• 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 Health Service Management
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• v.2 no.1
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• pp.37-55
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• 2008

This study aims to enhance work efficiency and satisfaction by offering data that make a physical therapist cope with stress coming from the job efficiently by identifying and analyzing the job satisfaction and work stress perceived by a physical therapist, and the level of reaction of a physical therapist. The study distributed survey questionnaires to 300 physical therapists working in medical institutions in Busan via mail and by visit from March 3, 2007 by selecting them simply and randomly from the physical therapist list, and collected the questionnaires by March 20, 2007, 103 respondents were working at 17 general hospitals including a university hospital, 65 respondents at 12 medical centers, and 79 respondents at 39 doctor's offices. The study collected 251 copies, which showed the collection rate of 83.7%, and analyzed 247 copies (82.3%) excluding 4 copies of insincere answers. As a research tool for measuring job satisfaction the study used a tool employed for research into the job satisfaction of physical therapists who work at medical institutions in Gwangju, Jeonnam, and Jeonbuk by Kim Hee-Gwon(1992) and research regarding job satisfaction by Jeong Jeong-Hee(2004) as well as research regarding the factors of job satisfaction by Flippo(1980) & Seberhagen(1970) after adjusting the research tools to the purpose of the study. Also for questions about work stress, the study employed nurses' job stress measurement tool developed by Kim Mae-Ja and em Mi-Ok(1984) by modifying the tool to the purpose of the study, and for a measurement tool for reaction to stress, the study used a tool employed for research into reaction to stress of nurses at general hospitals by Choi Eun-Deok(2005) without modification. For data analysis, the study used the SPSS12.0 as a statistical method, and then used t-test or ANOVA for verifying actual numbers, percentile, average :score, standard deviation, rank, and difference. Also, the study conducted which is a post-test method for variables that show a significant difference at the level of p<.05 level after the analysis. The findings include the following. 1) The respondents' job satisfaction score was 3.21 points on the average (out of 5 full points). The peer relationship ranked the highest, posting 4.02 points on the average, and the job satisfaction with rewards was proven the lowest, posting 2.51 points. For the job satisfaction level by characteristics, there were significant differences (p<.05) in gender, hospital type, weekly working hours, monthly working days, number of patients per day, department in charge of therapy, and number of peers, and there was no significant difference in characteristics other than that. 2) The respondents' work stress score was 2.72 points (out of 5 full points) on the average. The respondents were shown to be under the highest stress when they suffered from excessive workload, posting 3.49 points on the average, and they were shown to be under the least stress when they had a conflict with peers at another department, recording 1.90 points on the average. for the job stress level by the characteristics of job, there was a significant difference in the reflection of job assessment(p<.05). 3) 1n respondents' reaction to stress, most of them were shown to make efforts in coping with stress, posting 2.80 points (out of 5 full points). For their experience of being wider stress, they answered that 'they felt depressed (2.85 points)" for their experience of coping with stress, they answered that 'they were indifferent to it or thought about something else' (2.62 points). Also, for their efforts in coping with stress, they answered that 'they were motivated to remove their strain by taking leave, playing, or using their preferences' (3.52 points), which ranked higher. For the level of reaction to stress by characteristics, there were significant differences by age, gender, marital status, total service years as a physical therapist, monthly working days, and department in charge of therapy(p<.05). It is necessary to offer correct information by conducting an in-depth analysis of the stressful situations of physical therapists who exert efforts in rehabilitating patients at hospitals by factor, and seeking management plans based on the research results. Also, it is necessary to develop a program for coping with stress efficiently for removing stress and to conduct research into the understanding and cooperation of administrators and persons in charge of physical therapists for reducing physical therapists' stress at hospitals.

• Journal of the Korean Institute of Landscape Architecture
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• v.36 no.3
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• pp.9-20
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• 2008

The government is planning to link a small park with the soon to be ready subway line 9 as a part of Seoul's policy, "The standard or plan for making a water-friendly space by water use" (2007). However, the specified concepts and instructions of the small parks need further work. Therefore, the policy is expected to expand to neighboring small parks near the subway station, but these are not supported by research or data which suggests the needs or actual user behavior and utilization of small parks. our country added the specified concept of small parks and theme parks to the classification of urban parks in the Urban Park Act Revision (2005.3.31), but the concept of small parks is not clearly settled in the law in the scopes of its function, scale, promotion nor particularly defined plans for small park projects. This study examines as small park near a subway station. The characteristics of there region and users vary from the characteristics of the station and region. In the "directions for concrete standards under the types of urban parks and green zones" (2007.2) the types of small parks are classified by "regional characteristics" and "user characteristics". Therefore, this study classifies the subject of neighboring small parks near subway stations as the neighborhood and small urban parks according to the Urban Park Act. The study was paralleled with observation and questionnaires on the analysis of the neighborhood and small urban parks. The actual conditions of park utilization and user behavioral characteristics were deducted by observation, while the questionnaire determined actual user utilization, importance and satisfaction level as well as the small park environment. This study largely focused on three aspects: park facility, design of this sentence isn't even complete. The second aspect isn't finished and the third isn't here.

