• Title/Summary/Keyword: Medical delivery system

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Service Quality of Dental Institutes Measured by SERVQUAL Model and Intention to Re-visit (SERVQUAL 모형으로 측정한 일부 치과의원의 서비스 질과 재이용의도)

  • Jun, Mee-Jin;Noh, Eun-Kyung
    • Journal of dental hygiene science
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    • v.10 no.1
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    • pp.55-61
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    • 2010
  • The main purpose of this study was to identify the service quality of some dental clinics located in Gwangju and find an association between service quality and patient's intention to re-visit the same dental clinic. The search objects were 197 patients from five dental clinics, and data collected by self-administered questionnaire which was composed general characteristics, characteristics relating to visit of clinics, quality of service, patients satisfaction and intentions to re-visit. The used statistical analysis to find the association between quality of service and intention to re-visit was multiple regression analysis. This study looked at relations between quality of dental service, service satisfaction and intentions to visit again, and found that quality of service including six service areas had a statistically significant positive correlations with satisfaction and intentions of re-visit. When this study conducted a multiple regression analysis to identify variables that influence intentions of re-visit, it found that patients revisited the dental clinic only when quality of service was included. In conclusion, quality of service evaluated by patients influenced on their intention of re-visit and especially. Therefore, this study concludes that improvement in satisfaction and intentions of re-visit relies on Accessibility, that is, providing of medical information, consultant telephone, how delivery the dental medical system is. Service quality of dental institutes measured by SERVQUAL model and intention to re-visit.

Parishioner's role Expectations of Parish Nursing (한국 교인들의 목회간호 역할기대)

  • Kim, Chung-Nam;Kwon, Young-Sook
    • Research in Community and Public Health Nursing
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    • v.11 no.1
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    • pp.231-244
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    • 2000
  • Parish nursing is a community health nursing role developed in 1983 by Lutheran Chaplain Granger Westberg. An increasing emphasis on holistic care, personal responsibility for a healthy lifestyle, and changes in healthcare delivery systems have undoubtedly facilitated the establishment of an innovative nursing role in the community. Parish nurses are functioning in a variety of church congregations of various denominations. The parish nurse is a educator, a personal health counselor, a coordinator of volunteers. The parish nurses helps people relate to the complexed medical care system and assists people to integrate faith and health. The purpose of this study is to investigate what the korean parishioners want in parish nursing and what type of role expectation from parish nurse. The subjects were 1138 parishioners of 23 churches of various denominations in nationwide Korea. Data were collected by self-reported question naires from Feb 4 to June 25. 1999. The data were analyzed by using percentage. frequency. $x^2-test$. multiple Response set with SPSS program. The results are as follows: 1. Desired parish nursing contents by parish nurses are: psychological counselling(23.4%) out of private counselling. stress management(21.1 %) out of private health education. Emergency care(14.1%) out of group health education. Blood Pressure check-ups (19.0%) out of Health check ups. home visiting(44.9%) out of patient visiting method. B T. pulse, respiration and blood pressure check(15.0%) in Care to serve in home visiting. spiritual preparation to accept the death(41.7%) in hospice care, advices to choice of medical treatment using guide(50.1%) in introducing and guiding of health care facilities, pray(21.7%) in spiritual care' faith support. 2. Desired Health Teaching Content According to Period of Clients by Parish Nurse are: Vaccination(22.5%) in infant and toddler health management. sexual education(25.3%) in adolescent health management. prenatal care (29.5%) in pregnant health management. osteoporosis prevention and management (22.4%) in Middle aged health management. dementia prevention and management(25.5%) in elderly health management. 3. The expectant role from parish nurse is spiritual care faith support(14.1%). patient visiting care(13.2%), hospice care(12.9%), private counseling(12.8%), health check ups (11.1 %), volunteer organization and training out of believer(11.0%), private health education (9.3%), group health education (8.3%). 4. In Necessity of Performing Parish Nursing according to Region, Most(over 95%) responded that nursing program is needed. so there is no significance between regions. In Performing Parish Nursing in their church, Most(92.2%) responded they want to perform program. 5. In case of performing parish nursing, 52% out of the subjects responded they want to participated in parish nursing volunteer's activity, for example. to be in active to be a companion to chat(42.1%), necessity support (25.3%), donation support(25.0%), exercise support(18.2%), vehicles support (9.9%). As a result. in holistic care and spiritual care, the need of parish nursing and the role expectation from parish nurse are very high among korean believers. Therefore, I suggest parish nursing centering around Taegu and Kyungbuk province should be extended to nationwide. For extending parish nursing program. more active advertisement and research is needed. After performing parish nursing program through out the country, further comparative research between regions should be practiced and Korean parish nursing program will be developed and activated.

