Referral Patterns and Needs for Specialist Care among Patient Referred from Health Center (보건소의 진료의뢰 양상과 의뢰환자들의 전문과목 요구도)
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- Journal of Preventive Medicine and Public Health
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- v.29 no.1 s.52
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- pp.133-143
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- 1996
This study was conducted to assess the referral patterns to specialist from general practitioners in health center and perceived needs of referred patients for specialist care in health center. The study subjects were 249 patients who visited to health centers and were referred to other medical facilities. The data were obtained from questionnaire survey which was conducted in Kyongju-City Health Center, Seongju-Gun Health Center and Koryong-Gun Health Center in Kyongsangbuk-Do, from June 10 to October 17, 1995. The total referral rate was 2.7%. The proportion of patients who wished to be referred to medical specialists was 85.9%, and the proportion of patients referred by general practitioners in health centers was 14.1%. Among the patients who wished to be referred to medical specialists, 45.9% visited directly to health centers, 34.6% visited health centers via local clinics and 19.5% visited health centers to get referral permission only. The reasons for getting referral permission in health centers were easy geographical accessibility(34.6%), easy to get referral permission in health centers(27.1%), and very difficult to get referral permission in local clinics(16.4%). Among the diseases of referred patients, diseases of the musculoskeletal system and connective tissue were most prevalent on a whole, but diseases of nervous system and sensory organs were comparatively high among the patients who wished to be referred to medical specialists and infectious and parasitic diseases were comparatively high among the patients referred by general practitioners in health centers. The most favorable medical facility was general hospital including university hospital in both groups of patients who wished to be referred to medical specialist and the patient referred by general practitioners in health centers. Regarding the needs for specialist care in health center, 75.2% of patients who wished to be referred to medical specialists and 74.3% of patients referred by general practitioners in health center wanted the specialist care. The most frequently requested specialty is internal medicine(47.1%), and then orthopedics and general surgery. Based on above results, this study revealed that the majority of patients referred from health center wished to be referred to medical specialists at their own will, so, referral system at health center level should be changed. And if specialist care in health center be provided, the medical care by internist could be provided first, and then that of orthopedics and general surgery could be provided. These kinds of medical cares could be covered by local clinicians as a part-time job on a voluntary basis.
Objectives : The present study was performed to investigate whether acupuncture stimulation in the rats affected regeneration properties of the injured sciatic nerve. A differential effect of acupuncture stimulation on the one point near the spinal nerve root controlling sciatic nerve activity and the other point in the peripheral area subordinated by injured nerve was compared. Materials and Methods: Rat sciatic nerves were injured by crush, and the effects on axonal regeneration on injured sciatic nerves were evaluated by acupuncture stimulation at two different regions. In proximal acupuncture stimulation group, acupuncture stimulation was performed on Huatuo Jiaji(EX B2) points located from L5 to S1 vertebral levels to stimulate the nearest spinal nerve root that innervates sciatic nerves. In distal acupuncture stimulation group, acupuncture stimulation was performed on Zusanli(ST 36) and Weizhong(BL 40) points to stimulate at peripheral area dominated by injured sciatic nerves. Acupuncture stimulation was given every other days for 1 or 2 weeks. Sciatic nerve tissues collected from acupuncture stimulation experimental groups, injury control group, and intact animal group were used for protein analysis by Western blotting or Hoechst nuclear staining. To determine axonal regeneration, Dil fluorescence dye was injected into the sciatic nerve 0.5 cm distal to the injury site in individual animal groups and Dil-labeled cells by retrograde tracing were measured in the DRG at lumbar 5 or in the spinal cord. DRG sensory neurons prepared from individual animal groups were used to measure the extent of neurite outgrowth and for immunofluorescence staining with anti-GAP-43 antibody. Results : Animal groups given proximal or distal acupuncture stimulation showed upregulation of GAP-43 and Cdc2 protein levels in the sciatic nerve at 7 days after injury. Cdk2 protein levels were strongly induced by nerve injury, but did not show changes by acupuncture stimulation. Phospho-Erk1/2 protein levels were elevated