• Journal of Food Hygiene and Safety
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• v.23 no.1
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• pp.31-39
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• 2008

This study was performed to develop children's food quality certification system as part of the children's favorite foods safety management projects. As a component of the research, we developed a quality certification logo to build up brand image which is familiar with children, as well as to offer the right standard and opportunity for food selection. The age level contains elementary graders from 8 to 13. The logo concept was focused on 'Safety', 'Certification, Guidance' and 'Health' in accordance with the vision of the Korea Food and Drug Administration (KFDA), "Safe food, good nutrition and healthy children". The logo name was proposed as "Best Food for Children", "Safety Food for Children" and "Children Good Food", which was decided by public subscription in the KFDA. The 36 tentative plans for a seal were proposed depending on names. We conducted a survey for the 12 logo samples, designed by the name of "Children Good Food", to use as the basic material for the development of logo to convey the meaning of children's food quality certification system effectively. This survey was conducted among 321 elementary graders and 331 parents of elementary graders. We selected the most favorite design through the survey and applied it for products practicality. It is expected that a steady policy may be possible to implement by applying the basis of the children's food project.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.1
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• pp.77-85
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• 2013

Purpose: The accurate movement of gantry rotation, collimator and correct application of dose rate are very important to approach the successful performance of Volumetric Modulated Arc Therapy (VMAT), because it is tightly interlocked with a complex treatment plan. The interruption and restart of dose delivery, however, are able to occur on treatment by various factors of a treatment machine and treatment plan. If unexpected problems of a treat machine or a patient interrupt the VMAT, the movement of treatment machine for delivering the remaining dose will be restarted at the start point. In this investigation, We would like to know the effect of interruptions and restart regarding dose delivery at VMAT. Materials and Methods: Treatment plans of 10 patients who had been treated at our center were used to measure and compare the dose distribution of each VMAT after converting to a form of digital image and communications in Medicine (DICOM) with treatment planning system (Eclipse V 10.0, Varian, USA). We selected the 6 MV photon energy of Trilogy (Varian, USA) and used OmniPro I'mRT system (V 1.7b, IBA dosimetry, Germany) to analyze the data that were acquired through this measurement with two types of interruptions four times for each case. The door interlock and the beam-off were used to stop and then to restart the dose delivery of VMAT. The gamma index in OmniPro I'mRT system and T-test in Microsoft Excel 2007 were used to evaluate the result of this investigation. Results: The deviations of average gamma index in cases with door interlock, beam-off and without interruption on VMAT are 0.141, 0.128 and 0.1. The standard deviations of acquired gamma values are 0.099, 0.091, 0.071 and The maximum gamma value in each case is 0.413, 0.379, 0.286, respectively. This analysis has a 95-percent confidence level and the P-value of T-test is under 0.05. Gamma pass rate (3%, 3 mm) is acceptable in all of measurements. Conclusion: As a result, We could make sure that the interruption of this investgation are not enough to seriously affect dose delivery of VMAT by analyzing the measured data. But this investigation did not reflect all cases about interruptions and errors regarding the movement of a gantry rotation, collimator and patient So, We should continuously maintain a treatment machine and program to deliver the accurate dose when we perform the VMAT for the many kinds of cancer patients.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.1
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• pp.9-14
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• 2013

Purpose: High-energy radiotherapy with 10 MV or higher develops photoneutron through photonuclear reaction. Photoneutron has higher radiation weighting factor than X-ray, thus low dose can greatly affect the human body. An accurate dosimetric calculation and consultation are needed. This study compared and analyzed the dose change of photoneutron in terms of space according to the size of photon beam energy and treatment methods. Materials and Methods: To measure the dose change of photoneutron by the size of photon beam energy, patients with the same therapy area were recruited and conventional plans with 10 MV and 15 MV were each made. To measure the difference between the two treatment methods, 10 MV conventional plan and 10 MV IMRT plan was made. A detector was placed at the point which was 100 cm away from the photon beam isocenter, which was placed in the center of $^3He$ proportional counter, and the photoneutron dose was measured. $^3He$ proportional counter was placed 50 cm longitudinally superior to and inferior to the couch with the central point as the standard to measure the dose change by position changes. A commercial program was used for dose change analysis. Results: The average integral dose by energy size was $220.27{\mu}Sv$ and $526.61{\mu}Sv$ in 10 MV and 15 MV conventional RT, respectively. The average dose increased 2.39 times in 15 MV conventional RT. The average photoneutron integral dose in conventional RT and IMRT with the same energy was $220.27{\mu}Sv$ and $308.27{\mu}Sv$ each; the dose in IMRT increased 1.40 times. The average photoneutron integral dose by measurement location resulted significantly higher in point 2 than 3 in conventional RT, 7.1% higher in 10 MV, and 3.0% higher in 15 MV. Conclusion: When high energy radiotherapy, it should consider energy selection, treatment method and patient position to reduce unnecessary dose by photoneutron. Also, the dose data of photoneutron needs to be systematized to find methods to apply computerization programs. This is considered to decrease secondary cancer probabilities and side effects due to radiation therapy and to minimize unnecessary dose for the patients.