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Evaluation of the Positional Accuracy of the Delivered Beams from the Target: A Phantom Study (방사선 치료에서 치료 표적과 조사 빔의 일치 정도 평가: 팬텀 연구)

  • Kang, Sei-Kwon;Cho, Byung-Chul;Cheong, Kwang-Ho;Ju, Ra-Hyeong;Kim, Su-Ssan;Kim, Kyoung-Ju;Choi, Sang-Gyu;Bae, Hoon-Sik;Lee, Re-Na;Oh, Do-Hoon
    • Progress in Medical Physics
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    • v.17 no.4
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    • pp.192-200
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    • 2006
  • We evaluated the positional accuracy of the delivered beams to the target in a phantom by simulating the whole process of the radiation treatments Including CT scanning, planning and beam exposures with MLCs. For this purpose, a phantom was made to calibrate the alignment between the CT and the attached laser system. A new, convenient method was also devised to align the setup lasers in the treatment room. Film was used for the Identification of the delivered beam and analyzed with a homemade computer program. The positional differences between the target and the beam centers varied with the couch rotations. The accelerator we used showed a maximum discrepancy of 2.0 mm at the table angle of $295^{\circ}$. The same measurements based on the new isocenter from the Winston-Lutz test resulted in the maximum of 1.35 mm for all rotation angles. The evaluation of the differences between the target and the beam centers is useful for the treatment planning.

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Efficient Verification of X-ray Target Replacement for the C-series High Energy Linear Accelerator

  • Cho, Jin Dong;Chun, Minsoo;Son, Jaeman;An, Hyun Joon;Yoon, Jeongmin;Choi, Chang Heon;Kim, Jung-in;Park, Jong Min;Kim, Jin Sung
    • Progress in Medical Physics
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    • v.29 no.3
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    • pp.92-100
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    • 2018
  • The manufacturer of a linear accelerator (LINAC) has reported that the target melting phenomenon could be caused by a non-recommended output setting and the excessive use of monitor unit (MU) with intensity-modulated radiation therapy (IMRT). Due to these reasons, we observed an unexpected beam interruption during the treatment of a patient in our institution. The target status was inspected and a replacement of the target was determined. After the target replacement, the beam profile was adjusted to the machine commissioning beam data, and the absolute doses-to-water for 6 MV and 10 MV photon beams were calibrated according to American Association of Physicists in Medicine (AAPM) Task Group (TG)-51 protocol. To verify the beam data after target replacement, the beam flatness, symmetry, output factor, and percent depth dose (PDD) were measured and compared with the commissioning data. The difference between the referenced and measured data for flatness and symmetry exhibited a coincidence within 0.3% for both 6 MV and 10 MV, and the difference of the PDD at 10 cm depth ($PDD_{10}$) was also within 0.3% for both photon energies. Also, patient-specific quality assurances (QAs) were performed with gamma analysis using a 2-D diode and ion chamber array detector for eight patients. The average gamma passing rates for all patients for the relative dose distribution was $99.1%{\pm}1.0%$, and those for absolute dose distribution was $97.2%{\pm}2.7%$, which means the gamma analysis results were all clinically acceptable. In this study, we recommend that the beam characteristics, such as beam profile, depth dose, and output factors, should be examined. Further, patient-specific QAs should be performed to verify the changes in the overall beam delivery system when a target replacement is inevitable; although it is more important to check the beam output in a daily routine.

A STUDY ON CLINICAL USE OF HYPERBARIC OXYGEN THERAY OF THE ORAL AND MAXILLOFACIAL REGION (고압산소치료의 구강악안면영역에서의 임상적 이용에 관한 연구)

