• Title/Summary/Keyword: clinical evaluation

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Clinical Utility of the MMPI-A-RF's Internalization and Externalization Higher-Order Scales: Comparison With the K-CBCL's Internalization and Externalization Scales (MMPI-A-RF의 내재화 및 외현화 상위 척도의 임상적 유용성: K-CBCL의 내재화 및 외현화 척도와의 비교)

  • Eun-Bin, Shin;Eun-Hee, Park;Hyun-Joo, Hong
    • Korean Journal of Psychosomatic Medicine
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    • v.30 no.2
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    • pp.119-126
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    • 2022
  • Objectives : The purpose of this study was to examine the clinical utility of the internalization and externalization higher-order scales of the Minnesota Multiphasic Personality Inventory-Adolescent Restructured Form (MMPI-A-RF), compared with those scales of the Korean Child Behavior Checklist (K-CBCL). Methods : 43 adolescents with internalizing disorders and 44 adolescents with externalizing disorders and their parents were administered the MMPI-A-RF and K-CBCL each. To verify the difference between the internalization and externalization scales of the MMPI-A-RF and K-CBCL for each group, independent-sample t test was performed. To compare the agreement between the MMPI-A-RF and K-CBCL, correlation analysis was also conducted. Lastly, to identify which scales significantly best predict each of the internalizing and externalizing disorder, logistic regression analysis was conducted. Results : Internalization scales of the MMPI-A-RF and K-CBCL were significantly higher in the internalizing disorder group, and the externalization scales were significantly higher in the externalizing disorder group. The positive correlation was significant only for internalization problems between the two evaluation measures in both groups (each r=0.360, p<0.05, r=0.572, p<0.05). In addition, the scales significantly predicted internalizing and externalizing disorders were the internalization and externalization scales of the MMPI-A-RF, followed by the externalization scale of the K-CBCL (R2=0.407, p<0.05). Conclusions : The internalization and externalization higher-order scales of the MMPI-A-RF were found to reliably reflect the characteristics of each disorder in adolescents and be useful evaluative scales to differentiate disorders. Moreover, if adolescents show externalization problems, additional information from the K-CBCL can be more useful to differentiate disorders.

Possibility of Combined Meningitis in Under 90-Day-Old Infants With Urinary Tract Infection (생후 90일 미만 영아의 요로 감염에서 세균성 수막염의 동반 가능성)

  • Hwang, Jun Ho;Kim, Su Yeong;Lee, Na Mi;Yi, Dae Yong;Yun, Sin Weon;Chae, Soo Ahn;Lim, In Seok;Park, Ji Young
    • Pediatric Infection and Vaccine
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    • v.29 no.2
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    • pp.84-95
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    • 2022
  • Purpose: Urinary tract infections (UTIs) are the most common serious bacterial infections in young infants. Lumbar puncture (LP) has been used to diagnose coexisting meningitis in infants under 90 days of age with suspected UTI in many hospitals. However, the incidence of bacterial meningitis associated with UTIs is low. We aimed to describe the prevalence of concomitant bacterial meningitis in young infants with UTIs. Methods: The medical records of infants with the first episode of UTI admitted to the Chung-Ang University Hospital from January 2010 to December 2019 were retrospectively reviewed. Infants aged < 90 days who underwent LP with initial evaluation were included. Demographic and clinical features, laboratory findings, and imaging findings were collected and analyzed. Results: Eighty-six infants with UTIs were enrolled in the study. The median age was 61.5 days (interquartile range, 42.3-73.8 days) and boys (90.7%) were predominant. Escherichia coli was the most common pathogen (n=80, 93.0%) and followed by Klebsiella species (n=5, 5.8%). Fifteen (18.1%) specimens produced extended spectrum β-lactamase (ESBL). Five (5.8%) infants had positive blood culture results. Seven (8.1%) infants showed pleocytosis in the cerebrospinal fluid, but none had coexisting bacterial meningitis. Twenty-four (30.8%) infants showed renal dilatation or hydronephrosis on ultrasonography. Dimercaptosuccinic acid (DMSA) scans revealed cortical defects in 17 (21.3%) infants while voiding cystourethrography revealed vesicoureteral reflux in 6 (46.2%) infants. Conclusion: Co-existing bacterial meningitis was not observed in young infants with UTIs. LP could not be routinely performed considering the clinical condition of <90 days old UTI patients.

