• Title/Summary/Keyword: Review literature

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Clinical Analysis of Infective Endocarditis (감염성 심내막염의 임상적 고찰)

  • Kim, Hyuck;Kim, Young-Hak;Chung, Won-Sang;Shin, Kyung-Wook;Kim, Ji-Hoon
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.619-626
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    • 2010
  • Background: The indications and the optimal time of surgery of infective endocarditis are controversial. We report the surgical results of our hospital during the last 10 years with literature review. Material and Method: Between January 2000 and December 2009, we enrolled 23 infective endocarditis patients who underwent surgery, and analyzed retrospectively. In the preoperative blood culture, 8 cases (34.8%) were positive. The average preoperative antibiotics treatment period was $20.78{\pm}16.00$ days. There were 12 (52.2%) urgent operations. The average follow up period was $49.26{\pm}33.21$ months. Result: 20 mechanical valve replacements were performed, 9 in aortic position, 8 in mitral position and 3 in the both positions. The other procedures were one mitral valvuloplasty, one infected myxoma extirpation, and one infected pacemaker lead removal with debridement. The average period of postoperative intravenous antibiotic treatment was $24.39{\pm}15.98$ days. There were 5 complications, including 2 cases of postoperative bleeding, one postcardiotomy syndrome, one cerebral ischemia, and a low cardiac output syndrome. There were statistically significant postoperative improvement in NYHA class, left ventricle end diastolic/end systolic volume, and left atrium size (p-value < 0.05). Conclusion: We could obtain the satisfactory results without any moftalities by using sufficient preoperative antibiotics in hemodynamically stable patients, and by prompt surgery in unstable patients.

Study on Sacrifice Food of Bulchunwi Sacrificial Ceremony in Sangju Area (상주지역의 불천위제사 제수문화에 관한 연구)

  • Kim, Gwi-Young;Kim, Bo-Ram;Park, Mo-Ra
    • Journal of the East Asian Society of Dietary Life
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    • v.25 no.5
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    • pp.739-751
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    • 2015
  • This study investigated the table settings used in Bul-chun-wi sacrificial rituals in Sangju, Gyeongpook Province. This study took place from May 2014 to April 2015 and incorporated field research and literature review. The subjects of the study were Sojae jongga (family head), Wolgan jongga, Ubook jongga and Ipjae jongga. There were four rows in the table setting of the Wolgan, whereas there were five rows in the other jonggas. In row 5, there were fruits, seeds and confections. In row 4, there were vegetables. In row 3, there was tang (stew); in row 2, juk (steamed meats or fishes) and pyun (rice cake); and in row 1, meh (boiled rice), geng (soup) and myun (noodles). The common food setting was arranged in the order of meh, geng, myun, ganjang (Korean soy sauce), poh (dried meat/fish), chimchae (water kimchi), dates, chestnuts, pears, persimmons, walnuts, bracken, bellflowers, croaker, pyun, and ssam (rice wrapped in lettuce leaves). Ubook jongga had the most number of stews at seven. Sojae and Ipjae jongga each had five stews, and Wolgan jongga had three. The smaller Wolgan jongga had gehjuk (boiled chicken), uhjuk (steamed fish) and yookjuk (boiled meat) arranged in a neat pile on one dish used for rituals, whereas Ubook jongga had gehjuk, uhjuk and yookjuk arranged separately. Sojae and Ipjae jongga had gehjuk arranged separately while yookjuk and uhjuk were arranged as dojuk (gehjuk, uhjuk, yookjuk). The uhjuk was arranged separately. In Wolgan jongga, po was arranged on the right while in the other jonggas, it was arranged to the left. For raw meat Ubook jongga, raw mackerel; Ipjae jongga, raw croaker, and Sojae jongga Yukhoe (beef tartare) were set. However, pork, chicken and croaker were cooked. Other ritual food were used in seasoning and boiling. In the geng Wolgan and Ipjae jongga used miyeokguk (seawood soup), whereas Sojae and Ubook jongga used tangguk (meat soup with vegetables). For the ritual food, most jongga ordered yoogwa, yakgwa and bonpyun as one part, rice cakes (steamed rice cake, glutinous rice cake, jeungpyun, gyungdan), and jehju (alcohol). The other ritual food was prepared on the day by jongga.

