• 한국의료질향상학회지
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• 제7권2호
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• pp.204-216
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• 2000

Background : There has been a concern that the quality of care provided to end-stage renal disease (ESRD) patients in the United States may not be as good as recommended. This paper illustrates a composite measure to assess, the quality of care received by ESRD patients undergoing in-center hemodialysis by incorporating outcomes for 4 major treatment areas. The 4 treatment areas are: dialysis treatments, anemia control, nutritional management, and blood pressure control. Methods : The major data source for the study was the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave 1 (DMMS-1) d Sixteen categories of a composite quality indicator were constructed by combining 4 dichotomous variables (16=2*2*2*2). representing the optimal vs. less than optimal level of outcome for each of the 4 treatment outcome measure respectively. Optimal outcome level for each treatment area was defined based on the recommendation from the National Kidney Foundation: (a) delivered dialysis doses (Kt/V) ${\geq}$ 1.2; (b) hematocrit level ${\geq}$ 30%; (c) serum albumin concentration ${\geq}$ 3.8g/dl ; and (d) blood pressure of <140 / <90mmHg. The 16 quality indicator were ranked according to their relative quality weights, which were estimated from its association with the relative risk of survival, adjusting for patient's baseline severity and dialysis facility characteristics. Results : Out of the entire sample of 2,179 patients, only 229 (10%) meet th recommended outcome levels for all 4 treatment areas. Overall, the study patients were distributed evenly over the 16 quality indicators, indicating a great variation in the quality of ESRD care. It appears that the rank of the 16 quality-indicators is driven by serum albumin concentration, suggesting that serum albumin concentration may be the most powerful predictor of ESRD patient survival among the 4 outcome measures. Conclusion : The developed quality indicator has the advantage of describin a range of care for dialysis patients and thus providing a more complete picture of care as compared to previous studies that have focused on only single or few components of the ESRD care.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.326-330
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• 2007

Objective : Stroke is the most prevalent disease involving the central nervous system. Since medical modalities are sometimes ineffective for the acute edema following massive infarction, surgical decompression may be an effective option when medical treatments fail. The present study was undertaken to assess the outcome and prognostic factors of decompressive surgery in life threatening acute, severe, brain infarction. Methods : We retrospectively analyzed twenty-six patients (17 males and 9 females; average age, 49.7yrs) who underwent decompressive surgery for severe cerebral or cerebellar infarction from January 2003 to December 2006. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). Results : Of the 26 patients, 5 (19.2%) showed good recovery, 5 (19.2%) showed moderate disability, 2 (7.7%) severe disability, 6 (23.1%) persistent experienced vegetative state, and 8 (30.8%) death. In this study, the surgical decompression improved outcome for cerebellar infarction, but decompressive surgery did not show a good result for MCA infarction (30.8% overall mortality vs 100% mortality). The dominant-hemisphere infarcts showed worse prognosis, compared with nondominant-hemisphere infarcts (54.5% vs 70%). Poor prognostic factors were diabetes mellitus, dominant-hemisphere infarcts and low preoperative Glasgow Coma Scale (GCS) score. Conclusion : The patients who exhibit clinical deterioration despite aggressive medical management following severe cerebral infarction should be considered for decompressive surgery. For better outcome, prompt surgical treatment is mandatory. We recommend that patients with severe cerebral infarction should be referred to neurosurgical department primarily in emergency setting or as early as possible for such prompt surgical treatment.

• 산업경영시스템학회지
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• 제40권1호
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• pp.150-164
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• 2017

The development of an appropriate public service quality model has become increasingly recognised as an important subject of interest in the public sector as well as academia. In particular, the public systems enacted by governments are widely used and have a significant impact on national competitiveness. But few researches have been conducted to explore the quality dimensions of a public system service and empirically examine the relationship among related variables. Therefore, in this study, we strive to develop a quality measurement model of public system service that can be effectively used in practice. Using 601 samples gathered through a structured survey from project engineers, a conceptual quality model of public system is presented and discussed. Given the exploratory nature of this study, an exploratory factor analysis is used to investigate quality dimensions and partial least square (PLS) is employed in determining the structural relationships. From empirical results, we found that the quality dimensions of the public system had four distinct quality dimensions (design quality, environment quality, primary outcome quality, additive outcome quality). All four quality dimensions showed good representative factors in explaining user satisfaction. Perceived trust was proved to significantly mediate the relationship between quality dimensions and user satisfaction. Our research is expected to contribute to the literature by providing a good conceptual framework for assessing public system quality by linking four quality dimensions with user satisfaction. In particular, the developed model can elaborately measure process quality and multi-functional outcome quality of the system by the supplementation of design quality and additive outcome quality respectively. Practical implications are also suggested on the basis of our analysis.