Surgical Management of Comminuted Midshaft Clavicle Fractures Using Reconstruction Plate and Circumferential Wiring: Does the Circumferential Wiring Interfere with the Bone Union? (쇄골 간부 복합 골절에서 재건 금속판 및 환 강선을 이용한 수술적 치료: 환 강선이 골 유합을 방해하는가?)

  • Kim, Kyung-Tae;Shin, Chung-Shik;Park, Young-Chul;Kim, Dong-hyun;Kim, Min-Woo
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.3
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    • pp.245-252
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    • 2021
  • Purpose: This study examined the radiological and clinical outcomes of internal fixation using a reconstruction plate and 21G circumferential wire in comminuted midshaft clavicular fractures. Materials and Methods: A retrospective cohort study was performed on 51 patients between 2005 and 2019. Thirty-two patients underwent internal fixation with a reconstruction plate and a 21G circumferential wire with minimal soft tissue detachment, and 19 patients underwent surgery without a wire. The patients were assessed with the radiographic parameters, the University of California at Los Angeles (UCLA) score, and the visual analogue scale (VAS) pain score. Based on this, patients who operated without a circumferential wire were set as the control group, and the differences in bone union between the two groups were compared. Results: Thirty-two patients were followed-up for an average of 65 weeks, and 19 patients in the control group were followed-up for an average of 56 weeks. The radiological evaluation confirmed the anatomical reduction and bone union in all 32 patients. No case of nonunion was present. The UCLA score was 32.38 on average and 33.11 in the control group (p=0.395). The VAS score was 1.00 on average and 0.84 in the control group (p=0.668). A significant difference in the bony union time was observed between the group who underwent internal fixation with a reconstruction plate and a 21G circumferential wire with minimal soft tissue detachment, and the control group (p=0.015). On the other hand, there was no statistical significance when other variables were controlled (p=0.107). Conclusion: For displaced midshaft clavicular fractures, internal fixation using a reconstruction plate and 21G circumferential wire maintained accurate anatomical reduction. The satisfactory clinical and radiological results mean that internal fixation using a reconstruction plate and 21G circumferential wire may be a good option for surgical treatment.

Clinical Presentation and Prognosis of SARS-CoV-2 Infection in Infants Aged ≤90 Days: Insights for Management During Outbreaks

  • Hye Jeong Moon;Mi Seon Han;Kyung Min Kim;Kyung Jin Oh;Ju Young Chang;Seong Yong Lee;Ji Eun Choi
    • Pediatric Infection and Vaccine
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    • v.30 no.2
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    • pp.84-90
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    • 2023
  • Purpose: Infants aged ≤90 days with fever are susceptible to severe infections. This study aimed to analyze the clinical features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this particular age group. Methods: Infants aged ≤90 days who were diagnosed with coronavirus disease 2019 (COVID-19) and hospitalized between March 1, 2020, and May 1, 2022 were included. Medical records of patients were retrospectively reviewed. Results: A total of 105 infants with COVID-19 were included; 27 (25.7%) neonates aged <28 days, and 48 (45.7%) and 30 (28.6%) infants aged 28-59 days and 60-90 days, respectively. Five (4.7%) patients remained asymptomatic and 68 (62.8%) were febrile, with a median fever duration of 2 days. The most common symptoms were respiratory including cough (66.6%), nasal stuffiness (51.4%), and rhinorrhea (40.9%). Blood cultures were performed in 10 infants but no organisms were detected. Cultures of bag-collected urine specimens from 8 infants were grown, resulting in positive growth for 2 without pyuria. Nine (8.6%) infants were treated with empirical antibiotics for a median duration of 2.3 days (range, 1-7 days). All 105 infants showed improvement without any complications, and there were no fatal cases. Conclusions: In this study, most infants aged ≤90 days with COVID-19 presented with mild symptoms and none of those evaluated had documented bacterial co-infection. The favorable prognosis among young infants with SARS-CoV-2 may aid clinicians in tailoring their approach to evaluation and management during outbreaks.

