley, Mizrahi-Berk, and Heinz-Casson models are all applicable and have an almostly equivalent ability to quantitatively describe the steady shear flow behavior of vaseline, whereas the Bingham, Casson,and Vocadlo models do not give a good ability.

• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.14
• /
• pp.6033-6038
• /
• 2015

Background: Experience of lung cancer includes negative impacts on both physical and psychological health. Pain is one of the negative experiences of lung cancer. Cognitive behavioral therapy techniques are often recommended as treatments for lung cancer pain. The objective of this review was to synthesize the evidence on the effectiveness of cognitive behavioral therapy techniques in treating lung cancer pain. This review considered studies that included lung cancer patients who were required to 1) be at least 18 years old; 2) speak and read English or Thai; 3) have a life expectancy of at least two months; 4) experience daily cancer pain requiring an opioid medication; 5) have a positive response to opioid medication; 6) have "average or usual" pain between 4 and 7 on a scale of 0-10 for the day before the clinic visit or for a typical day; and 7) able to participate in a pain evaluation and treatment program. This review considered studies to examine interventions for use in treatment of pain in lung cancer patients, including: biofeedback, cognitive/attentional distraction, imagery, hypnosis, and meditation. Any randomized controlled trials (RCTs) that examined cognitive behavioral therapy techniques for pain specifically in lung cancer patients were included. In the absence of RCTs, quasi-experimental designs were reviewed for possible conclusion in a narrative summary. Outcome measures were pain intensity before and after cognitive behavioural therapy techniques. The search strategy aimed to find both published and unpublished literature. A three-step search was utilised by using identified keywords and text term. An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all the identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference list of all identified reports and articles were searched for additional studies. Searches were conducted during January 1991- March 2014 limited to English and Thai languages with no date restriction. Materials and Methods: All studies that met the inclusion criteria were assessed for methodological quality by three reviewers using a standardized critical appraisal tool from the Joanna Briggs Institute (JBI). Three reviewers extracted data independently, using a standardized data extraction tool from the Joanna Briggs Institute (JBI). Ideally for quantitative data meta-analysis was to be conducted where all results were subject to double data entry. Odds ratios (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were to be calculated for analysis and heterogeneity was to be assessed using the standard Chi-square. Where statistical pooling was not possible the finding were be presented in narrative form. Results: There were no studies located that met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to cognitive behavioral therapy techniques pain and lung cancer patients.Conclusions: There is currently no evidence available to determine the effectiveness of cognitive behavioural therapy techniques for pain in lung cancer patients.

• Journal of the Korea Society of Computer and Information
• /
• v.25 no.5
• /
• pp.73-79
• /
• 2020

As the number of earthquakes gradually increases on the Korean Peninsula, much research has been actively conducted to detect earthquakes quickly and accurately. Because traditional seismic stations are expensive to install and operate, recent research is currently being conducted to detect earthquakes using low-cost MEMS sensors. In this article, we evaluate how a low-cost MEMS acceleration sensor installed in a smartphone can be used to detect earthquakes. To this end, we installed about 280 smartphones at various locations in Korea to collect acceleration data and then assessed the installed sensors' noise floor through PSD calculation. The noise floor computed from PSD determines the magnitude of the earthquake that the installed MEMS acceleration sensors can detect. For the last few months of real operation, we collected acceleration data from 200 smartphones among 280 installed smartphones and then computed their PSDs. Based on our experiments, the MEMS acceleration sensor installed in the smartphone is capable of observing and detecting earthquakes with a magnitude 3.5 or more occurring within 10km from an epic center. During the last several months of operation, the smartphone acceleration sensor recorded an earthquake of magnitude 3.5 in Miryang on December 30, 2019, and it was confirmed as an earthquake using STA/LTA which is a simple earthquake detection algorithm. The earthquake detection system using MEMS acceleration sensors is expected to be able to detect increasing earthquakes more quickly and accurately.

• Clinics in Shoulder and Elbow
• /
• v.12 no.2
• /
• pp.255-263
• /
• 2009

Purpose: An osseous defect in the glenoid and humeral head is closely associated with recurrence of anterior shoulder instability. The purpose of this article is to describe the open surgical techniques and introduce our experiences with anterior instability with a significant osseous defect. Materials and Methods: We reviewed the articles that have focused on and/or mentioned the affect of osseous defects on anterior shoulder instability. The open surgical techniques and its related pearls are summarized in this review. Results: Accurate evaluation for the size and location of the osseous defect is critical for preventing recurrence after restoration of the anterior capsulolabral structure. The glenoid bone restoration techniques include the coracoids transfer (the Bristow procedure and the Latarjet procedure) and a structural iliac bone graft. Rotational humeral osteotomy and an osteoarticular allograft could be used for repairing a significant posterosuperior humeral defect (Hill-Sachs lesion). Shoulder arthroplasty may be tried for treating a humeral bone defect, but more study on this is needed. Conclusion: Open surgical restoration decreases the risk of recurrence anterior shoulder instability that is combined with a significant osseous defect. Arthroscopic surgery currently has limitations for treating an osseous defect, but it will become useful in proportion to the development of arthroscopic instruments and techniques in the future.

