• The Journal of Asian Finance, Economics and Business
• /
• v.8 no.1
• /
• pp.419-430
• /
• 2021

The study aims to analyze the factors that shape patient loyalty, namely, by involving the service quality factor (SERVQUAL), hospital image, patient value, and patient satisfaction in private hospitals. This study was conducted in Makassar City, Indonesia, with a sample of 296 eligible samples from private hospitals. The sample criteria were patients with outpatient and hospitalization status. Then, this study developed 23 hypotheses to test the statistical relationship between direct, intervening and multiple-effect models. Problem-solving and research focus are carried out using a quantitative method approach with a PLS-SEM-based testing tool. The bootstrapping method is being used with the constant bootstrapping step to demonstrate the results of hypothesis testing; we find that the overall hypothesis has a positive and significant effect. The combination of testing models involving several variables shows that a patient's loyalty can be formed if a patient's satisfaction has been realized. Satisfaction can be realized if the value-customer has been felt by the patients. Therefore, the hospital image must be directly proportional to service quality. Service quality is the essence of service that directly affects customers; service quality is also the reason that shapes consumer perceptions in increasing rationalization and solid customer (patient's) decision-making.

• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.5
• /
• pp.1813-1816
• /
• 2015

Background: The aim of this study was to research the importance of the neutrophil to lymphocyte ratio (NLR) in prediction of PSA recurrence after radical prostatectomy, which has not been reported so far. Materials and Methods: The data of 175 patients who were diagnosed with localised prostate cancer and underwent retropubic radical prostatectomy was retrospectively examined. Patient pre-operative hemogram parameters of neutrophil count, lymphocyte count and NLR were assessed. The patients whose PSAs were too low to measure after radical prostatectomy in their follow-ups, and then had PSAs of 0,2 ng/mL were considered as patients with PSA recurrence. Patients with recurrence made up Group A and patients without recurrence made up Group B. Results: In terms of the power of NLR value in distinguishing recurrence, the area under OCC was statistically significant (p<0.001) .The value of 2.494 for NLR was found to be a cut-off value which can be used in order to distinguish recurrence according to Youden index. According to this, patients with a higher NLR value than 2.494 had higher rates of PSA recurrence with 89.7% sensitivity and 92.6% specificity. Conclusions: There are certain parameters used in order to predict recurrence with today's literature data.We think that because NLR is easy to use in clinics and inexpensive, and also has high sensitivity and specificity values, it has the potential to be one of the parameters used in order to predict biochemical recurrence in future.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.8
• /
• pp.4847-4851
• /
• 2013

Objectives: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancer cases and to determine prognostic value of metabolic tumor response. Materials and Methods: Between 2009 and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated with definitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3 oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14 females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy. Results: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients. Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection of residual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responders while it was 34% in non-complete responders. Conclusions: FDG PET CT is a valuable tool for assessment of treatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis. Definitely more precise criteria are required for assessment of response, there being no clear cut uptake value indicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appear as increased uptake in control FDG PET CT.

• Clinical and Experimental Emergency Medicine
• /
• v.5 no.4
• /
• pp.264-271
• /
• 2018

Objective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI. Methods Patients transported by EMS to 4 study hospitals from 2008 to 2012 were included. Using EMS and administrative emergency department databases, patients were stratified according to the presence of EMS-assessed cardiac symptoms and emergency department diagnosis of AMI. Cardiac symptoms were defined as chest pain, dyspnea, palpitations, and syncope. Disproportionate stratified sampling was used, and medical records of sampled patients were reviewed to identify an actual diagnosis of AMI. Using inverse probability weighting, verification bias-corrected diagnostic performance was estimated. Results Overall, 92,353 patients were enrolled in the study. Of these, 13,971 (15.1%) complained of cardiac symptoms to EMS providers. A total of 775 patients were sampled for hospital record review. The sensitivity, specificity, positive predictive value, and negative predictive value of EMS provider-assessed cardiac symptoms for the final diagnosis of AMI was 73.3% (95% confidence interval [CI], 70.8 to 75.7), 85.3% (95% CI, 85.3 to 85.4), 3.9% (95% CI, 3.6 to 4.2), and 99.7% (95% CI, 99.7 to 99.8), respectively. Conclusion We found that EMS provider-assessed cardiac symptoms had moderate sensitivity and high specificity for diagnosis of AMI. EMS policymakers can use these data to evaluate the pertinence of specific prehospital treatment of AMI.