Investigation on the Perception of Mandatory Clinical Practice in the Department of Radiology Following the Amendment of the Medical Technologists Act (의료기사 등에 관한 법률 개정으로 방사선(학)과 현장실습 의무화에 따른 인식 조사)

  • Jeong-Mu Lee;Yong-Ki Lee;Sung-Min Ahn
    • Journal of the Korean Society of Radiology
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    • v.18 no.3
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    • pp.293-300
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    • 2024
  • On October 31, 2023, the revision of the Medical Technologist Act made it mandatory to complete field training courses in order to obtain a license as a radiologic technologist. Therefore, we would like to survey the actual situation of field training in medical institutions to inform the revised Medical Technologist Act and propose improvement measures to increase the effectiveness of field training. A survey was conducted from March to April, 2023, among radiologic technologists working in medical institutions. The questionnaire was sent through a form on a domestic portal site, Company N, and 120 respondents completed it. Eighty-two respondents, or 68.3 percent, had experience in educating on-the-job training students. 58% of the respondents were aware of the fact that the amendment to the Act on Medical Technologist etc. made field training mandatory to obtain a radiologic technologist license. In accordance with Article 9 of the Medical Technologist Act, which prohibits unlicensed persons from practicing, 50% of the respondents were aware that those who are in training to complete an education course equivalent to the license they are seeking to obtain at a university or other institution are allowed to practice as medical Technologists. When asked what is currently taught during fieldwork, 6% of respondents said that they are required to perform radiation-generating activities in addition to observing, guiding patients, and positioning and moving patients. When asked about the future direction of education as fieldwork becomes mandatory for licensure, 77% of respondents said that they will teach more than they currently do. When asked about the appropriate total length of fieldwork, 35% said 12 weeks and 480 hours, 33% said 8 weeks and 320 hours, and 27% said 16 weeks and 640 hours. It can be seen that the current on-the-job training is inadequate according to various regulations, and students' satisfaction is low. However, with the revision of the Act on Medical Technologists, field training has become mandatory to obtain a license as a radiologist, and it is necessary to improve the educational conditions of field training. Therefore, it is necessary to comply with the Nuclear Safety Act and the Rules on the Safety Management of Diagnostic Radiation Generating Devices, introduce standardized training objectives and evaluation systems, designate training hospitals and radiologists in charge of training, and introduce extended training periods and simulation exercises to internalize field training.

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer (조기위장관암 내시경 치료 임상진료지침)

  • Park, Chan Hyuk;Yang, Dong-Hoon;Kim, Jong Wook;Kim, Jie-Hyun;Kim, Ji Hyun;Min, Yang Won;Lee, Si Hyung;Bae, Jung Ho;Chung, Hyunsoo;Choi, Kee Don;Park, Jun Chul;Lee, Hyuk;Kwak, Min-Seob;Kim, Bun;Lee, Hyun Jung;Lee, Hye Seung;Choi, Miyoung;Park, Dong-Ah;Lee, Jong Yeul;Byeon, Jeong-Sik;Park, Chan Guk;Cho, Joo Young;Lee, Soo Teik;Chun, Hoon Jai
    • Journal of Digestive Cancer Research
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    • v.8 no.1
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    • pp.1-50
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    • 2020
  • Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