  • Lyoo, Jung-Ho;Um, Ki-Hun;Bae, Jun-Su;You, Jun-Young;Jang, Myung-Jin;Kim, Yong Kwan
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.27 no.5
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    • pp.447-452
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    • 2001
  • Hyperbaric oxygen therapy(HBO) is defined as breathing 100% oxygen while in an enclosed system pressurized to greater than on atmosphere(sea level). This increased oxygen delivery furthers your body's ability to kill germs and to increase healing. HBO is a supplemental therapy to be used in addition to the current medical and surgical therapy you are receiving. HBO typically is used to complement treatments of medical problems such as bone infections, complication of radiotherapy, and certain chronic, non-healing wounds. On an emergency basis, the chamber also is used to treat problems such as carbon monoxide poisoning and the decompression sickness. We analysed stastically cases which are treated by hyperbaric oxygen therapy in point of oral and maxillofacial region on the Kangnam General Hospital for aid in comprehension and application of this therapy. Total 760 patients were treated at Gangnam General Hospital from July 1996 to September 1999. They were classified by region to Decompression sickness(DCS), Carbon monoxide poisoning(CO), General surgery(GS), Orthopedics(OS), Oral and Maxillofacial surgery(OMFS), others. Patients of Oral and Maxillofacial surgery were divided by diseses to Osteomyelitis, Osteoradionecrosis, Reconstruction, Bone graft, Difficult wounds, others. The results were as follows. 1. This institute conducts HBO therapy for DCS which takes up 62% and 10.5% for OMF region. 2. In OMF region, Osteomyelitis is 40%, Osteoradionecrosis is next, Bone graft, and Reconstruction is a row. 3. According to our precious study, HBO has been frequently conducted in OMF region compared to past, however, it is less actively conducted in this area for research than other conturies. Therefore, We need further application to the clinical use.

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Nurse Practitioner Roles and Curriculums in the United States (미국 전문간호사(NP)의 역할과 교육과정에 관한 고찰)

  • Lee Sun-Ock
    • The Journal of Korean Academic Society of Nursing Education
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    • v.5 no.1
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    • pp.97-105
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    • 1999
  • Based on literature, status and role of the NP in America was reviewed. The process of developing NP program in America suggests us many things. In America, nurse practitioners have sustained a mutually beneficial status with their patients for over thirty years. Excel fence in academic education and clinical training will enable nurse practitioners to continue to provide quality health care. The magnitude changes in the health care system of the United States, the challange of providing real access of health care continues. Lack of access to adequate primary care was the driving force in the initial 1965 Federal Involvement in developing the NP role. In 1993 President Bill Clinton's health care reform initiative provided policy support for NPs as primary care providers. The Institute of Medicine explicitly recognized NPs as an integral part of the primary care team. In addition, several national reports recognized NPs as affordable, accessible, high-quality care providers. The recent passage of direct Medicare reimbursement for NPs reflected public policy statements coincided with and likely contributed to a growth spurt in the NP workforce. From 1965 to 1977 NP programs offered traditional primary care clinical tracks(adult, family, woman's health, and pediatrics) for relatively small clusters of students in a variety of institutional settings. From 1978 to 1990 these educational programs were incorporated into graduate schools of nursing. By 1990 the majority of NPs received educational preparation in master's-level nursing programs. A new emphases was placed on postmaster's NP programs designed for master's prepared clinical nurse specialists and nurse managers. he the health care system shifted hospital nursing resources toward community-based care, these master's -level nurses sought additional NP preparation. NP educational programs are defined as the educational structure in which one or more NP clinical tracks are offered. NP clinical tracks, in turn, offer curriculum and supervised clinical experiences that match standards in specific practice areas such as family(FNP), adult(AUP), geriatrics(GNP), pediatrics(PNP), women's health (WHNP), neonatal (NNP), and acute care(ACNP). There were indications that NP practice was expanding into new clinical areas as evidenced by new types of tracks, particularly in acute care and psychiatry. The increase in acute care NP students likely reflects the increased demand from hospitals and other acute care settings. In Korea, change of nurse's role into nurse practitioner's role may have many difficulties. The need of health consumer, policy support of government, approval of medical care team are all essential component. Every nursing personnel make effort to planning the new health care delivery system.

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Development of validated Nursing Interventions for Home Health Care to Women who have had a Caesarian Delivery (조기퇴원 제왕절개 산욕부를 위한 가정간호 표준서 개발)