• Journal of Korean Academy of Nursing
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• v.8 no.2
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• pp.89-102
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• 1978

Owing to the development of modern science, prolonging man's life, the sudden increase of population and betterment of the standard of living has increased health needs. In order to fulfill these health needs, more active plans for developing health should be made. Health education is one of the methods at hand that can improve the health behavior of the community and the individual through the contact of individuals with their groups. Proper understanding of the characteristics of the sampled group and participation of individuals within the community for the development of their health plan are needed for efficient health education. This study was attempted for the purpose of presenting some data helpful for pre-paring the fundamentals of a health education plan that can improve personal health maintenance practice of a community through efficient health education by investigating the relationship between the response of subjects to personal health maintenance practice and selected decisive factors in personal health maintenance practice. The subjects for this study were a systematic sample of 120 housewives selected from 600 housewives from B Zone Apt. Younhi-3-Dong in Seoul. Data was collected for 4 days from May 16th to May 19th, 1578 through personal interviews with questionnaires by well trained interviewers. Percentage, t-test and stepwise multiple regression analysis by use of EDPS were employed for statistical analysis. Results of this study can be summarized : 1. General characteristics of subjects Subjects over 20 and below 40 years of age formed 62.5% of the toed and the rest were subjects of 40 years and upward. 76.7% of the subjects have less than 4 children. 51.3% of the subjects had completed at least the senior high school course. 2. The response of subjects to personal health maintenance practice. Ratios of personal health maintenance practice to the maximum score for each category are as follows; 84.1% in the category of population and family planning, which was the highest ratio; 82.4% in the prevention of accidents; 68.0% in control of communicable disease; 67.8% in personal health care and habits of daily life, 64.3% in mental health and 52.5% in control of parasites, which was the lowest. 3. The response of subjects to selected decisive factors. in personal health maintenance practice. The arithmetic mean of the score for each decisive factor was as follows: the mutual relation between family members marked 18.33, which is under 73,3% of the maximum score; the degree of interest in health marked 34.48, 70.0% of the maximum score: the degree of utilization and demand for health care facilities marked 25.79 or 64.5% of the maximum score and health maintenance of the family marked 11.58, 43.6% of the maximum score. 4. The relationship between personal health maintenance practice and general characteristics of subjects. 1) There was a significant difference in the numbers of children. (t = 1.83, d.f. =117, p< 0.1) 2) There was a significant difference in the contact rates with mass-media, (t = 5.02, d.f. = 118, p< 0,05) 5. The multiple correlation between personal health maintenance practice and their selected decisive factors. 1) The factor“the degree of interest in health”could account for personal health maintenance practice in 43.6% of the sample. (R = 0.6602, R²= 0,4359, F = 91.1678, p< 0.001) 2) When the factor,“health maintenance of family”is added to this, it accounts for 51.2% of personal health maintenance practice. (R = 0.7158, R²= 0.5124, F = 61.4653, p< 0.001) 3) When the factor,“mutual relations between family members”is also included, it accounts for 53.7% of personal health maintenance practice. (R = 0.7324, R²= 0.5365, F = 44.7509, p< 0.001) 4) When the factor, “the degree of utilization and demand for health care facilities”is included, it accounts for 55.1% of personal health maintenance practice. (R = 0.7421, R²= 0.5507, F = 35.2430, p< 0.001).