Enhancing Technology Learning Capabilities for Catch-up and Post Catch-up Innovations (기술학습역량 강화를 통한 추격 및 탈추격 혁신 촉진)

  • Bae, Zong-Tae;Lee, Jong-Seon;Koo, Bonjin
    • The Journal of Small Business Innovation
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    • v.19 no.2
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    • pp.53-68
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    • 2016
  • Motivation and activities for technological learning, entrepreneurship, innovation, and creativity are driving forces of economic development in Asian countries. In the early stages of technological development, technological learning and entrepreneurship are efficient ways in which to catch up with advanced countries because firms can accumulate skills and knowledge quickly at relatively low risk. In the later stages of technological development, however, innovation and creativity become more important. This study aims to identify a) the factors (learning capabilities) that influence technological learning performance and b) barriers to enhancing innovation capabilities for the creative economy and organizations. The major part of this study is related to learning capabilities in the post-catch-up era. Based on a literature review and observations from Korean experiences, this study proposes a technological learning model composed of various influencing factors on technological learning. Three hypotheses are derived, and data are collected from Korean machine tool manufacturers. Intense interviews with CEOs and R&D directors are conducted using structured questionnaires. Statistical analysis, such as correlation and ANOVA are then carried out. Furthermore, this study addresses how to enhance innovation capabilities to move forward. Innovation enablers and barriers are identified by case studies and policy analysis. The results of the empirical study identify several levels of firms' learning capabilities and activities such as a) stock of technology, b) potential of technical labor, c) explicit technological efforts, d) readiness to learn, e) top management support, f) a formal technological learning system, g) high learning motivation, h) appropriate technology choice, and i) specific goal setting. These learning capabilities determine firms' learning performance, especially in the early stages of development. Furthermore, it is found that the critical factors for successful technological learning vary along the stages of technology development. Throughout the statistical and policy analyses, this study confirms that technological learning can be understood as an intrinsic principle of the technology development process. Firms perform proactive and creative learning in the late stages, while reactive and imitative learning prevails in the early stages. In addition, this study identifies the driving forces or facilitating factors enhancing innovation performance in the post catch-up era. The results of the preliminary case studies and policy analysis show some facilitating factors such as a) the strategic intent of the CEO and corporate culture, b) leadership and change agents, c) design principles and routines, d) ecosystem and collaboration with partners, and e) intensive R&D investment.

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Domestic and International Experts' Perception of Policy and Direction on STEAM Education (융합인재교육(STEAM)의 정책과 실행 방향에 대한 국내외 전문가들의 인식)

  • Jung, Jaehwa;Jeon, Jaedon;Lee, Hyonyong
    • Journal of Science Education
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    • v.39 no.3
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    • pp.358-375
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    • 2015
  • The purposes of this study were to investigate the value, necessity and legitimacy of STEAM Education and to propose practical approaching methods for STEAM Education to be applicable in Korea through a variety of literature review, case studies and collecting suggestions from domestic and international educational experts. The research questions are as follows: (1) To investigate the perception, understanding and recognitions of domestic and foreign professionals in STEAM education. (2) To analyze policy implications for an improvement in STEAM. The following aspects of STEAM were found to be challenges in our current STEAM policy after analyzing multiple questionnaires with the professionals and case studies including their experiences, understanding, supports and directions of the policy from the governments. The results indicate that (1) there was a lack of precise and conceptual understanding of STEAM in respect to experience. Training sessions for teachers in this field to help transform their perception is necessary. Development of practical programs with an easy access is also required. It is important to get the aims of related educational activities recognized by the professionals and established standards for an evaluation. The experts perceived that a theme-based learning is the most preferred and effective approaching method and the programs that develop creative thinking and learning applicable to practice are required to promote. (2) The results indicate that there was a lack of programs and inducements for supporting outstanding STEAM educators. It is shown that making an appropriate environment for STEAM education takes the first priority before training numbers of teachers unilaterally, thus securing enough budget seems critical. The professionals also emphasize on developing specialized teaching materials that include diverse inter-related subjects such as science technology, engineering, arts and humanities and social science with diverse viewpoints and advanced technology. This work requires a STEAM network for teachers to link up and share their materials, documents and experiences. It is necessary to get corporations, universities, and research centers participated in the network. (3) With respect to direction, it is necessary to propose policy that makes STEAM education ordinary and more practical in the present education system. The professionals have recommended training sessions that help develop creative thinking and amalgamative problem-solving techniques. They require reducing the workload of teachers and changing teachers' perspectives towards STEAM. They further urge a tight cooperation between departments of the government related with STEAM.

