• Quality Improvement in Health Care
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• v.10 no.2
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• pp.176-189
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• 2003

Background : Gastric cancer is the most common malignant tumor in Korea. Surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for reducing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and the unplanned readmission rate between the pre-pathway group (n=67) and the post-pathway group (n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days (p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was not statistically significant (p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group and 0% in the post-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korean hospital settings.

• Journal of dental hygiene science
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• v.11 no.1
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• pp.15-21
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• 2011

Introduction The aim of this study, personal trait and their dental care based on experience level of dental fear is to analyze the differences. Catastrophizing is an irrational belief that something is far worse than it actually is. Because it makes it possible to analyze patients' anxious thoughts and tendencies. Methods The Dental Fear Survey(DFS) and Anxious Thoughts and Tendencies(AT&T) were used as measuring tools, and the independent sample t-test and ANOVA were performed on the basis of the mean value of the summated scale scores and the standard deviation. On the factors to dental anxiety, the multiple regression analysis was performed. Results Demographically, the total DFS score was higher in women($25.73{\pm}8.27$) than in men. Also, AT&T was higher in women($31.01{\pm}7.05$) (p<0.05). Dental fear was intense in the group of patients who visited dental clinics only problems($25.29{\pm}8.57$) than in those regular visited($22.29{\pm}7.78$). In relation to dental experiences, the DFS score was significantly higher in children. In many cases, patients experienced therapeutic pains in children($26.40{\pm}9.54$) (p=0.004). Also in many patients, dental anxiety began to occur in adolescence(44.3%). The multiple regression analysis result, it was found that dental treatment pain and their AT&T wielded great influence upon dental fear.

• Journal of Chest Surgery
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• v.32 no.6
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• pp.536-542
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• 1999

Background: The purpose of this study is to improve the quality of the diagnostic procedures in the preoperative evaluation so as to reduce the unnecessary thoracotomy and to ensure resectability in non-small cell lung cancer. Material and Method: Of 616 patients who underwent thoracotomy for primary lung cancer from January 1990 to December 1996, 59 patients(9.6%) turned out to have inoperable lesions after the thoracotomy. We reprospectively reviewed the bronchoscopic findings, methods of tissue diagnosis, CT scans, pulmonary function test and lung perfusion scan, reasons for nonresectability, and adjuvant therapy, and then followed up on the survival rate after exploratory thoracotomy. Result: The cell types were squamous cell carcinoma in 38, adenocarcinoma in 15, large cell carcinoma in 3 and others in 3. Primary loci were RUL in 20, RML in 6, RLL in 8, LUL in 13, LLL in 4 and others in 8. The reasons for non-resectability were various; direct tumor invaison to mediastinal structures(n=41), seeding on pleural cavity(n=8), poor pulmonary function(n=2), invasions to extranodal mediastinal lymph node(n=2), technical non- resectability due to extensive chest wall invasion (n=3), small cell carcinoma (n=1), malignant lymphoma(n=1), and multiple rib metastases(n=1). In the follow-up of 58 patients, 1-year survival rate was 55.2% and 2-year survival rate was 17.2% and the mean survival time was 14 months. When compared according to cell types or postoperative adjuvant therapeutic modalities, no significant difference in the survival rates were found. The squamous cell carcinoma was frequently accompanied by local extension to contiguous structures and was the main cause of non-resectability. In adenocarcinoma, pleural seeding with malignant effusion was frequently encountered, and was the major reason for non-resectability. Conclusion: These data revealed that if appropriate preoperative diagnostic tools had been available, many unnecessary thoracotomies could have been avoided. Both the use of thoracoscopy in selected cases of adenocarcinoma and the more aggressive surgical approach to the locally advanced tumor could reduce the incidence of unnecessary thoracotomies for non-small cell lung cancers.