• 한국산학기술학회논문지
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• 제13권5호
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• pp.2079-2086
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• 2012

창업에 대한 기대가 성장의도에 미치는 영향을 살필 본 연구목적은, 현재 중국 및 한국에서 기업경영하고 있는 기업가들을 대상으로 창업 초기에 가졌던 기대감과 창업 이후 성장의도에 어떤 영향이 있었는지를 확인하고자 양국 간의 차이를 발견하기 위한 것이다. 본 연구에서 기업가의 기대는 창업에 대한 기대로, 창업창출 및 성장의도는 기업가의 주도적 생각으로 정의되었다. 총 489 개 표본 연구결과에 따르면 제시된 상위가설은 모두 채택되었다. 즉 양국 기업가의 창업에 대한 기대는 창업 창출, 그리고 성장의도에 모두 유의한 정(+)의 영향을 미치는 것으로 나타났다. 또한 양국 기업가의 특성 간에 서로 차이가 비교했으므로, 창업에 대한 기대는 창업창출에 미치는 영향에서 한국 기업가들이 중국 기업가들보다 강하게 영향을 미치는 것으로 나타났으면서 창업창출은 성장의도에 미치는 영향에서 양국 기업가들 간에 차이가 없는 것으로 나타났다.

• Journal of Korean Neurosurgical Society
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• 제47권2호
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• pp.119-123
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• 2010

Objective : Aneurysmal rebleeding is a major cause of death and disability. The aim of this study is to investigate the incidence of rebleeding, and the factors related with patient's outcome. Methods : During a period of 12 years, from September 1995 to August 2007, 492 consecutive patients with aneurysmal subarachnoid hemorrhage (SAH) underwent surgery at our institution. We reviewed the patient's clinical records, radiologic findings, and possible factors inducing rebleeding. Also, we statistically analyzed various factors between favorable outcome group (FG) and unfavorable outcome group (UG) in the rebleeding patients. Results : Rebleeding occurred in 38 (7.7%) of 492 patients. Male gender, location of aneurysm (anterior communicating artery) were statistically significant between rebleeding group and non-rebleeding group (p=0.01 and p=0.04, respectively). Rebleeding occurred in 26 patients (74.3%) within 2 hours from initial attack. There were no statistically significant factors between FG and UG. However, time interval between initial SAH to rebleeding was shorter in the UG compared to FG (FG=28.71 hrs, UG=2.9 hrs). Conclusion : Rebleeding occurs more frequently in the earlier period after initial SAH. Thus, careful management in the earlier period after SAH and early obliteration of aneurysm will be necessary.

• Communications for Statistical Applications and Methods
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• 제30권6호
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• pp.631-652
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• 2023

In the two-condition within-subject mediation design, pairs of variables such as mediator and outcome are observed under two treatment conditions. The main objective of the design is to investigate the indirect effects of the condition difference (sum) on the outcome difference (sum) through the mediator difference (sum) for comparison of two treatment conditions. The natural condition variables mean the original variables, while the rotated condition variables mean the difference and the sum of two natural variables. The outcome difference (sum) is expressed as a linear model regressed on two natural (rotated) mediators as a parallel two-mediator design in two condition approaches: the natural condition approach uses regressors as the natural condition variables, while the rotated condition approach uses regressors as the rotated condition variables. In each condition approach, the total indirect effect on the outcome difference (sum) can be expressed as the sum of two individual indirect effects: within- and cross-condition indirect effects. The total indirect effects on the outcome difference (sum) for both condition approaches are the same. The invariance of the total indirect effect makes it possible to analyze the nature of two pairs of individual indirect effects induced from the natural conditions and the rotated conditions. The two-condition within-subject design is extended to the addition of a between-subject moderator. Probing of the conditional indirect effects given the moderator values is implemented by plotting the bootstrap confidence intervals of indirect effects against the moderator values. The expected indirect effect with respect to the moderator is derived to provide the overall effect of moderator on the indirect effect. The model coefficients are estimated by the structural equation modeling approach and their statistical significance is tested using the bias-corrected bootstrap confidence intervals. All procedures are evaluated using function lavaan() of package {lavaan} in R.