• The Korean Journal of Health Service Management
• /
• v.8 no.2
• /
• pp.89-100
• /
• 2014

The purpose of this study was to reveal association between medical service quality, consumer satisfaction, service value and customer loyalty. Medical service quality was composed of physical quality, personal quality, technical quality, procedural quality. We thought these factors affect to the consumer satisfaction, service value and customer loyalty. For this study, 221 dental patients in Busan and Ulsan are participated in this study. The data were analyzed with descriptive statistics, t-test, ANOVA, pearson's correlation coefficients, and stepwise multiple regression analysis with SPSS 18.0 program. In conclusion, we obtained the next results. First, the influencing factor in consumer satisfaction were physical quality(${\beta}$=.519), personal quality(${\beta}$=.262), procedural quality(${\beta}$=.110), adjusted $R^2$=.537. Second, the influencing factor in service value were physical quality(${\beta}$=.253), personal quality(${\beta}$=.251), technical quality(${\beta}$=.210), procedural quality(${\beta}$=.136), adjusted $R^2$=.401. Third, the influencing factor in customer loyalty were personal quality(${\beta}$=.343), physical quality(${\beta}$=.302), procedural quality(${\beta}$=.148), adjusted $R^2$=.398. As dental patients' desire to medical service quality becomes diversified, the analysis result is considered to help the future dental service management.

• The Journal of Internal Korean Medicine
• /
• v.35 no.4
• /
• pp.483-497
• /
• 2014

Objectives: The aims of study were developing cut-off value of Yin-deficiency questionnaire (YDQ) for diagnosis of Yin-deficiency (YD) and compare diagnostic ability between YDQ and Yin-deficiency scale score (YDS) in xerostomia patients. Methods: We recruited 58 xerostomia patients. They were diagnosed YD or non-YD by 3 Korean medicine doctors (KMD). We assessed YD using YDQ and YDS. We evaluated xerostomia using VAS, Dry Mouth Symptom Questionnaire (DMSQ), Salivary Flow Rate (SFR), oral moisture on buccal mucosa and tongue surface (OMB and OMT). We surveyed tongue coatings using Winkel Tongue Coating Index (WTCI). Results: We diagnosed 23 patients YD and 35 patients non-YD. There were no significant differences of age, sex and body mass index between the YD and non-YD groups. Using receiver operating characteristic curve analysis, the optimal cut-off value of YDQ was defined as 304. Sensitivity, specificity and Youden index of YDQ were 86.96%, 71.43% and 1.5839 respectively. Using Cohen's coefficient of agreement, we found that degree of agreement between KMD and YDQ diagnosis was moderate (${\kappa}$=0.524, p<0.001). Using Pearson's correlation analysis, we found concurrent validity of YDQ and YDS were significant correlated. Using area under curve value, we found diagnostic ability between YDQ and YDS were not significantly different (p=0.505), but there were more strong correlations between DMSQ-symptoms and YDQ (r=0.731, p<0.001) than correlations between DMSQ-symptoms and YDS (r=0.418, p<0.01). Conclusions: The cut-off value of YDQ can diagnose YD in xerostomia and diagnostic ability of YDQ in xerostomia is better than YDS.

• Journal of Korean Academy of Nursing
• /
• v.4 no.2
• /
• pp.144-158
• /
• 1974

This study was undertaken in an attempt to; 1) measure value orientation of nursing activities, 2) identify the relationship between nurse's role perception and patient's expectation, and 3) evaluate the pattern of nursing education and nursing service administration. 203 hospitalized adults and 203 professional nurses from 11 general hospitals in Seoul during the period of July to December 1973 were tested according to questionnaire based on 4 categories of clinical nursing activities, 1) physical care, 2) observation and control, 3) psycho-social care and 4) therapeutic measures. Results of the study are as follows: 1. Nurses were more concerned than patients in the physical care category. Significant difference was revealed by p<.01 level (t=2.800). Mean value score of nurses was average (2.84), and mean value score of patients was relative' y low (2.49). None of the physical care category questionnaire items were over 3.5. 2. Respondents from hospitals of total care system revealed significant difference in the physical care category by P〈.025 level. (t=2.242). Mean value score of both group were average level (nurse 2.90, patient 2.53), nurses showed higher concern. 3. Difference between nurse's role perception and patient's expectation in observation and control category was revealed non- significance by p〉0.05. level (t=1.238). Mean value score of both group revealed relatively high (nurse=3.44, patient 3.19). 4. Difference between nurse's role perception and patient〉expectation in psycho-social cart category revealed non- significance by p〉.05 level (t=0.758), Mean value score of both group revealed average level (nurse =2.71, patient =2.53), 5. Non- significant difference was noted between B. S. N. and diploma nurse's role perception in the psycho- social care category by p> 0.1 level (t=0.316). 4. Difference between nurse's role perception and patient's expectation in the rapeutic me assures category revealed non- significance by p〉0.05 level) t=0.503). Horses showed high concern by mean value score 3.56 level and patients relatively high by 3.41. All items of this category revealed very high or relatively high value score.