• Journal of Technologic Dentistry
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• v.26 no.1
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• pp.9-34
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• 2004

The present study reviews the license registration status of dental technicians and dentists from 1970 to 2002, the number of technician members of The Korea Dental Technician Association from 1990 to 2003, and the number of dentist members in 2003. It also considers the yearly membership fluctuations, its growth rates, yearly increase/decrease, the rate of dentist to dental technician, regional distribution of association members, regional yearly increase/decrease of the members, and the regional distribution of dentists and dental technicians. The purpose is to identify and predict the problems in the demand/supply of dental technicians and the regional imbalance of manpower distribution. By doing so, this study attempts to propose the appropriate standard for the supply of dental technicians and point out the necessity of making mid- or long-term plans for ensuring the efficiency of manpower supply and balanced regional distribution. The result is as follows: 1. The number of dental technicians and dentists in 2002 has grown 36.79 and 9.27 times from 1970, and 2.20 and 2.05 times from 1990, respectively. It tool 11 years for the twofold increase of dental technicians from 1990, one year faster than the same increase of dentists. The number of dental technicians per a dentist was the lowest in 1972 (0.21 person), and the highest in 2002 (0.86 person). Specifically, the fastest growth was observed for a year from 1983 (0.47 technician per a dentist) to 1984 (0.6). From 1984 to 1986, the ratio grew by 0.1 every year. Summing up the numbers of dentists and dental technicians who passed the national certification examination, this study predicted the number of dental technicians per a dentist to be 0.88 in 2003, and 0.90 in 2004. 2. From 1990 to 2003, the average distribution of dental technician was 71.76% in the metropolitan areas and 28.24% in other smaller regions. The proportion of dental technicians working in the three major cities (Seoul, Busan, and Daegu) was the lowest in 2001 (52.39%) and the highest in 1996 (62.66%). The majority number of dental technicians who practiced in the metropolitan areas (about 70% of the entire population) were in service in the three major cities. 3. Compared with 1990, the number of dental technicians in 2003 grew 2.28 times in the large cities, and 2.05 times in other smaller regions. The yearly growth rate was the highest in 1994 over the previous year: 26.06% in large cities and 17.86% in the other regions. In the large metropolitan cities, the growth rate was the highest in Incheon (5.8 times for 5 years from 1998 to 2003), In the rest of the regions, the increase of dental technicians was the highest in Gyeonggi (6.5 times from 1990 to 2003). 4. In 2003, as much as 73.40% of all the members of the Korea Dental Technician Association were distributed in the large metropolitan cities, and the rest 26.60% were in other smaller regions. Meanwhile, 54.35% of the dentists practiced in the metropolitan cities, and the rest 45.65% were in service at other regions. This result indicates that more dental technicians than dentists are concentrated in large cities. More than half of all the technician members of the Association are distributed in the three major cities (i.e. Seoul, Busan, Daegu). On the other hand, 42.03% of dentist members are in these three cities and 53.97% of them practice in Seoul, Gyeonggi, and Busan. In 2003, the ratio of dentist to dental technician is 1:0.43 in general, while the ratio is 1:0.58 in the metropolitan cities, and 1:0.43 in other regions. In 2003, 33.30% of all the certified dental technicians are the member of the Korea Dental Technician Association, while 66.82% of all the licensed dentists are its members.

• Journal of Gastric Cancer
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• v.5 no.2
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• pp.95-100
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• 2005

Purpose: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. Materials and Methods: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. Results: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the $7^{th}$ postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was $7.7\%$ (2/26), and the variance rate was $30.8\%$ (8/26). The mean hospital stay was 11.3 days ($10\~15$ days) for the CP group compared with 17.5 days ($9\∼68$ days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days ($7\∼68$ days) and 8.3 days ($7\∼12$ days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group ( $\\$ 6,292,200) than in the CP group ( $\\$ 4,863,685). The charge per hospital day was higher in the CP group ( $\\$ 430,414) than in the non-CP group ( $\\$ 359,554). Patient satisfaction was higher in the CP group than in the non-CP group. Conclusion: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.

• Journal of Korea Port Economic Association
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• v.30 no.3
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• pp.163-185
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• 2014

The growth of a city requires substantial resources, an appropriate environment, and the alignment of several factors. City growth also evolves through changes in its history, culture, economics, societies, groups, and government systems. However, current port city development plans designed to encourage the growth of local businesses fail to provide the support needed for both the city and businesses. The recent actions of urban administrations and federal and local governments have revealed that they have yet to create a mature decentralized management system, or perhaps have ignored the reality of needing one. Taking a clear look at the differences between port regions, such as Gwangyang and Pyeongtaek, and understanding their effect on city growth would be a prudent course of action when preparing for future developments. The purpose of this study is to determine the relationship between ports and cities by analyzing the effect of port characteristics on nearby city growth. This study used a comparison analysis to determine how port characteristics affected the growth of Pyeongtaek and Gwangyang. One result of this analysis showed that an increase in the number of goods being imported or exported had a positive effect on the growth of both port cities, In this respect, an aggressive plan and cooperation between the federal and local government should occur simultaneously. Furthermore, efficient local policies that focus on the increase of personnel and material resources should be pursued as a standard strategy, which would also promote the international status of these locations. The results of this study show the importance of government cooperation. The federal government should lead with aggressive strategies that aim to optimize efficiency, while the local government should provide the necessary assistance and coordination in order to achieve optimal results.