• Journal of Korean Academy of Nursing
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• v.26 no.4
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• pp.946-962
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• 1996

The purpose of this study was to contribute to the development of clinical instruction by students' ratings of teaching effectiveness in clinical nursing education. The subjects were comprised of graduating class 618 students from 24 nursing colleges in the nation. The instruments used in this study were "general characteristics & status of clinical nursing education" developed by the researcher and "Instrument to Measure Effectiveness of Clinical Instructors" by Reeve(1994). The 50 questions used in the questionaire were categorized into 13 components subject to factor analysis. The 13 components were interpersonal relationships, communication skills, role model, resource for students, favorable to students, encouraging to think for selves, teaching methods, evaluation, finding assignments for objectives, organization of subject matter, professional competence, knowledge of subject matter & working with agency personnel. The results of this study are as follows 1. Status of clinical nursing educaion : 1) Clinical nursing education were led by nursing professors(44.9%), a team of both nuring professor & head nurse(6.8%), instructors from specific hospital(15.1%), instuctos for a specific subject(14.6%), & head nurse(6.8%). For 3-year program students, 34.6% of the clinical nursing education were led by instructors from specific hospital & 51.4% of the education by nursing professors for Bachelor's program. 2) The contents for clinical education comprised of Conference being the most frequent of 34.5% ; a combination of Nursing skills, Orientation, Conference etc.22.0% : Nursing process 21.7% : Orientation 13.5% : Inspection(making rounds ) 6.4%, & Nursing skills of 2% being the least frequent. 3) Students' preference of clinical teachers from the highest to the lowest were instructors for a specific subject being the most desired (44.9%) followed by nursing professor, head nurse, a team of both nursing professor & head nurse, & instructors from specific hospital being the least desired. 4) Students felt that the qualification for clinical teachers should be at least a master's degree holder and 5 or more years of clinical experience. The reason they felt was because knowledge & experience are imperative for professional education. 2. Clinical teaching effectiveness : The total points for teaching effectiveness was 147.97(mean of 2.95±0.98) where the total score is considered to be an average rating. 3. Teaching effectiveness as status of clinical nursing education : 1) The score ratings for the clinical instructors from the highest to the lowest were as follows : instructors for a specific subject, instructors from specific hospitals, a team of both nursing professors & head nurses, nursing professors, head nurses, which resulted in significunt difference(F=4.53, P<0.001). 2) The rating scores based on the teaching program from the highest to the lowest were as follws ; nursing skills, nursing process, a combination of nursing skills, orientation, conference etc. , conferences, orientation, inspection, which resulted in significunt difference(F=10.97, P<0.001). 4. Based on 13 categorized components from the questionaires, questions related to communication skills scored the highest points of 3.20 where inquiries regarding resource for students scored the lowest points of 2.38. 5. Among the 13 categorial components from the questionaire, Interpersonal relationship, Communication skills, Resource for students, Encouraging to think for selves, Evaluation, Teaching method, Finding assignment for objectives, Organization of subject matter, Professional competence, & Working with agency personnel, instructors for a specific subject scored the highest points and head nurse scored the lowest, which resulted in significant difference. Favorable for students, instructors for a specific subject scored highest points and nursing professor scored the lowest, which resulted in significant deference (F=5.39, P<0.001). Role model & Professional competence, instructors for a specific subject scored the highest points and head nurse scored the lowest, with minimum variation(F=1.29, P>0.05 : F=1.64, P>0.05) 6. Based on 13 categorial components as a whole, the highest points scored among the 5 groups of clinical teachers was instructors for a specific subject and the lowest, by head nurse(F=1.94, P<0. 001). A team of both nursing professor & head nurse attained higher score in clinical education than their independent education.

• Journal of Korean Academy of Nursing Administration
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• v.2 no.1
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• pp.97-114
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• 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 Journal of Nuclear Medicine
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• v.39 no.6
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• pp.445-455
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• 2005