• 디지털융복합연구
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• 제13권10호
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• pp.295-303
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• 2015

본 연구는 프로젝트 매트릭스 조직의 신제품개발 프로젝트에서 해당 프로젝트 관리자의 역량을 지적, 관리, 감성 역량으로 분류한 후, 각 역량이 사전/사후 측면에서 기획 성과와 완료 성과에 미치는 영향을 실증적으로 분석하였다. 이를 위하여 프로젝트 매트릭스 조직 내 프로젝트 관리자들을 대상으로 한 설문조사 결과를 토대로 역량과 성과 간의 관계를 PLS(partial least square) 구조방정식 모형으로 확인하였다. 가설검증 결과, 프로젝트 관리자의 지적 역량은 기획 성과와 완료 성과 모두에 유의한 영향을 미치는 반면, 관리 역량과 감성 역량은 두 성과 모두에 긍정적인 영향을 미치지 못한 것으로 나타났다. 이와 같은 노력은 프로젝트 관리의 역량과 성과에 관한 연구에서 매트릭스 조직을 대상으로 구체화된 역량과 성과를 분석한 차별화된 시도이며, 본 연구결과는 최근 재조명을 받고 있는 프로젝트 매트릭스 조직 내 신제품개발 프로젝트 관리자의 선발과 교육 시 프로젝트 성과에 중요한 역량 개발에 도움이 될 것으로 기대된다.

• 대한간호학회지
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• 제39권3호
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• pp.366-375
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• 2009

Purpose: To evaluate the effects of case management using Resident Assessment Instrument-Home Care(RAI-HC) in home health service for older people. Methods: All elders were assessed at baseline and 3 months later using RAI-HC. The change of function in the intervention group was compared with that of a conventional intervention group. Function was measured with Activities of Daily Living(ADL), Instrumental Activities of Daily Living(IADL), Cognitive Performance Scale(CPS), Depression Rating Scale(DRS), Pain and the number of Clinical Assessment Protocols(CAP). Results: Among ninety two elders participated in the program, 59 were allocated to the case management group and 33 to the conventional group. The intervention, home health service by a nurse over a 3 month period, consisted of comprehensive assessment, case conference for care plan, direct care, education and referral, and outcome evaluation. The percent of elders whose function improved in the intervention group was greater than the conventional group for depression(odds ratio [OR]: 10.941, confidence interval [CI]: 2.338-51.206), IADL(OR: 4.423, CI: 1.151-16.999) and the number of CAP(OR: 11.443, CI: 3.805-34.410). Conclusion: Case management was effective for older people in the community. The effect might have resulted from individual, systematic intervention, however, standards of service including eligibility criteria for case management and collaboration of multi-disciplines is required for more effective home health service programs.

• Journal of Preventive Medicine and Public Health
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• 제45권2호
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• pp.90-97
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• 2012

Objectives: While there have been many quantitative studies on the public's attitude towards mental illnesses, it is hard to find quantitative study which focused on the contextual effect on the public's attitude. The purpose of this study was to identify factors that affect the public's beliefs and attitudes including contextual effects. Methods: We analyzed survey on the public's beliefs and attitudes towards mental illness in Korea with multi-level analysis. We analyzed the public's beliefs and attitudes in terms of prejudice as an intermediate outcome and social distance as a final outcome. Then, we focused on the associations of factors, which were individual and regional socioeconomic factors, familiarity, and knowledge based on the comparison of the intermediate and final outcomes. Results: Prejudice was not explained by regional variables but was only correlated with individual factors. Prejudice increased with age and decreased by high education level. However, social distance controlling for prejudice increased in females, in people with a high education level, and in regions with a high education level and a high proportion of the old. Therefore, social distance without controlling for prejudice increased in females, in the elderly, in highly educated people, and in regions with a high education and aged community. Conclusions: The result of the multi-level analysis for the regional variables suggests that social distance for mental illness are not only determined by individual factors but also influenced by the surroundings so that it could be tackled sufficiently with appropriate considering of the relevant regional context with individual characteristics.

• 한국재난정보학회 논문집
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• 제10권2호
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• pp.208-218
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• 2014

재난 안전사고에 따른 피해액 증가 및 재난 안전 관련 산업의 성장은 소방방재 R&D 사업에 대한 과학적 성과평가의 필요성을 높여 주고 있다. 2004~2011년 동안의 소방방재 R&D 성과분석 결과에 따르면 성과유형에 있어서 학술적 성과와 공공적 성과가 다수를 이룬다. 그리고 연구수행주체와 연구개발단계별로 성과유형의 특성이 있음을 확인하였다. 이와 같은 결과는 연구수행주체별 성과물의 특성과 연구개발단계별 성과물의 특성을 감안하여 연구과제 선정평가 시 적절한 연구수행 주체와 과학기술분야의 선정과 수행 주체별 성과목표 설정의 적절성을 판단하는데 활용할 수 있을 것으로 보인다. 아울러 성과관리를 위한 기초적인 자료로 활용될 것으로 보인다. 향후 이와 같은 소방 방재 특성을 개선하기 위한 방안을 마련하기 위한 연구를 전문적으로 수행할 필요가 있는 것으로 보인다.