• Child Health Nursing Research
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• v.5 no.1
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• pp.38-47
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• 1999

This study is the study on health promoting behaviors of 6th grade students according to sex. The purpose of this study is to find the difference in the value of health in their lives among 6/sup th/ grade students according to sex, to examine the differences in practicing health promoting behaviors, and to determine the correlation between the practice of health promoting behaviors and the characteristics of these students. The subjects of this study were 177 6/sup th/ grade students who were randomly selected from two elementary schools in Taegu City. The tools used to measure health promoting behaviors were the measuring utility for practicing health promoting behaviors developed by Kyung-Suk Ki (1983) and the utility for the values of health in lives developed by Wallston, Maides and Wallston and translated by Gin Yoon (1989). The data collected were analyzed with t-test, Pearson correlation coefficient, and descriptive statistics using SPSS program. The results of the present study were as follows : 1) According to the results of the value placed in health in their lives, the number of students who placed health high in their lives was 69 boys (75%) and 64 girls (75.3%). 2) According to the results obtained from comparing the degree of practicing health promoting behaviors according to sex, in the field of personal hygiene and daily habits, the girls showed a higher degree of practice with 3.26±0.33 and the boys, 3.05±0.45(t=-3.484, p=0.001) : and in the field of contagious diseases, the girls scored significantly higher with 3.40±0.39 than the boys with 2.99±0.54(t=-2.363, p=0.019). In the filed of preventing accidents, the girls showed a meaning high significant result with 3.16±0.46 than the boys with 2.99±0.54(t=-2.362, p=0.019). When the results from the total questions in the field of health promoting behaviors were compared, the girls showed a meaningfully high correlation with 3.19±0.28 than the boys with 3.07±0.36(t=-2.601, p=0.010). Thus, the results showed that the girls, compares with the boys, practice more behaviors of personal hygiene & daily habits, prevention of communicable diseases, and prevention of accidents. 3) According to the results of the relationship between the subjects’ characteristics and their health promoting behaviors according to set in the case of the boys, they showed a meaningful positive correlation with health promoting behaviors and the current status of health (r=0.266, p=0.005). Thus, for the boys, as their health status was better, the more health promoting behaviors they showed. In the case of the girls, the meaningful variables had a correlation with the health promoting behaviors were the number of extra-curricula activities(r=0.182, p=0.047) and the birth order(r=-0.192, p=0. 024). In overall regardless of sex, the health status (r=0.188, p=0.006) and birth order(r=-0.149, p=0.024) showed a meaningful correlation with practicing health promoting behaviors. With the above results, we suggest the following proposals. 1) In elementary children of lower and upper classmen as applied with the current school age, developing a utility to measure health promoting behaviors is needed since the physical, emotional and intellectual development of these children exist. 2) According to the results of this study, developing a program for health promotion is needed in 6/sup th/ grade students.

• Journal of Korean Academy of Nursing
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• v.24 no.4
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• pp.584-596
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• 1994

The objective of the study is to explore the relationships between the variables of nursing productivity on the framework of system del in the tertiary university based care hospital in Korea. Productivity is basically defined as the relation-ship between inputs and outputs. Under the proposition that the nursing unit is a system that produces nursing care output using personal and material resources through the nursing intervention and nursing care management. And this major conception of nursing productivity system comproises input, process and output and feed-back. These categorized variables are essential parts to produce desirable and meaningful out-put. While nursing personnel from head nurse to staff nurses cooperate with each other, the head nurse directs her subordinates to achieve the goal of nursing care unit. In this procedure, the head nurse uses the leadership of authority and benevolence. Meantime nursing productivity will be greatly influenced by environment and surrounding organizational structures, and by also the operational objectives, the policy and standards of procedures. For the study of nursing productivity one sample hospital with 15 general nursing care units was selected. Research data were collected for 3 weeks from May 31 to June 20 in 1993. Input variables were measured in terms of both the served and the server. And patient classification scores were measured drily by degree of nursing care needs that indicated patent case-mix. And also nurses' educational period for profession and clinical experience and the score of nurses' personality were measured as producer input variables by the questionnaires. The process varialbes act necessarily on leading input resources and result in desirable nursing outputs. Thus the head nurse's leadership perceived by her followers is defined as process variable. The output variables were defined as length of stay, average nursing care hours per patient a day the score of quality of nursing care, the score of patient satisfaction, the score of nurse's job satis-faction. The nursing unit was the basis of analysis, and various statistical analyses were used : Reliability analysis(Cronbach's alpha) for 5 measurement tools and Pearson-correlation analysis, multiple regression analysis, and canonical correlation analysis for the test of the relationship among the variables. The results were as follows : 1. Significant positive relationship between the score of patient classification and length of stay was found(r=.6095, p.008). 2. Regression coefficient between the score of patient classification and length of stay was significant (β=.6245, p=.0128), and variance explained was 39%. 3. Significant positive relationship between nurses’ educational period and length of stay was found(r=-.4546, p=.044). 5. Regression coefficient between nurses' educational period and the score of quality of nursing care was significant (β=.5600, p=.029), and variance explained was 31.4%. 6. Significant positive relationship between the score of head nurse's leadership of authoritic characteristics and the length of stay was found (r=.5869, p=.011). 7. Significant negative relationship between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was found(r=-.4578, p=.043). 8. Regression coefficient between the score of head nurse's leadership of benevolent characteristics and average nursing care hours was significant(β=-.6912, p=.0043), variance explained was 47.8%. 9. Significant positive relationship between the score of the head nurse's leadership of benevolent characteristics and the score of nurses' job satis-faction was found(r=.4499, p=050). 10. A significant canonical correlation was found between the group of the independent variables consisted of the score of the nurses' personality, the score of the head nurse's leadership of authoritic characteristics and the group of the dependent variables consisted of the length of stay, average nursing care hours(Rc²=.4771, p=.041). Through these results, the assumed relationships between input variables, process variable, output variables were partly supported. In addition it is also considered necessary that-further study on the relationships between nurses' personality and nurses' educational period, between nurses' clinical experience including skill level and output variables in many research samples should be made.