• The Journal of the Korea Contents Association
• /
• v.19 no.5
• /
• pp.187-193
• /
• 2019

Key-value storage engines are an essential component of growing demand in many computing environments, including social networks, online e-commerce, and cloud services. Recent key-value storage engines offer many features such as transaction, versioning, and replication. In a key-value storage engine, transaction processing provides atomicity through Write-Ahead-Logging (WAL), and a synchronous commit method for transaction processing flushes log data before the transaction completes. According to our observation, flushing log data to persistent storage is a performance bottleneck for key-value storage engines due to the significant overhead of fsync() calls despite the various optimizations of existing systems. In this article, we propose a group synchronization method to improve the performance of the key-value storage engine. We also design and implement a transaction scheduling method to perform other transactions while the system processes fsync() calls. The proposed method is an efficient way to reduce the number of frequent fsync() calls in the synchronous commit while supporting the same level of transaction provided by the existing system. We implement our scheme on the WiredTiger storage engine and our experimental results show that the proposed system improves the performance of key-value workloads over existing systems.

• Korean Medical Education Review
• /
• v.17 no.2
• /
• pp.78-87
• /
• 2015

Mongolia is suffering from the inadequate capacity of medical doctors due to a poor education and training system. The purpose of this article is to evaluate the effect of a clinical training program for capacity building of medical doctors in Mongolia, and to suggest an effective model for continuing professional development in developing countries. Based on the results of a needs assessment, Korean and Mongolian medical experts developed a clinical training program and trained the trainers on 32 topics regarding major clinical problems in 6 specialties, including cardiology, endocrinology, pediatrics, obstetrics and gynecology, neurology, and emergency medicine. Surveillance survey and pre/post-test were used on every topic to evaluate the satisfaction and achievement, respectively, of the trainees. Six months after the clinical training program, we interviewed a sample of medical professionals to evaluate the change and impact. A total of 612 (person-year) medical doctors participated in the training, and the average score for satisfaction was 7.69 out of 8. The average score of the pre-test was 46.9 out of 100, while the post-test was 82.4. After the training, the medical doctors were applying their new knowledge and skills to their practice, and using the materials as guidelines, which improved their practice and increased patient satisfaction. They also started their own training program and adopted new equipment at their hospitals. The satisfaction and achievement of the trainees were very high, and there was significant change in the medical practice, education system, and infrastructure after the training program. This training program can be an effective model for capacity building of medical doctors in developing countries.

• Journal of Construction Engineering and Project Management
• /
• v.8 no.4
• /
• pp.1-24
• /
• 2018

In the last decade, the use of Building Information Modeling (BIM) as a new technology has been applied with traditional Computer-aided design implementations in an increasing number of architecture, engineering, and construction projects and applications. Its employment alongside construction management, can be a valuable tool in helping move these activities and projects forward in a more efficient and time-effective manner. The traditional stakeholders, i.e., Owner, A/E and the Contractor are involved in this BIM system that is used in almost every activity of construction projects, such as design, cost estimate and scheduling. This article extracts major features of the application of BIM from perspective of participating BIM components, along with the different phrases, and applies to them a logistic analysis using a fuzzy performance tree, quantifying these phrases to judge the effectiveness of the BIM techniques employed. That is to say, these fuzzy performance trees with fuzzy logic concepts can properly translate the linguistic rating into numeric expressions, and are thus employed in evaluating the influence of BIM applications as a mathematical process. The rotational fuzzy models are used to represent the membership functions of the performance values and their corresponding weights. Illustrations of the use of this fuzzy BIM performance tree are presented in the study for the uninitiated users. The results of these processes are an evaluation of BIM project performance as highly positive. The quantification of the performance ratings for the individual factors is a significant contributor to this assessment, capable of parsing vernacular language into numerical data for a more accurate and precise use in performance analysis. It is hoped that fuzzy performance trees and fuzzy set analysis can be used as a tool for the quality and risk analysis for other construction techniques in the future. Baldwin's rotational models are used to represent the membership functions of the fuzzy sets. Three scenarios are presented using fuzzy MEAN, AND and OR gates from the lowest to intermediate levels of the tree, and fuzzy SUM gate to relate the intermediate level to the top component of the tree, i.e., BIM application final performance. The use of fuzzy MEAN for lower levels and fuzzy SUM gates to reach the top level suggests the most realistic and accurate results. The methodology (fuzzy performance tree) described in this paper is appropriate to implement in today's construction industry when limited objective data is presented and it is heavily relied on experts' subjective judgment.