Purpose: We developed an animal SPECT system using clinical Philips ARGUS scintillation camera and pinhole collimator with specially manufactured small apertures. In this study, we evaluated the physical characteristics of this system and biological feasibility for animal experiments. Materials and Methods: Rotating station for small animals using a step motor and operating software were developed. Pinhole inserts with small apertures (diameter of 0.5, 1.0, and 2.0 mm) were manufactured and physical parameters including planar spatial resolution and sensitivity and reconstructed resolution were measured for some apertures. In order to measure the size of the usable field of view according to the distance from the focal point, manufactured multiple line sources separated with the same distance were scanned and numbers of lines within the field of view were counted. Using a Tc-99m line source with 0.5 mm diameter and 12 mm length placed in the exact center of field of view, planar spatial resolution according to the distance was measured. Calibration factor to obtain FWHM values in 'mm' unit was calculated from the planar image of two separated line sources. Te-99m point source with i mm diameter was used for the measurement of system sensitivity. In addition, SPECT data of micro phantom with cold and hot line inserts and rat brain after intravenous injection of [I-123]FP-CIT were acquired and reconstructed using filtered back protection reconstruction algorithm for pinhole collimator. Results: Size of usable field of view was proportional to the distance from the focal point and their relationship could be fitted into a linear equation (y=1.4x+0.5, x: distance). System sensitivity and planar spatial resolution at 3 cm measured using 1.0 mm aperture was 71 cps/MBq and 1.24 mm, respectively. In the SPECT image of rat brain with [I-123]FP-CIT acquired using 1.0 mm aperture, the distribution of dopamine transporter in the striatum was well identified in each hemisphere. Conclusion: We verified that this new animal SPECT system with the Phlilps ARGUS scanner and small apertures had sufficient performance for small animal imaging.

• The Korean Journal of Nuclear Medicine Technology
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• v.22 no.1
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• pp.35-42
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• 2018

Purpose Standardized uptake value(SUV) has been widely used as a quantitative metric of uptake in PET/CT for diagnosis of malignant tumors and evaluation of tumor therapy response. However, the SUV depends on various factor including PET/CT scanner specifications and reconstruction parameter. The purpose of this study is to validate a EQ PET to evaluate SUV across different PET/CT systems. Materials and Methods First, NEMA IEC body phantom data were used to calculate the EQ filter for OSEM3D with PSF and TOF reconstruction from three different PET/CT systems in order to obtain EARL compliant recovery coefficients of each spheres. The Biograph true point 40 PET/CT images were reconstructed with a OSEM3D+PSF reconstruction, images of the Biograph mCT 40 and Biograph mCT 64 PET/CT scanners were reconstructed with a OSEM3D+PSF, OSEM3D+TOF, OSEM3D+PSF+TOF. Post reconstructions, the proprietary EQ filter was applied to the reconstruction data. Recovery coefficient can be estimated by ratio of measured to true activity concentration for spheres of different volume and coefficient variability(CV) value of RC for each sphere was compared. For clinical study, we compared SUVmax applying different reconstruction algorithms in FDG PET images of 61 patients with lung cancer using Biograph mCT 40 PET/CT scanner. Results For the phantom studied, the mean values of CV for OSEM3D, OSEM3D+PSF, OSEM3D+TOF and OSEM3D+PSF+TOF reconstructions were 0.05, 0.04, 0.04 and 0.03 respectively for RC. Application of the proprietary EQ filter, the mean values of CV for OSEM3D, OSEM3D+PSF, OSEM3D+TOF and OSEM3D+PSF+TOF reconstructions were 0.04, 0.03, 0.03 and 0.02 respectively for RC. Clinical study, there were no statistical significance of the difference applying EQ PET on SUVmax of 61 patients FDG PET image. (p=1.000) Conclusion This study indicates that CV values of RC in phantom were decreased after applying EQ PET for different PET/CT system and The EQ PET reduced reconstruction dependent variation in SUVs for 61 lung cancer patients, Therefore, EQ PET will be expected to provide accurate quantification when the patient is scanned on different PET/CT system.

• Radiation Oncology Journal
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• v.27 no.2
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• pp.55-63
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• 2009

Purpose: This study was performed to objectively evaluate the rate of tumor response to hypofractionated radiotherapy for advanced squamous cell carcinomas of the head and neck. Materials and Methods: Thirty-one patients with advanced squamous cell carcinoma of the head and neck, who were treated by hypofractionated radiotherapy with 3 Gy per fraction for palliative purpose between 1998 and 2008, were reviewed retrospectively. Every tumor-volume was measured and evaluated from CT (computed tomography) images obtained before and 2~3 months after radiotherapy. The radiation toxicity was assessed during and after radiotherapy. A statistical analysis was performed to investigate overall survival, progressionfree survival, and the prognostic factors for survival and response. Results: The median age of the study patients was 70 years. In addition, 85% of the patients were in stage 4 cancer and 66.7% had an ECOG performance status of 1~2. The mean tumor-volume was 128.4 cc. Radiotherapy was administered with a total dose of 24~45 Gy (median: 36 Gy) over 10~25 days. Twenty-nine patients were treated with 30 Gy or more. The observed complete response rate was 12.9% and the partial response rate was 61.3%. Median survival time was 8.9 months and the 1-year progression-free survival rate was 12.9%. The treatment response rate was confirmed as a prognostic factor in the rate of survival. The primary site, stage, tumor-volume, radiotherapy field and overall radiation-dose showed a significant relationship with survival and treatment response. No grade 4 toxicity was observed during and after radiotherapy. Conclusion: There was an objective tumor-regression in about 74% of patients treated by hypofractionated radiotherapy. Further evaluation is needed to select the appropriate fraction-size and patient who may require the additional radiotherapy.