• The Journal of Korean Academy of Sensory Integration
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• v.6 no.1
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• pp.47-62
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• 2008

Introduction : Sensory Integration(SI) theory, science it is developed by an occupational therapist A. Jean Ayres, is the one of the most popular frames of reference used in occupational therapy(OT) intervention. It has been proved as a scientific theory especially in neuroscience discipline through abundant research and practice. Occupational therapists apply the SI therapy with strong clinical reasoning to improve adaptive behaviors of their clients and try to link the adaptive behaviors with occupational performance in the clients' everyday life. One of the manners regarding clinical reasoning is Top-down approach. In occupational therapy discipline, Top-down approach is well-reflected within two evaluation tools; Canadian Occupational Performance Measure(COPM) and Assessment of Motor and Process Skills(AMPS) and two models of practice; Canadian Model of Occupational Performance(CMOP) and Occupational therapy intervention process model(OTIPM). Objective : The purpose of this paper demonstrates how SI therapy can be employed within OTIPM and how the OT process (evaluation-intervention-outcome) can be structuralized based on the Top-down approach. This single-case study recognizes the impact of a SI therapy for a male adolescent on his occupational performance. Intervention Examined : "P" was 16 years old male adolescent with no diagnosis and junior of the high school when he was referred. P was always with mouth opened, showed difficulties in gathering things need to be prepared and managing and paying money for shopping, and his colleges dislike getting close to him because he can't was his body well. AMPS was administrated in initial evaluation and reevaluation of P's occupation performance, Bruininks-Oserestky Test of Motor Proficiency-2(BOT-2) was carried out to assess motor functions and perception skills related in sensory integration, and occupational therapist performed clinical observation in order to complement the evaluation quantitatively and quantitatively. Based on the evaluation, it is concluded that the SI therapy is primary means to improve P's occupational performance, and three therapeutic approaches were constructed; restorative, acquired and compensatory approach. P showed improved motor and process skills in occupational performance after undergone the occupational therapy. Conclusions : The sensory integration therapy was practical enough to build the bridge between the occupational performance(Top) and the underlying component problems (Bottom). The OTIPM was helpful to identify meaningful occupation for P and P's family within P's contexts, and the AMPS was valuable to analyze and clarify the cause of difficulties in the chosen occupational performance.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.3
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• pp.337-347
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• 2009

Dental caries during infantile and early childhood period is a complex disease resulting from multiple caries factors. Streptococcus mutans(S. mutans) plays a critical role in the initiation of caries, and its early transmission through mothers provides a strong etiologic factor for future development of caries in the primary dentition. Therefore, early detection of caries risk factor is important for prevention of caries. Recent studies about etiologic factors of caries have brought advent of various tools for caries risk assessment in order to predict progress of caries more accurately. Cariogram is a common tool for caries risk assessment, which illustrates present caries risk assessment and correlation of caries risk factors for an individual graphically. The aim of this study was to assess if there is any correlation in the level of S. mutans and caries activity and to verify the effect of caries risk factors between children with age ranging from 3 to 5 years with severe early childhood caries(S-ECC) and their mothers using caries-related salivary test and Cariogram. The results of this study were as follows. 1. Children with S-ECC had a statistically higher level of Streptococcus mutans compared to caries-free children(p<0.05). 2. There was significant correlation between mothers and their children in the aspect of the level of Streptococcus mutans(p<0.05). 3. When caries activity was assessed using Cariogram, significant correlation between mothers and their children was found(p<0.05). 4. When each caries risk factor was evaluated for its affect on caries activity, host was more influential factor compared to microorganism and diet in children. Based on these results, we could conclude that assessing the level of S. mutans can be an effective tool for predicting possibility of caries formation in future. Since prediction of future caries progression and evaluation of caries risk factor became possible with Cariogram, we may conduct early and preventive measures for treatment of caries.

