• Radiation Oncology Journal
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• v.17 no.3
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• pp.209-216
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• 1999

Purpose : To evaluate the effectiveness of external radiation therapy and the prognostic factors, we retrospectively analyzed therapeutic results of malignant extrahepatic biliary obstruction (EHBO). Methods and Materials : We analyzed the results of the external radiation therapy in 59 patients of inoperable malignant EHBO who had been treated with more than 10 Gy of external radiation therapy from April 1984 to December 1990. There were 21 stomach cancer ($35.6\%$), 12 pancreas cancer ($20.3\%$), 15 extrahepatic biliary cancer ($18.0\%$) and 11 another cancer ($18.0\%$). Their pathologies were confirmed in 31 patients ($52.5\%$). They divided into 27 adenocarcinoma and 4 nonadenocarcinoma. Their chief complaints were jaundice in 47 patients ($79.7\%$) and abdominal pain in 15 patients ($49.2\%$). Twelve patients had slightly increased bilirubin level in liver function test without jaundice. We treated twenty four patients ($40.6\%$) with percutaneous transhepatic biliary drainage (PTBD) and 32 patients ($54\%$) with systemic chemotherapy (CT). We performed external radiation therapy (ERT) upto $10.8\~55.8$ Gy (median 37.8 Gy) with palliative aim. Results : Overall median survival duration was $7.80\pm1.15$ months. The response rates of jaundice were $81.8\%$ in PTBO group and $66.7\%$ in non-PTBD group without statistical significance. The improving rate of jaundice was not significantly different in decreased ratio of total bilirubin level. But abdominal pain was more decreased in CT group than non-CT group (p<0.05). The significant prognostic factors were high performance status (Karnofski Performance Status >70), total radiation dose more than 35 Gy and good response of pain after therapy. There were increased in bacterial cholagitis in PTBD group and gastrointestinal complications in CT group. Conclusion : External radiotheapy could improve jaundice and abdominal pain in malignant EHBO patients, Overall survival duration was prolonged in patients with higher performance status and patients who had been treated with more than 35 Gy of total radiation dose. In the future, we expect not only better palliative role but also the prolongation of survival of using the ERT combined with other treatment method. But to achieve certain conclusion, we need luther study consisted with many kinds of treatment methods including new technologies in RT.

• Asia Marketing Journal
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• v.14 no.1
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• pp.99-130
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• 2012