• Journal of Korean Neurosurgical Society
• /
• v.49 no.2
• /
• pp.92-96
• /
• 2011

Objective : We retrospectively evaluated the prognostic factors that can influence long-term survival in patients who suffered acute large cerebral infarction. Methods : Between June 2003 and October 2008, a total of 178 patients were diagnosed with a large cerebral infarction, and, among them, 122 patients were alive one month after the onset of stroke. We investigated the multiple factors that might have influenced the life expectancies of these 122 patients. Results : The mean age of the patients was $70{\pm}13.4$ years and the mean survival was $41.7{\pm}2.8$ months. The mean survival of the poor functional outcome group ($mRS{\geq}4$) was $33.9{\pm}3.3$ months, whereas that of the good functional outcome group ($mRS{\leq}3$) was $58.6{\pm}2.6$ months (p value=0.000). The mean survival of the older patients (270 years) was $29.7{\pm}3.4$ months, whereas that of the younger patients (<70 years) was much better as $58.9{\pm}3.2$ months (p value=0.000). Involvement of ACA or PCA territory in MCA infarction is also a poor prognostic factor (p value=0.021). But, other factors that are also known as significant predictors of poor survival (male gender, hypertension, heart failure, atrial fibrillation, diabetes mellitus, a previous history of stroke, smoking, and dyslipidemia) did not significantly influence the mean survival time in the current study. Conclusion : Age (older versus younger than 70 years old) and functional outcome at one month could be critical prognostic factors for survival after acute large cerebral infarction. Involvement of ACA or PCA territory is also an important poor prognostic factor in patients with MCA territorial infarction.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.18
• /
• pp.7737-7740
• /
• 2014

Background: The neutrophil-to-lymphocyte ratio (NLR) is a strong predictor of mortality in patients with pancreatic, colorectal, lung, gastric cancer and renal cell carcinoma. The aim of this study was to determine the relationship between pathological complete response (pCR) and pretreatment NLR values in locally advanced breast cancer (BC) patients receiving neoadjuvant chemotherapy (NACT). Materials and Methods: Datawere collected retrospectively from the Akdeniz University School of Medicine Database for locally advanced BC patients treated with NACT between January 2000-December 2013. Results: A total of 78 patients were analyzed. Sixteen (20%) patients achieved pCR. Estrogen receptor (ER) positivity was lower in pCR+ than pCR-cases (p=0.011). The median NLR values were similar in both arms. The optimum NLR cut-off point for BC patients with PCR+ was 2.33 (AUC:0.544, 95%CI [0.401-0.688], p=0.586) with sensitivity, specificity, positive predictive value and negative predictive value (NPV) of 50%, 51,6%, 21,1%, and 80%, respectively. Conclusions: This study showed no relationship between the pCR and pretreatment NLR values. Because of a considerable high NPV, in the patients with higher NLR who had luminal type BC in which pCR is lower after NACT, such treatment may not be recommended.

• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.8
• /
• pp.3111-3116
• /
• 2015

Background: This study was designed to investigate the value of CEA and CA199 in predicting the treatment response to palliative chemotherapy for advanced gastric cancer. Materials and Methods: We studied 189 patients with advanced gastric cancer who received first-line chemotherapy, measured the serum CEA and CA199 levels, used RECIST1.1 as the gold standard and analyzed the value of CEA and CA199 levels changes in predicting the treatment efficacy of chemotherapy. Results: Among the 189 patients, 80 and 94 cases had increases of baseline CEA (${\geq}5ng/ml$) and CA199 levels (${\geq}27U/ml$), respectively. After two cycles of chemotherapy, 42.9% patients showed partial remission, 33.3% stable disease, and 23.8% progressive disease. The area under the ROC curve (AUC) for CEA and CA199 reduction in predicting effective chemotherapy were 0.828 (95%CI 0.740-0.916) and 0.897 (95%CI 0.832-0.961). The AUCs for CEA and CA199 increase in predicting progression after chemotherapy were 0.923 (95%CI 0.865-0.980) and 0.896 (95%CI 0.834-0.959), respectively. Patients who exhibited a CEA decline ${\geq}24%$ and a CA199 decline ${\geq}29%$ had significantly longer PFS (log rank p=0.001, p<0.001). With the exception of patients who presented with abnormal levels after chemotherapy, changes of CEA and CA199 levels had limited value for evaluating the chemotherapy efficacy in patients with normal baseline tumor markers. Conclusions: Changes in serum CEA and CA199 levels can accurately predict the efficacy of first-line chemotherapy in advanced gastric cancer. Patients with levels decreasing beyond the optimal critical values after chemotherapy have longer PFS.