by acupuncture stimulation above those present in the injury control animals. These increase in regeneration-associated protein levels appeared to be related with increase cell proliferation in the injured sciatic nerves. Hoechst 33258 staining of sciatic nerve tissue to visualize nuclei of individual cells showed increased Schwann cell number in the distal portion of the injured nerve 7 and 14 days after injury and further increases by acupuncture stimulation particularly at the proximal position. Measurement of axonal regeneration by retrograde tracing showed significantly increased Dil-labeled cells in proximal acupuncture stimulation group compared to distal acupuncture stimulation group and injury control group. Finally, an evaluation of axonal regeneration by retrograde tracing showed increased number of Dil labeled cells in the DRG at lumbar 5 or in the ventral horn of the spinal cord at lower thoracic level at 7 days after nerve injury. Conclusions : The present data show that the proximal acupuncture stimulation at Huatuo Jiaji(EX B2) points governing injured sciatic nerves was more effective for axonal regeneration than the distal acupuncture stimulation. Further studies on functional recovery or associated molecular mechanisms should be critical for developing animal models and clinical applications.
This study is to empirically examine the primary dimensions of visual merchandising (VMD) of internet shopping mall, namely store design, merchandise, and merchandising cues, to be a attractive virtual store to the shoppers. The authors reviewed the literature related to the major components of VMD from the perspective of the AIDA model, which has been mainly applied to the offline store settings. The major purposes of the study are as follows; first, tries to derive the variables related with the components of visual merchandising through reviewing the existing literatures, establish the hypotheses, and test it empirically. Second, examines the relationships between the components of VMD and the attitude toward the VMD, however, putting more emphasis on finding out the component structure of the VMD. VMD needs to be examined with the perspective that an online shopping mall is a virtual self-service or clerkless store, which could reduce the number of employees, help the shoppers search, evaluate and purchase for themselves, and to be explored in terms of the in-store persuasion processes of customers. This study reviewed the literatures related to store design, merchandise, and merchandising cues which might be relevant to the store, product, and promotion respectively. VMD is a total communication tool, and AIDA model could explain the in-store consumer behavior of online shopping. Store design has to do with triggering a consumer attention to the online mall, merchandise with a product related interest, and merchandising cues with promotions such as recommendation and links that induce the desire to pruchase. These three steps might be seen as the processes for purchase actions. The theoretical rationale for the relationship between VMD and AIDA could be found in Tyagi(2005) that the three steps of consumer-oriented merchandising are a store, a product assortment, and placement, in Omar(1999) that three types of interior display are a architectural design display, commodity display, and point-of-sales(POS) display, and in Davies and Ward(2005) that the retail store interior image is related to an atmosphere, merchandise, and in-store promotion. Lee et al(2000) suggested as the web merchandising components a merchandising cues, a shopping metaphor which is an assistant tool for search, a store design, a layout(web design), and a product assortment. The store design which includes differentiation, simplicity and navigation is supposed to be related to the attention to the virtual store. Second, the merchandise dimensions comprising product assortments, visual information and product reputation have to do with the interest in the product offerings. Finally, the merchandising cues that refer to merchandiser(MD)'s recommendation of products and providing the hyperlinks to relevant goods for the shopper is concerned with attempt to induce the desire to purchase. The questionnaire survey was carried out to collect the data about the consumers who would shop at internet shopping malls frequently. To select the subject malls, the mall ranking data announced by a mall rating agency was used to differentiate the most popular and least popular five mall each. The subjects was instructed to answer the questions after navigating the designated mall for five minutes. The 300 questionnaire was distributed to the consumers, 166 samples were used in the final analysis. The empirical testing focused on identifying and confirming the dimensionality of VMD and its subdimensions using a structural equation modeling method. The confirmatory factor analysis for the endogeneous and exogeneous variables was carried out in four parts. The second-order factor analysis was done for a store design, a merchandise, and a merchandising cues, and first-order