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Development of Korean Healthy Eating Index for adults using the Korea National Health and Nutrition Examination Survey data (국민건강영양조사 자료를 이용한 한국 성인의 식생활평가지수 개발)

  • Yook, Sung-Min;Park, Sohee;Moon, Hyun-Kyung;Kim, Kirang;Shim, Jae Eun;Hwang, Ji-Yun
    • Journal of Nutrition and Health
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    • v.48 no.5
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    • pp.419-428
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    • 2015
  • Purpose: The current study was conducted in order to develop the Korean Healthy Eating Index (KHEI) for assessing adherence to national dietary guidelines and comprehensive diet quality of healthy Korean adults using the 5th Korea National Health and Nutrition Examination Survey (KNHANES) data. Methods: The candidate components of KHEI were selected based on literature reviews, dietary guidelines for Korean adults, 2010 Dietary Reference Intakes for Koreans (2010 KDRI), and objectives of HP 2020. The associations between candidate components and risk of obesity, abdominal obesity, and metabolic syndrome were assessed using the 5th KNHANES data. The expert review process was also performed. Results: Diets that meet the food group recommendations per each energy level receive maximum scores for the 9 adequacy components of the index. Scores for amounts between zero and the standard are prorated linearly. For the three moderation components among the total of five, population probability densities were examined when setting the standards for minimum and maximum scores. Maximum scores for the total of 14 components are 100 points and each component has maximum scores of 5 (fruit intakes excluding juice, fruit intake including juice, vegetable intakes excluding Kimchi and pickles, vegetable intake including Kimchi or pickles, ratio of white meat to read meat, whole grains intake, refined grains intake, and percentages of energy intake from carbohydrate) or 10 points (protein foods intake, milk and dairy food intake, having breakfast, sodium intake, percentages of energy intake from empty calorie foods, and percentages of energy intake from fat). The KHEI is a measure of diet quality as specified by the key diet recommendations of the dietary guidelines and 2010 KDRIs. Conclusion: The KHEI will be used as a tool for monitoring diet quality of the Korean population and subpopulations, evaluation of nutrition interventions and research.

Suggestion of Optimal Radiation Fields in Rectal Cancer Patients after Surgical Resection for the Development of the Patterns of Care Study (Patterns of Care 연구 개발을 위한 직장암의 수술 후 방사선치료 시 적정 방사선치료 조사영역 제안)

  • Kim, Jong-Hoon;Park, Jin-Hong;Kim, Dae-Yong;Kim, Woo-Cheol;Seong, JinSil;Ahn, Yong-Chan;Ryu, Mi-Ryeong;Chun, Mison;Hong, Seong-Eon;Oh, Do-Hoon;Kim, Il-Han
    • Radiation Oncology Journal
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    • v.21 no.3
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    • pp.183-191
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    • 2003
  • Purpose: To suggest the optimal radiation fields after a surgical resection based on a nationwide survey on the principles of radiotherapy for rectal cancer in the Korean Patterns on Care Study. Materials and method: A consensus committee, composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area, developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer after a surgical resection. The survey format included 19 questions on the principles of defining field margins, and was sent to the radiation oncologists in charge of gastrointestinal malignancies in all korean hospitals (48 hospitals). Thirty three ($69\%$) oncologists replied. On the basis of the replies and literature review, the committee developed guidelines for the optimal radiation fields nor rectal cancer Results: The following guidelines were developed: superior border between the lower tip on the L5 vertebral body and upper sacroiliac joint; inferior border $2\~3$ cm distal to the anastomosis in patient whose sphincter was saved, and $2\~3$ cm distal to the perineal scar In patients whose anal sphincter was sacrificed; anterior margin at the posterior lip of the symphysis pubis or $2\~3$ cm anterior to the vertebral body, to include the internal iliac lymph node and posterior margin $1.5\~2$ cm posterior to the anterior surface of the surface, to include the presacral space with enough margin. Comparison with the guidelines, the replies on the superior margin coincided in 23 cases ($70\%$), the inferior margin after sphincter saving surgery in 13 ($39\%$), the inferior margin after adbominoperineal resection in 32 ($97\%$), the lateral margin in 32 ($97\%$), the posterior margins in 32 ($97\%$) and the anterior margin in 16 ($45\%$). Conclusion: These recommendations should be tailored to each patient according to the clinical characteristics such as tumor location, pathological and operative findings, for the optimal treatment. The adequacy of these guidelines should be proved be following the Korean Patterns of Care Study.