Service failure and a poor service recovery may lead loyal customers to try to aggressively punish the service firm. We use perceived betrayal and desire for vengeance as the key constructs to understand customer retaliation. Perceived betrayal is defined as a customer's belief that a firm has intentionally violated what is normative in the context of their relationship. And the desire for vengeance is defined as the retaliatory feelings that consumers feel toward a firm, such as the desire to exert harm on the firm. The perceived betrayal and the desire for vengeance are key antecedents of retaliatory behaviors such as vindictive complaining, negative WOM and third-party complaining for publicity. The empirical results suggest that betrayal is a key motivational factor that lead customers to restore fairness by making use of all means, including retaliation. We also find that relationship quality has effect on a customer's response to a failure in service recovery. As the levels of relationship increases, a violation of the proper fairness has a stronger effect on the sense of betrayal experienced by customers. Considerable research has investigated consumer responses to dissatisfaction. But our study examine the response of outraged and highly frustrated consumers. We focus on emotional and behavioral processes that have not been covered by previous dissatisfaction researches and which are unique to outraged consumers caused by extremely dissatisfied purchase experience. It has recently been pointed out by various mass media that the customers not only have positive effects on the company performance but also put the company in crisis. It has often been reported that one customer's dissatisfaction, for example, never ends as it is, and it tends to grow for retaliating upon the company, depending on the level of seriousness of the dissatisfaction. This sometimes leads to a lawsuit against the company. Our study focuses on the customers' emotional and behavioral responses induced by their extreme dissatisfactions. We divided the customer groups into the customers with high relationship quality and the customers with low relationship quality, and the difference between two groups is examined. The objective of this study is to comprehend the causal relationship between the feeling of betrayal caused by the service failure and the retaliatory behavior triggered by the desire of revenge. Our study is divided into three parts. First, a causal relationship between perceived unfairness and the perceived betrayal and desire for revenge. Second, the effect of the perceived betrayal and desire for revenge on the retaliatory behavior is investigated. Finally, the moderating role of relationship quality in the causal relationship between the unfairness in service recovery and the perceived betrayal is analyzed. This study finds the following empirical results. The distributive unfairness, procedural unfairness and interactional unfairness had significant effects on the perceived betrayal. Especially, the perceived distributive unfairness results in the highest perceived betrayal. When the service company does not provide customers proper and sufficient compensation for the failure, they feel the strong sense of betrayal. And in the causal relationship between the perceived betrayal, desire for revenge and retaliatory behavior, the perceived betrayal has significant effects on e desire for revenge. In addition desire for revenge has significant effects on negative word of mouth, retaliatory complaining behavior and publicity of complaints through third group. Therefore the perceived unfairness has effects on retaliatory behavior through the mediation of the perceived betrayal and desire for revenge. Finally the moderating role of relationship quality was examined in the relationship between the unfairness and perceived betrayal. If the customers experienced the perceived unfairness in the process of service recovery, the customers with high relationship quality feel the stronger perceived betrayal than the customers with low relationship quality do. When they experience the double service failure, the customer group with high relationship quality accumulating the sense of trust feel the more perceived betrayal than the customer with low relationship quality who do not have strong trust. The contribution of this study is to find the effect of the service failure on the retaliatory behavior with the moderating roles of relationship quality. The dimensions of unfairness in service recovery is found to have differential effects on the perceived betrayal, desire for revenge. And these differential effect is moderated by the level of relationship quality.

• The Korean Journal of Health Service Management
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• v.2 no.1
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• pp.137-154
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• 2008

The increase of the supply of medical service and the increase of hospitals have intensified the competition of hospitals, and the advancement towards internationalization in the opening of medical industry has triggered the infinite competition of medical profession. In addition, the high expectation of customers and quality improvement in the medical care in accordance with the improvement of overall income, and the change of active role of medical consumers according to the popularization and the improvement of rights awareness reflect the customer needs and choice in the medical service. Customers wanted to receive the kind and pleasant service under the up-to-date medical service. Therefore, as a solution, hospital coordinators were emerged for the purpose of smooth treatment and customer satisfaction by generalizing all service of hospital. Accordingly, this thesis attempted to investigate the effect of hospital coordinator education curriculum on the education satisfaction and the quality of medical service. In order to solve the purpose of this study, I, author reviewed the existing literatures, established hypothesis, and verified hypothesis by using the variety of statistics techniques such as reliability, validity, frequency analysis, and regression analysis. The verification of hypothesis is as followings: First, among education training factors of hospital coordinators, the quality of instructor significantly affects the satisfaction of hospital coordinator education training. Second, among training factors of hospital coordinator, the attitude of trainee significantly affects the training satisfaction of hospital coordinator. Third, among education training factors of hospital coordinator, education course significantly affects the training satisfaction of hospital coordinator education. As the qualities of instructor are better equipped, the satisfaction of education becomes higher. It indicates that the education method of instructors is important as an index to represent the qualities of instructor such as the appropriateness of education method, preparation, passion, visual materials, the adequacy of education procession, and specialized knowledge, and it has important effect on the satisfaction of education. In order to enhance the satisfaction of hospital coordinator education, the creation of education environment, making trainee concentrate on the education, is required by appropriately allocating programs, arousing interest in education, based on the attitude of trainee, discussion, and preliminary programs, preparation, ahead of enforcement of education. Fourth, the satisfaction of hospital coordinator education training significantly affects the reliability among the qualities of medical service. Fifth, satisfaction of hospital coordinator education training significantly affects hospitality I kindness among the qualities of medical service. If the education satisfaction of trainee is high, it is effective in the practical application such as dealing with complaints, the duty performance for the patients, and so on in offering the medical service, related to reliability and furthermore, we can find the positive change in the attitude change of medical professions related to the reliability of hospital coordinator. In addition, in the process of offering medical services such as the kind explanation on the duty, rapid response to the customers inquiry, and tidy uniform, practical effect was verified. Sixth, the education training factor of hospital coordinator significantly affects the reliability among the quality of medical service. Seventh, the education training factors of hospital coordinator significantly affect hospitality/kindness. In the education of hospital coordinator, the methods to attract the interest of trainee by emphasizing reliability should be sought and for gaining the practical effect of hospital coordinator education, the sufficient preparation and investigation on the education curriculum should be prerequisite and under this condition, intensified discussion on the instructor and education course is needed. In the design of education course, more education hours and subjects should be allocated in the part of hospitality in order to improve the practical application of hospitality. Therefore, it is meaningful in a sense that this study newly approached the components of hospital coordinator education and the need to modify the quality components of medical service in accordance with the study subjects was raised. This study also finds its meaning in that it provides basic materials for the study of future hospital coordinator education by suggesting the system development model of hospital coordinator education through preliminary study of education training. In addition, this study is meaningful in the aspect that it suggested the direction of education training by showing how the hospital coordinator education training would applied to the hospital coordinator course of the Continuing Education Center at Pusan and Kyungnam National University to some extent. Since all investigation of this study was approached from the side of hospital coordinator, the thoughts of patients who are beneficiaries of medical service, and care givers cannot be identified. Therefore, the satisfaction of patients and care givers through the experience of medical service, which is the essential prerequisite of medical service, should be importantly considered and investigated. Accordingly, The study of comparing and analyzing the views of both patients and care givers should be carried out in the future.