confirmatory factor analysis for the attitude toward the VMD. The model test results shows that the chi-square value of structural equation is 144.39(d.f 49), significant at 0.01 level which means the proposed model was rejected. But, judging from the ratio of chi-square value vs. degree of freedom, the ratio was 2.94 which smaller than an acceptable level of 3.0, RMR is 0.087 which is higher than a generally acceptable level of 0.08. GFI and AGFI is turned out to be 0.90 and 0.84 respectively. Both NFI and NNFI is 0.94, and CFI 0.95. The major test results are as follows; first, the second-order factor analysis and structural equational modeling reveals that the differentiation, simplicity and ease of identifying current status of the transaction are confirmed to be subdimensions of store design and to be a significant predictors of the dependent variable. This result implies that when designing an online shopping mall, it is necessary to differentiate visually from other malls to improve the effectiveness of the communications of store design. That is, the differentiated store design raise the contrast stimulus to sensory organs to promote the memory of the store and to have a favorable attitude toward the VMD of a store. The results that navigation which means the easiness of identifying current status of shopping affects the attitude to VMD could be interpreted that the navigating processes via the hyperlinks which is characteristics of an internet shopping is a complex and cognitive process and shoppers are likely to lack the sense of overall structure of the store. Consequently, shoppers are likely to be alost amid shopping not knowing where to go. The orientation tool enhance the accessibility of information to raise the perceptive power about the store environment.(Titus & Everett 1995) Second, the primary dimension of merchandise and its subdimensions was confirmed to be unidimensional respectively, have a construct validity, and nomological validity which the VMD dimensions supposed to have a positive correlation with the dependent variable. The subdimensions of product assortment, brand fame and information provision proved to have a positive effect on the attitude toward the VMD. It could be interpreted that the more plentiful the product and brand assortment of the mall is, the more likely the shoppers to favor it. Brand fame and information provision as well affect the VMD attitude, which means that the more famous the brand, the more likely the shoppers would trust and feel familiar with the mall, and the plentifully and visually presented information could have the shopper have a favorable attitude toward the store VMD. Third, it turned out to be that merchandising cue of product recommendation and hyperlinks affect the VMD attitude. This could be interpreted that recommended products could reduce the uncertainty related with the purchase decision, and the hyperlinks to relevant products would help the shopper save the cognitive effort exerted into the information search and gathering, which could lead to a favorable attitude to the VMD. This study tried to sheds some new light on the VMD of online store by reviewing the variables mentioned to be relevant with offline VMD in the existing literatures, and tried to link the VMD components from the perspective of AIDA model. The effect size of the VMD dimensions on the attitude was in the order of the merchandise, the store design and the merchandising cues.It is said that an internet has an unlimited place for display, however, the virtual store is not unlimited since the consumer has a limited amount of cognitive ability to process the external information and internal memory. Particularly, the shoppers are likely to face some difficulties in decision making on account of too many alternative and information overloads. Therefore, the internet shopping mall manager should take into consideration the cost of information search on the part of the consumer, to establish the optimal product placements and search routes. An efficient store composition would be possible by reducing the psychological burdens and cognitive efforts exerted to information search and alternatives evaluation. The store image is in most part determined by the product category and its brand it deals in. The results of this study support this proposition that the merchandise is most important to the VMD attitude than other components, the manager is required to take a strategic approach to VMD. The internet users are getting more accustomed and more knowledgeable about the internet media and more likely to accept the internet as a shopping channel as the period of time during which they use the internet to shop become longer. The web merchandiser should be aware that the product introduction using a moving pictures and a bulletin board become more important in order to present the interactive product information visually and communicate with customers more actively, therefore leading to making the quantity and quality of product information more rich.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70