The Relationship among Country of Origin, Brand Equity and Brand Loyalty: Comparison among USA, China and Korea (원산지효과, 상표자산 및 상표충성 간의 관계에 관한 연구: 미국, 중국, 한국의 비교분석)

  • Ko, Eun-Ju;Kim, Kyung-Hoon;Kim, Sook-Hyun;Li, Guo-Feng;Zou, Peng;Zhang, Hao
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.1
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    • pp.47-58
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    • 2009
  • The marketing environment has become competitive to an extent that requires firms to target their products at markets that span national boundaries. However, competitive clout cannot be achieved in global consumer markets unless firms thoroughly understand and adequately respond to the core values and needs of those consumers. Brand equity is one of the most important assets to a company. Especially in sportswear markets, brand equity is the crucial value added to a product by its brand name. Factors such as country of origin also influence customer's attitude towards brand equity. Therefore, this paper discusses the relationship between country of origin effect and brand equity, and how they influence consumers' loyalty for respective brands. This paper focused on the sports shoes market, because it is an increasing area of opportunity for world manufacturers. The objectives of this study were the following. (1) Test the effect of country of origin on brand equity. (2) Test how brand equity influences consumers' brand loyalty. (3) Find whether there are differences in the effects of country of origin and brand equity among the three countries. (4) Find whether there are differences in the effects of country of origin and brand equity among the different lifestyles. Based on the review of literature results, the hypotheses are concluded as the following: H1-a: Country image has positive influence on country of origin. H1-b: Product perception has positive influence on country of origin. H2-a: Perceived quality has positive effect on brand equity. H2-b: Perceived price has positive effect on brand equity. H3: Country of origin has positive effect on brand equity. H4: Brand equity has a positive impact on brand loyalty. Research model was constructed (see Fig. 1). After data analysis, the following results were concluded: sports shoes purchase behavior showed significant differences among Korean, Chinese, and American consumers for favorite brand, purchased brand, purchased place, information usage, and favorite sports games. The results of this study also extend the research of the relationship among country of origin, brand equity and brand loyalty to the sports shoes market. Brand equity was proven to have a significant relationship with brand loyalty for all countries. The factors which can influence brand equity are different for different countries. The third finding of this paper is that we identified different three lifestyles, adventurer, follower, and laggard, for Korean, Chinese and American consumers. Without the nationality boundary, seeing the emergence of a new group of consumers who have similar preferences and buy similar brands is more important. All of the consumers consider brand equity to keep their brand loyalty. Perceived price is the only factor which can influence brand equity for adventurers; brand is more important for them. The laggards were not influenced by any factor. All of the factors expect perceived price are important for the followers. Marketing managers should consider brand equity when introducing their brand into a new market. Also localization is the basic strategy that all the sports shoes companies should understand. But as a global brand, understanding the same characteristics for each country is more important to build global strategy.

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Marketing Standardization and Firm Performance in International E.Commerce (국제전자상무중적영소표준화화공사표현(国际电子商务中的营销标准化和公司表现))

  • Fritz, Wolfgang;Dees, Heiko
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.3
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    • pp.37-48
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    • 2009
  • The standardization of marketing has been one of the most focused research topics in international marketing. The term "global marketing" was often used to mean an internationally standardized marketing strategy based on similarities between foreign markets. Marketing standardization was discussed only within the context of traditional physical marketplaces. Since then, the digital "marketspace" of the Internet had emerged in the 90's, and it became one of the most important drivers of the globalization process opening new opportunities for the standardization of global marketing activities. On the other hand, the opinion that a greater adoption of the Internet by customers may lead to a higher degree of customization and differentiation of products rather than standardization is also quite popular. Considering this disagreement, it is notable that comprehensive studies which focus upon the marketing standardization especially in the context of global e-commerce are missing to a high degree. On this background, the two basic research questions being addressed in this study are: (1) To what extent do companies standardize their marketing in international e-commerce? (2) Is there an impact of marketing standardization on the performance (or success) of these companies? Following research hypotheses were generated based upon literature review: H 1: Internationally engaged e-commerce firms show a growing readiness for marketing standardization. H 2: Marketing standardization exerts positive effects on the success of companies in international e-commerce. H 3: In international e-commerce, marketing mix standardization exerts a stronger positive effect on the economic as well as the non-economic success of companies than marketing process standardization. H 4: The higher the non-economic success in international e-commerce firms, the higher the economic success. The data for this research were obtained from a questionnaire survey conducted from February to April 2005. The international e-commerce companies of various industries in Germany and all subsidiaries or headquarters of foreign e-commerce companies based in Germany were included in the survey. 118 out of 801 companies responded to the questionnaire. For structural equation modelling (SEM), the Partial-Least. Squares (PLS) approach in the version PLS-Graph 3.0 was applied (Chin 1998a; 2001). All of four research hypotheses were supported by result of data analysis. The results show that companies engaged in international e-commerce standardize in particular brand name, web page design, product positioning, and the product program to a high degree. The companies intend to intensify their efforts for marketing mix standardization in the future. In addition they want to standardize their marketing processes also to a higher degree, especially within the range of information systems, corporate language and online marketing control procedures. In this study, marketing standardization exerts a positive overall impact on company performance in international e-commerce. Standardization of marketing mix exerts a stronger positive impact on the non-economic success than standardization of marketing processes, which in turn contributes slightly stronger to the economic success. Furthermore, our findings give clear support to the assumption that the non-economic success is highly relevant to the economic success of the firm in international e-commerce. The empirical findings indicate that marketing standardization is relevant to the companies' success in international e-commerce. But marketing mix and marketing process standardization contribute to the firms' economic and non-economic success in different ways. The findings indicate that companies do standardize numerous elements of their marketing mix on the Internet. This practice is in part contrary to the popular concept of a "differentiated standardization" which argues that some elements of the marketing mix should be adapted locally and others should be standardized internationally. Furthermore, the findings suggest that the overall standardization of marketing -rather than the standardization of one particular marketing mix element - is what brings about a positive overall impact on success.