• Journal of Korean Physical Therapy Science
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• v.9 no.3
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• pp.31-49
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• 2002

The purpose of this study was to investigate discomforts and sexual life and to identify the relation between the discomforts and sexual life with low back pain. The data were collected from March 2 through July 31, 2001. Four hundred forty-two questionnaires were returned (response rate=88.0%). Analysis of the data was done with SPSS PC+ and use descriptive statistics, $x^2$-test, t-test, ANOVA. regression. The statistics shows that over than 80% of the adults experienced lumbago at least one time in their life, and Back pain is known as one of the most common complaints made by the patients of all ages in the general hospital or local medical clinics throughout. However, in certain case it leads to a chronic condition which can cause a great deal of problems in management and in financial burden to individuals and society. The result of this study was summarized as follows: 1) It appeared that regarding the distribution of gender, male was the higher(63.6%) then that of female, the portion of forties was 28.5%. Sitting for long time was 23.1% in men and 21.7% in women. Unknown reason including sexual behaviour was 12.9% in men and 15.5% in women. Patients treated medicine and physical therapy were 36.4%. In level of educational background, the rate of high school was 31.0%, technical college was 28.5%. The highest proportion by occupation was 18.3% of office workers, occupation posture was 41.9% of sitting. 2) Men(26.0%) and most of women(34.8%) were not satisfied in the explanation satisfaction rate of sex life concerned disease. 23.8% in men and 23.6% in women considered flexibility of waist good. Man(33.3%) and most of woman(35.0%) considered that Health education is necessary. 32.7% in men and 27.3% in women did't mind educator is whoever. Preventing of lower back pain(LBP) and proper Health education of sex life are demanded in daily life. 3) 58.0% of man and 64.0% of woman mostly had a posture which is man over woman. 28.5% in men and 27.8% in women considered that proper information finding of LBP and sex life was very few and few. 37.7% in men and 42.7% in women have acquired information about sex life flung their friends. 4) The number of sex life was decreased from 2.96 0.98 to 2.61 1.63 and also the time of sex life was decreased from 3.65 1.89 to 226 1.64. The satisfaction rate of sex life changed from 3.60 0.86 to 2.77 1.10. In the number of sex life, The non correct group was 2.62 1.91 and the correct group was higher in 2.68 1.65. In the time of sex life, The non correct group was 2.02 1.47 and the correct group was higher in 229 1.65. The satisfaction rate of sex life was 2.76 0.86 in non correct group and 2.88 1.10 in correct group. So there was a difference. 5) In the satisfaction rate of sex life, Men who have a lower back pain were higher than women and no attack group was higher than attack group. As they had many sex life, the satisfaction rate was higher significantly in statistics. As the time of sex life was short, the satisfaction rate was lower significantly in statistics. As the age was low, the demand rate of Health education was high and as means of patient who had a lower back pain was high, the demand rate of Health education was high. As the patient who had a lower back pain had a long married life, the demand rate of Health education was high and as education level was high, the demand rate of Health education was high. It is necessary to provide patients with conservative treatment, educational teaching, and training to prevent further injuries in the future. In general, it is important to educate the public how to prevent back injuries and how to treat themselves in an onset period to prevent further injuries sliding into a chronic state. Sexuality is an integral part of normal and healthy relationships, but patients are unable to enjoy sex because they are riot able to get into a comfortable position due to back pain. Many conditions of the spine can make certain positions uncomfortable. Health educator should make the education program of the discomforts and the sexual pattern for low back pain in workplace and/or hospital. Further study Is needed on how to integrate the educational program on sexuality into the total rehabilitation program.