• Journal of Technologic Dentistry
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• v.28 no.1
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• pp.121-142
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• 2006

Collecting materials for study on teaching efficiency and satisfaction of clinical training, it changes. Dental technology's educational procedure to many ways of a prospect. In a circumstance that needed higher level of education, this study is aimed on realizing an importance of clinical training through the various materials that previously carried out and offering basic knowledge to take better clinical training for the students. Study results below 1. This Investigation conducted on 123 of sophomores(70.3%) and 52 of juniors(29.7%) who have been taken clinical training, and men's proportion(51.45%)is a bit higher than girls(48.6%). The 64% of respondents taken largest proportion were 20 to 24 years old. As 67.9% of respondents attended daytime school and 30.3% of them attended nighttime one, their school time shows a little difference. In a question about relation ship, one answered "Harmonious" took largest proportion by 72.6% during training, and about the degree of satisfaction of campus life who answered "normal" were the most with 59.4%. 2. About the reason choosing dental technology as a major, 41.1% taken the most answered "due to the specialized job", "Getting job easily" was second with 26.9%, and third was "recommended from around" with 18.3%. 50.3% of the respondents answered "normal" about the Satisfaction of their major, student marked in grade "B" most with 51.4% 3. In a investigation result about clinical training statues and preference, most(72.6%) choose place less than 10 for clinical training, and 60.6% of them resided own home. About their commuting time from home to training place, 44% was under 30min, 40% took time 30-60min. It shows students prefer shotter distance in terms of choosing training place. 4. Each part manager took large proportion as a clinical trainer with 33.7%, Training curriculum reform and developing method were most answer as a improvement measure after completing training with 30%. 5. The average of total score about clinical training was 3.15 of 5. In the detailed question, 'satisfaction of clinical training' got 3.38 as a highest score, the lowest score was 2.86 that is about satisfaction of clinical training period. The average score about efficiency of study was 2.86 and in detailed question, 'a Role model' got 3.26 as a highest score and participation of student got 3.05 as a lowest score. 6. The result of T-test to see the difference of the satisfaction according to the general character and clinic training condition between teaching efficiency is that the degree of satisfaction of clinical training showed statistical significance only in the degree of satisfaction of campus life(p<0.05), and teaching efficiency has a statistical significance with their age, grade, and satisfaction of campus life (p<0.05). 7. The relation between of teaching efficiency of clinical training and satisfaction of clinical training of dental technologic student has a statistical meaning in significance leveler 0.01. Now, therefore we suggest following based on these result. 1. To elevate satisfaction of clinical training, it agentry needs development of consistent clinical training curriculum. 2. To grasp the satisfaction and requirement, in needs to measure anxiousness and satisfactory degree after completing training 3. To train efficiently and evaluate efficiency over the teaching activities, it needs to develop measuring tools for teaching efficiency in terms of teacher's important rules in a clinical training. 4. Strengthen the relations with the study developing and managing curriculum gathering theoretical knowledge and practice. And make an effort to apply to their students. 5. Let the trainee take a class setting a belief, sense of value, function and obtain behavior by making the students comfort over clinical training as increasing teaching efficiency.

• Journal of Animal Science and Technology
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• v.45 no.3
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• pp.343-354
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• 2003