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A Study on Qulity Perceptions and Satisfaction for Medical Service Marketing (의료서비스 마케팅을 위한 품질지각과 만족에 관한 연구)

  • Yoo, Dong-Keun
    • 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.

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A RURAL HEALTH SERVICE MODEL FOR KOREA BASED OH A PRIMARY CARE NURSING SERVICE SYSTEM

  • Hong, Yeo-Shin
    • Journal of Korean Academy of Nursing
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    • v.11 no.2
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    • pp.5-8
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    • 1981
  • This study concerns itself with the development of a new model of comprehensive health service for rural communities of Korea. The study was conceived to resolve the problems of both underservice in rural communities and underutilization of valuable health manpower, namely the nurses, the disenchanted elite health personnel in Korea. On review of the current situation, the greatest deficiencies in the Korean health care system were found in the availability of primary care at the peripheries of md communities, in the dissemination of knowledge of disease prevention and health care, and in the induction of and guidance for active participation by the clientele in health maintenance at the personal, family and community level Abundant untapped health resources were identified that could be brough to bear upon the national effort to extend health services to every member of the Korean Population. Therefore, it was Postulated that the problem of underservice in rural communities of Korea can be structurcturally resolved by the effective mobilization and organization of untapped health resources, and that. a primary care Nursing Service System offers the best possibility for fulfillment of rural health service goals within the current health man-power situation. In order to identify appropriate strategies to combat the present difficulties in Korean rural health services and to utilize nurses and other health personnel in community-centered health programs, a search was made for examples of innovative service models throughout the world. An extensive literature survey and field visits to project sites both in Korea and in the United States were made. Experts in the field of world health, health service, planners, administrators, and medical and nursing practitioners in Korea, in the United States as well as visitors from other Asian countries were widely consulted. On the basis of information and inputs from these experts a new rural health service model has been constructed within the conceptual framework of community development, especially of the innovation diffusion Model. It is considered especially important that citizens in each community develop capacities for self-care with assistance and supports from available health professionals and participate in health service-related decisions that affect their own well-being. The proposed model is based upon the regionalization of health care planning utilizing a comprehensive Nursing Service System at the immediate delivery level The model features: (1) a health administration unit at each administrative level; (2) mechanisms for community participation; (3) a continuous source of primary health care at the local community level; (4) relative centralization of specialty care and provision of tertiary or super-specialty care only at major national metropolitan centers; and (5) a system for patient referral to the appropriate level of care. This model has been built around professional nurses as the key community health workers because their training is particularly suited and because large numbers of well-trained nurses are currently available and being trained. The special element in this model is a professional nurse-guided, self-care facilitating primary care Community Nursing Service System. This is supported by a Nursing Extension Service as a new training and support structure. (See attached diagrams). A broad spectrum of programs was proposed for the Community Nursing Service System. These were designed to establish a balance of activities between the clinic-centered individual care component and the field activity-centered educational and supportive component of health care services. Examples of possible program alternatives and proposed guidelines for health care in specific situations were presented, as well as the roles and functions of the key health personnel within the Community Nursing Service System. This Rural Health Service Model was proposed as a real alternative to the maldistributed, inequitable, uncoordinated solo-practice, physician-centered fee-for-service health care available to Koreans today.

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