• The korean journal of orthodontics
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• v.30 no.3 s.80
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• pp.367-375
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• 2000

If a mandibular prognathic patient has an extremely unnatural anteroposterior and vertical maxilla or keen esthetical perception for facial profile, orthognathic surgery must be performed along with orthodontic treatment, which alone cannot provide satisfactory results in this case. Esthetical improvement becomes an important factor in the satisfaction level of the patient's treatment result, but an attempt to objectively measure beauty holds many problems. Therefore, in the end, the patient submits the final esthetical evaluation based on his/her subjective viewpoint. Because Korean people have a tendency to prefer the facial appeareance of westerners, they favor an oval shaped face over the traditional round face. This research was conducted in response to the complaints raised by patients who claim that their face had become more round from widening of facial width after the orthognathic surgery for manidibular prognathism than before the surgery. The following results were obtained on the changes in facial appearance and patient satisfaction level by analyzing the skull P-A analysis of total of 14 patients (8 male and 6 female) who underwent orthognathic surgery primarily chief complaint for manidibular prognathism and from their responses on questionnaires. These results are to be used in the research on the pre- and post- operative changes in facial height and width from orthognatic surgery. 1. Three ($21.4\%$) of 14 patients said that their face had widened. 2. The A group showed no change in mandibular width but B group showed a 0.7mm reduction. The facial width increased by 0.45mm and 0.66mm in groups A and B, respectively, after the orthognathic surgery 3. After the surgery the facial length changed by an 0.52mm increase in upper facial height , 1.19mm reduction in lower facial height, and 0.7mm reduction in mandibular height in group A. In group B group, there was a 0.67mm reduction in upper facial height, 3.66mm reduction in lower facial height, and 5mm reduction in mandibular height. 4. In reference to facial width, the facial height showed $1.5\%$ reduction in group A and $3.6\%$ reduction in group B after the surgery. 5. In reference mandibular height-to-facial width ratio, there was a $1.3\%$ reduction in group A, and $4.4\%$ reduction in group B after the surgery. 6. In reference to the mandibular height-to-width ratio, there was a $1.3\%$ reduction in group A and $4.3\%$ reduction in group B after the surgery. 7. Although the change in the facial width due to surgery can be ignored, sufficient explanation should be Provided to the patient before surgery on the fact that the face can appear to be relatively wide because of the reduced facial length as result of the surgery.