• Radiation Oncology Journal
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• v.29 no.2
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• pp.63-70
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• 2011

Purpose: To evaluate the extent of pain response and objective response to palliative radiotherapy (RT) for bone metastases from hepatocellular carcinoma according to RT dose. Materials and Methods: From January 2007 to June 2010, palliative RT was conducted for 103 patients (223 sites) with bone metastases from hepatocellular carcinoma. Treatment sites were divided into the high RT dose and low RT dose groups by biologically effective dose (BED) of 39 $Gy_{10}$. Pain responses were evaluated using the numeric rating scale. Pain scores before and after RT were compared and categorized into 'Decreased', 'No change' and 'Increased'. Radiological objective responses were categorized into complete response, partial response, stable disease and progression using modified RECIST (Response Evaluation Criteria In Solid Tumors) criteria; the factors predicting patients' survival were analyzed. Results: The median follow-up period was 6 months (range, 0 to 46 months), and the radiologic responses existed in 67 RT sites (66.3%) and 44 sites (89.8%) in the high and low RT dose group, respectively. A dose-response relationship was found in relation to RT dose (p=0.02). Pain responses were 75% and 65% in the high and low RT dose groups, respectively. However, no statistical difference in pain response was found between the two groups (p=0.24). There were no differences in the toxicity profiles between the high and low RT dose groups. Median survival from the time of bone metastases diagnosis was 11 months (range, 0 to 46 months). The Child-Pugh classification at the time of palliative RT was the only significant predictive factor for patient survival after RT. Median survival time was 14 months under Child-Pugh A and 2 months under Child-Pugh B and C. Conclusion: The rate of radiologic objective response was higher in the high RT dose group. Palliative AT with a high dose would provide an improvement in patient quality of life through enhanced tumor response, especially in patients with proper liver function.

• Korean Journal of Psychosomatic Medicine
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• v.17 no.1
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• pp.15-22
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• 2009

Objectives : Prevalence of postpartum depressive disorders reaches approximately 10-15% of childbearing women. This preliminary study was intended to explore the relationships between postpartum depressive disorders and family adaptability and cohesion. Methods : Childbearing women(n=24) were assessed for risk factors for postpartum depression before and after childbirth prospectively. At gestational age between 36th and 40th week, the questionnaire about various factors before childbirth, Edinburgh postnatal depression scale(EPDS), Family adaptability-cohesion evaluation scale (FACES), and Beck anxiety inventory(BAI) were assessed. After childbirth, for the diagnosis of postpartum depressive disorders, a structured diagnostic interview according to MINI International Neuropsychiatric Interview was performed, furthermore, the questionnaire about various factors after childbirth, EPDS, and BAI were assessed at 4-6 weeks postpartum. Results : Among various factors and scales, family adaptability and cohesion, mood symptom and change during pregnancy were associated with postpartum depressive disorder in comparison with non-postpartum depressive disorder subjects. In addition, low family adaptability and cohesion and mood change during pregnancy were significantly associated factors with postpartum depressive disorder using logistic regression analysis. Conclusion : The results suggest the postpartum depressive disorder could be related with prenatal low family adaptability and cohesion. This preliminary study, however, includes only a few subjects, so that further large-sized study will be needed to replicate our results.