Simulation studies were carried out to investigate the responses of selection for three carcass traits (longissimus muscle area: EMA, fat thickness: BF, and marbling score: MS) based on either adjusted phenotypes (APH) or estimated breeding values (EBV) in multivariate animal model with different breeding schemes. Selection responses were estimated and compared on six different models with respect to breeding schemes using either carcass measurements or real time ultrasonic (RTU) scans generated by Monte Carlo computer simulation supporting closed breeding population. From the base population with 100 sires and 2000 dams, 20 sires and 1000 dams by each generation were selected by either APH or EBV for 10 generations. Relative economic weights were equal of three traits as EMA(1): BF(－1) : MS(1) for standardized either APH or EBV. For first two models which were similarly designed with current progeny-test program in Korean cattle, three carcass traits with records either only on male progenies (Model 1) or on male and female progenies (Model 2) were used for selecting breeding stocks. Subsequently, generation intervals on males were assumed as 6${\sim}$10 years in these two models. The other two models were designed with tools of selection by RTU rather than carcass measurements with genetic correlations of 0.81${\sim}$0.97 between RTU and corresponding carcass traits in addition to whether with records (Model 4) or without records (Model 3) on female. In these cases, generation intervals on males were assumed as 2${\sim}$4 years. The remaining last two models were designed as similar with Models 3 and 4 except genetic correlations of 0.63${\sim}$0.68 between RTU and corresponding carcass traits with records (Model 6) and without records (Model 5) on females. The results from 10 replicates on each model and selecting methods suggested that responses indirect selection for carcass traits in Model 4 were 1.66${\sim}$2.44 times efficient rather than those in Model 1. Otherwise, in Model 6 with assuming moderate genetic correlations, those efficiencies were 1.18${\sim}$2.08 times with comparing to responses in Model 1. However, selection response for marbling score was the smallest among three carcass traits because of small variation of measurements. From these results, this study suggested that indirect selection using RTU technology for improving high meat qualities in Korean cattle would be valuable with modifying measuring rules of marbling score forward to large variation or modifying relative economic weight for selection.

• Asia pacific journal of information systems
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• v.18 no.1
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• pp.1-23
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• 2008

As managing customer relationship gets more important, companies are strengthening information service using multi-channels to their customers as a part of their customer relationship management (CRM) initiatives. It means companies are now accepting such information services not as simple information -delivering tools, but as strategic initiatives for acquiring and maintaining customer loyalty. In this paper, we attempt to validate whether or not such various information services would impact on organizational performance in terms of CRM strategy. More specifically, our research objective is to answer the next three questions: first, how to construct the instruments to measure not information quality but information service quality?; second, which attributes of information service quality can influence corporate image and customer loyalty?; finally, does each information service type have unique characteristics compared with others in terms of influencing corporate image and customer loyalty? With respect to providing answers to those questions, the previous studies had been limited in that those studies failed to consider the variety of types of information service or restricted the quality of information service to information quality. An appropriate research model answering the above questions should consider the fact that most companies are utilizing multi channels for their information services, and include the recent strategic information service such as customer online community. Moreover, since corporate information service could be regarded as a type of products or services delivered to customer, it is necessary to adopt the criteria for assessing customer's perceived value when to measure the quality of information service. Therefore, considering both multi-channels and multi-traits may enable us to tell the detailed causal routes showing which quality attributes of which information service would affect corporate image and customer loyalty. As information service channels, we include not only homepage and DM (direct mail), which are the most frequently applied information service channels, but also online community, which is getting more strategic importance in recent years. With respect to information service quality, we abstract information quality, convenience of information service, and timeliness of information service through a wide range of relevant literature reviews. As our dependant variables, we consider corporate image and customer loyalty that both of them are the critical determinants of organizational performance, and also attempt to grasp the relationship between the two constructs. We conducted a huge online survey at the homepage of one of representative dairy companies in Korea, and gathered 367 valid samples from 407 customers. The reliability and validity of our measurements were tested by using Cronbach's alpha coefficient and principal factor analysis respectively, and seven hypotheses were tested through performing correlation test and multiple regression analysis. The results from data analysis demonstrated that timeliness and convenience of homepage have positive effects on both corporate image and customer loyalty. In terms of DM, its' information quality was represented to influence both corporate image and customer loyalty, but we found its' convenience have a positive effect only on corporate image. With respect to online community, we found its timeliness contribute significantly both to corporate image and customer loyalty. Finally, as we expected, corporate image was revealed to provide a great influence to customer loyalty. This paper provides several academic and practical implications. Firstly, we think our research reinforces CRM literatures by developing the instruments for measuring information service quality. The previous relevant studies have mainly depended on the measurements of information quality or service quality which were developed independently. Secondly, the fact that we conducted our research in a real situation may enable academics and practitioners to understand the effects of information services more clearly. Finally, since our study involved three different types of information service which are most frequently applied in recent years, the results from our study might provide operational guidelines to the companies that are delivering their customers information by multi-channel. In other words, since we found that, in terms of customer loyalty, the key areas would be different from each other according to the types of information services, our analysis would help to make decisions such as selecting strengthening points or allocating resources by information service channels.