  • HwangBo, Su-Ja
    • Journal of Korean Academy of Nursing Administration
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    • v.6 no.1
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    • pp.135-146
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    • 2000
  • The purpose of this study was to develope, based on the Nursing Intervention Classification (NIC) system. a set of standardized nursing interventions which had been validated. and their associated activities. for use with nursing diagnoses related to home health care for women who have had a caesarian delivery and for their newborn babies. This descriptive study for instrument development had three phases: first. selection of nursing diagnoses. second, validation of the preliminary home health care interventions. and third, application of the home care interventions. In the first phases, diagnoses from 30 nursing records of clients of the home health care agency at P. medical center who were seen between April 21 and July 30. 1998. and from 5 textbooks were examined. Ten nursing diagnoses were selected through a comparison with the NANDA (North American Nursing Diagnosis Association) classification In the second phase. using the selected diagnoses. the nursing interventions were defined from the diagnoses-intervention linkage lists along with associated activities for each intervention list in NIC. To develope the preliminary interventions five-rounds of expertise tests were done. During the first four rounds. 5 experts in clinical nursing participated. and for the final content validity test of the preliminary interventions. 13 experts participated using the Fehring's Delphi technique. The expert group evaluated and defined the set of preliminary nursing interventions. In the third phases, clinical tests were held at in a home health care setting with two home health care nurses using the preliminary intervention list as a questionnaire. Thirty clients referred to the home health care agency at P. medical center between October 1998 and March 1999 were the subjects for this phase. Each of the activities were tested using dichotomous question method. The results of the study are as follows: 1. For the ten nursing diagnoses. 63 appropriate interventions were selected from 369 diagnoses interventions links in NlC., and from 1.465 associated nursing activities. From the 63 interventions. the nurses expert group developed 18 interventions and 258 activities as the preliminary intervention list through a five-round validity test 2. For the fifth content validity test using Fehring's model for determining lCV (Intervention Content Validity), a five point Likert scale was used with values converted to weights as follows: 1=0.0. 2=0.25. 3=0.50. 4=0.75. 5=1.0. Activities of less than O.50 were to be deleted. The range of ICV scores for the nursing diagnoses was 0.95-0.66. for the nursing interventions. 0.98-0.77 and for the nursing activities, 0.95-0.85. By Fehring's method. all of these were included in the preliminary intervention list. 3. Using a questionnaire format for the preliminary intervention list. clinical application tests were done. To define nursing diagnoses. home health care nurses applied each nursing diagnoses to every client. and it was found that 13 were most frequently used of 400 times diagnoses were used. Therefore. 13 nursing diagnoses were defined as validated nursing diagnoses. Ten were the same as from the nursing records and textbooks and three were new from the clinical application. The final list included 'Anxiety', 'Aspiration. risk for'. 'Infant behavior, potential for enhanced, organized'. 'Infant feeding pattern. ineffective'. 'Infection'. 'Knowledge deficit'. 'Nutrition, less than body requirements. altered', 'Pain'. 'Parenting'. 'Skin integrity. risk for. impared' and 'Risk for activity intolerance'. 'Self-esteem disturbance', 'Sleep pattern disturbance' 4. In all. there were 19 interventions. 18 preliminary nursing interventions and one more intervention added from the clinical setting. 'Body image enhancement'. For 265 associated nursing activities. clinical application tests were also done. The intervention rate of 19 interventions was from 81.6% to 100%, so all 19 interventions were in c1uded in the validated intervention set. From the 265 nursing activities. 261(98.5%) were accepted and four activities were deleted. those with an implimentation rate of less than 50%. 5. In conclusion. 13 diagnoses. 19 interventions and 261 activities were validated for the final validated nursing intervention set.

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A Method to Calculate a Pass Rate of the ${\gamma}$-index Analysis in Tomotherapy Delivery Quality Assurance (DQA) (단층치료기를 이용한 방사선 치료의 환자별 정도관리 평가를 위한 감마인덱스의 정량화 방법)

  • Park, Dahl;Kim, Yong-Ho;Kim, Won-Taek;Kim, Dong-Won;Kim, Dong-Hyun;Jeon, Ho-Sang;Nam, Ji-Ho;Lim, Sang-Wook
    • Progress in Medical Physics
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    • v.21 no.4
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    • pp.340-347
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    • 2010
  • DQA, a patient specific quality assurance in tomotherapy, is usually performed using an ion chamber and a film. The result of DQA is analysed with the treatment planning system called Tomo Planning Station (TomoPS). The two-dimensional dose distribution of film measurement is compared with the dose distribution calculated by TomoPS using the ${\gamma}$-index analysis. In ${\gamma}$-index analysis, the criteria such as 3%/3 mm is used and we verify that whether the rate of number of points which pass the criteria (pass rate) is within tolerance. TomoPS does not provide any quantitative information regarding the pass rate. In this work, a method to get the pass rate of the ${\gamma}$-index analysis was suggested and a software PassRT which calculates the pass rate was developed. The results of patient specific QA of the intensity modulated radiation therapy measured with I'mRT MatriXX (IBA Dosimetry, Germany) and DQA of tomotherapy measured with film were used to verify the proposed method. The pass rate was calculated using PassRT and compared with the pass rate calculated by OmniPro I'mRT (IBA Dosimetry, Germany). The average difference between the two pass rates was 0.00% for the MatriXX measurement. The standard deviation and the maximum difference were 0.02% and 0.02%, respectively. For the film measurement, average difference, standard deviation and maximum difference were 0.00%, 0.02% and 0.02%, respectively. For regions of interest smaller than $24.3{\times}16.6cm^2$ the proposed method can be used to calculate the pass rate of the gamma index analysis to one decimal place and will be helpful for the more accurate DQA in tomotherapy.