• Journal of Korean Ophthalmic Optics Society
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• v.18 no.4
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• pp.357-363
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• 2013

Purpose: To investigate the visual function with prescription swimming goggles. Methods: 15 university students (mean age: $22{\pm}1.54$ years) participated, with a mean distance refractive error of RE: S-1.67 D/C-0.40 D, LE: S-1.70D/C-0.37 D. Inclusion criteria were no ocular pathology, able to wear soft contact lenses to correct their refractive error to emmetropia and able to swim. Participants were fitted with contact lenses to correct all ametropia. Subjective evaluation for satisfaction of visual acuity, asthenopia and balance were also measured using a questionnaire while wearing swimming goggles with cylinder (C+1.50 D, Ax $90^{\circ}$) compared with plano sphere outside the swimming pool area. Visual acuity was assessed using the same ETDRS chart. The prescription swimming goggles powers were assessed in random order and ranged in power from S+3.00 D to S-3.00 D in 0.50 D steps. Results: Subjective evaluation was significantly worse for the swimming goggles with cylinder than for the plano powered goggles for all 3 questions, visual acuity, asthenopia and balance. Visual acuity were significantly affected by the different power of the swimming goggles (p<0.05), but there was no significant difference between the in-air in-clinic and underwater in-swimming pool measures (p=0.173). However, visual acuity measured in the clinic was significantly better than underwater for some swimming goggle powers (+3.00, +1.00, +0.50, 0, -1.00 and -2.00 D). Conclusions: Wearing swimming goggles underwater may degrade the visual acuity compared to within air but as the difference is less than 1 line of Snellen acuity, and it is unlikely to result in significant real-life effects. Having an incorrect cylinder correction was found to be detrimental resulting in lower score of satisfaction. Considering slippery floor of swimming pool area, it can be a potential risk factor. Therefore, it is important to correct any refractive error in addition to astigmatism for swimming goggle.

• Journal of Korean Orthopaedic Sports Medicine
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• v.7 no.2
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• pp.122-127
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• 2008

Purpose: Evaluation and analysis of the incidence of postoperative complications after arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. Materials and Methods: We reviewed 172 cases of arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft in anterior cruciate ligament tear without meniscal injury. We performed Lysholm knee score and KT-2000 testing, simple radiograph, physical examination as evaluation factor. Also, around knee pain, swelling, limitation of motion, patellofemoral crepitation, paresthesia and pain on kneeling were evaluated. Results: The average follow up period was 49.8 months. In 172 patients, 148 males and 26 femlaes were evaluated. The average age was 34.4 years. The Lysholm knee score improved from 51.9 points preoperatively to 90.8 points at final follow up. Clinical outcome was excellent in 83%, good in 11%, fair in 4% and poor in 2%. There were many cases of complications, 24 cases (14%) of around knee pain, 12 cases (7%) of swelling, 45 cases (26.2%) of patellofemoral crepitation, 52 cases (30%) of donor site paresthesia, 65 cases (38%) of pain on kneeling, 10 cases (5.8%) of limitation of motion at extension, 13 cases (8%) of limitation of motion at flexion and 2cases (1.2%) of patellar fracture. Conclusion: Although arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone had good clinical results, many complications were noted. Some factors in surgical technique were suspected to be related to the complications and long term follow up will be necessary to further evaluated.

• Journal of Oral Medicine and Pain
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• v.36 no.4
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• pp.225-234
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• 2011

Tobacco smoking is a major risk factor of systemic health and also impairs oral health, which is related to development of oral cancers, periodontitis, delayed wound healing, tooth loss, failure of implant, etc. Aside from smoking, many other risk factors can be related to oral health and long-term effects of smoking on salivary flow and taste threshold are still in controversy. Authors considered dental students to be an appropriate group with good oral hygiene for a long-term study to reveal effects of smoking on oral health. This study was performed to compare smoking patterns and current oral health conditions between smokers and nonsmokers in dental students prior to long-term evaluation. 192 volunteers (85.7%) of 224 male dental students in Dankook University were evaluated through questionnaires and clinical examination in 2010. Questionnaires included smoking pattern, alcohol use, nicotine dependence, preventive care, psychological profile and clinical examinations comprised assessment of teeth or periodontal status, nicotine pigmentation, salivary flow, electrical taste thresholds and halitosis. From the study, (current) smokers were older, and drank more frequently with more alcohol intake compared to former smokers and nonsmokers(p<0.05). There was no significant difference among them in salivary flow rate, halitosis and electrical taste threshold. However, there was significant difference in DMFT rate, periodontal treatment need, nicotinic pigmentation between smokers and nonsmokers(p<0.05), irrespective of their levels of preventive care. The smokers in this study, who are young dental students with relatively shorter duration of smoking, less use of cigarettes and low level of nicotine dependence, did not reveal significant impairment of oral health. However, their oral health was found to be relatively impaired compared to nonsmokers', which suggests negative effect of smoking on the oral health and a need of smoking cessation.