Success rate and marginal bone loss of Osstem USII plus implants; Short term clinical study (Osstem USII plus 임플란트의 단기간 성공률 및 변연골 흡수량 평가)

  • Kim, Sun-Keun;Kim, Jee-Hwan;Lee, Keun-Woo;Cho, Kyoo-Sung;Han, Dong-Hoo
    • The Journal of Korean Academy of Prosthodontics
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    • v.49 no.3
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    • pp.206-213
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    • 2011
  • Purpose: The aim of this study was to evaluate the clinical value of Osstem$^{(R)}$ USII plus system implants. Clinical and radiographic data were analyzed for 88 implants placed and functionally loaded for a 12 month period at the Yonsei University Dental Hospital. Materials and Method: Based on the patient's medical records, clinical factors and their effects on implant marginal bone resorption, distribution and survival rate were analyzed. The marginal bone loss was evaluated at implant placement and during a 6 to 12 months functional loading period. The independent sample t-test was used to evaluate the interrelationship between the factors (${\alpha}$=0.05), and one way repeated measures ANOVA was used to compare the amount of marginal bone resorption. Results: The cumulative survival rate for 88 implants was 100%. The marginal bone resorption from implant placement to prosthetic delivery was 0.24 mm and the average marginal bone resorption from prosthetic delivery to 12 months of functional loading was 0.19 mm. The total average bone resorption from implant placement to 12 months of functional loading was 0.43 mm. There were no statistically differences in the amount of marginal bone resorption when implants were placed in the maxilla or the mandible (P>.05), however, implants placed in the posterior areas showed significantly more marginal bone loss than those placed in the anterior areas (P<.05). Conclusion: Based on these results, the short term clinical success rate of RBM surface treated external connection domestic implants showed satisfactory results and the marginal bone loss was in accord with the success criteria of dental implants.

Model Development a Womens' Health Care Center in the Community (여성건강 간호센터를 위한 모형개발 - 일개 통합시를 중심으로-)

  • Lee, Eun-Hui;So, Ae-Yeong;Choe, Sang-Sun
    • Journal of Korean Academy of Nursing
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    • v.30 no.5
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    • pp.1195-1206
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    • 2000
  • The purpose of this study was to analyze womens' health problems using Green & Kreuter's 1991 PRECEDE model and to develop a model for a womens' health care center located in the community. The subjects were recruited from Wonju City. 1. The results showed that 23% of the sample population felt there was a need for a womens' health care center. The mean number of health problems was 3.1. The prevalence rate, was 44.4%, and the rate for an artificial abortion, was 36.4%. Also 30.5% did not have a health examination in the past year. Women using the hospital for medical care accounted for 45% of the sample, while 40% used the drugstore. The average score on the HPLP was 2.41, and this was influenced by self-efficacy, family support, sexual role, and health locus of control. There are a few educational programs in the city provided by the Wonju Health Center and by community health nurse practitioners. 2. The nursing center, as defined in North America, is a nurse-anchored system of primary health care delivery or neighborhood health center. Centers offer various services ranging from primary care to the more traditional such as education, health promotion, wellness screening, and coordination of services by advanced practice nurses. For examples in Sweden MCH centers provide total services for childbearing women and their families, sexual counseling and education for adolescents, and screening by midwives for cervical cancer. 3. The developed model combines purpose, target population, organization, and services, and is related to health resources. The purpose is primary health care and promotion of the quality of life. The target population can be grouped according to the life cycle, (premarriaged age group, the childbearing/child rearing age group, and middle aged and elderly women) and focuses on self-help. The organization of the center includes an advisory committee to plan and evaluate, and a health services team that will be multidisciplinary to provide health care, counseling education, and research. The model development suggested that a variety of women's health care centers are needed to insure adequate management of women's health. Follow-up research using PROCEED is needed to analyze health outcomes. Also a health nursing specialist system is required to develop health promotion, and improve the quality of life of women.

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