A Study on the Stainability and DNA Conservation of Tissue Slides according to Fixation Time and Temperature (고정시간과 온도에 따른 조직 슬라이드의 염색성 및 DNA 보존성 연구)

  • Da-som JEONG
    • Korean Journal of Clinical Laboratory Science
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    • v.56 no.3
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    • pp.217-227
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    • 2024
  • In this paper, the factors affecting tissues during fixation on slides were determined by changing the tissue type, fixation time, and temperature. Also, stainability and DNA conservation were evaluated. The tissues selected were parenchymal and intestinal tissue. The stainability was evaluated using hematoxylin and eosin staining and a special stain suitable for the tissue. DNA conservation was evaluated using the DNA integrity number (DIN) for stability evaluation after purity measurement. The results showed that, at all temperatures, as time increased, there was no histomorphological difference and the stainability tended to intensify. The intestinal tissue tended to have less mucosal change and proper muscle layer degeneration. There was little difference in the purity. However, the longer the fixation time, the lower the DIN value for DNA. Significant differences were identified at 25℃ and 50℃. This means that fixation at 4℃ is the more safe for DNA. This experiment confirmed that, between the time and temperature conditions associated with fixation, time had a greater effect on both staining and DNA conservation. The results of this study are expected to provide basic data for future research on the setting appropriate conditions for fixation for histopathological examinations or diagnoses.

Pharmacological Studies of Cefoperazone(T-1551) (Cefoperazone(T-1551)의 약리학적 연구)

  • Lim J.K.;Hong S.A.;Park C.W.;Kim M.S.;Suh Y.H.;Shin S.G.;Kim Y.S.;Kim H.W.;Lee J.S.;Chang K.C.;Lee S.K.;Chang K.C.;Kim I.S.
    • The Korean Journal of Pharmacology
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    • v.16 no.2 s.27
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    • pp.55-70
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    • 1980
  • The pharmacological and microbiological studies of Cefoperazone (T-1551, Toyama Chemical Co., Japan) were conducted in vitro and in vivo. The studies included stability and physicochemical characteristics, antimicrobial activity, animal and human pharmacokinetics, animal pharmacodynamics and safety evaluation of Cefoperazone sodium for injection. 1) Stability and physicochemical characteristics. Sodium salt of cefoperazone for injection had a general appearance of white crystalline powder which contained 0.5% water, and of which melting point was $187.2^{\circ}C$. The pH's of 10% and 25% aqueous solutions were 5.03 ana 5.16 at $25^{\circ}C$. The preparations of cefoperazone did not contain any pyrogenic substances and did not liberate histamine in cats. The drug was highly compatible with common infusion solutions including 5% Dextrose solution and no significant potency decrease was observed in 5 hours after mixing. Powdered cefoperazone sodium contained in hermetically sealed and ligt-shielded container was highly stable at $4^circ}C{\sim}37^{\circ}C$ for 12 weeks. When stored at $4^{\circ}C$ the potency was retained almost completely for up to one year. 2) Antimicrobial activity against clinical isolates. Among the 230 clinical isolates included, Salmonella typhi was the most susceptible to cefoperazone, with 100% inhibition at MIC of ${\leq}0.5{\mu}g/ml$. Cefoperazone was also highly active against Streptococcus pyogenes(group A), Kletsiella pneumoniae, Staphylococcus aureus and Shigella flexneri, with 100% inhibition at $16{\mu}g/ml$ or less. More than 80% of Escherichia coli, Enterobacter aerogenes and Salmonella paratyphi was inhibited at ${\leq}16{\mu}/ml$, while Enterobacter cloaceae, Serratia marcescens and Pseudomonas aerogenosa were somewhat less sensitive to cefoperagone, with inhibitions of 60%, 55% and 35% respectively at the same MIC. 3) Animal pharmacokinetics Serum concentration, organ distritution and excretion of cefoperazone in rats were observed after single intramuscular injections at doses of 20 mg/kg and 50 mg/kg. The extent of protein binding to human plasma protein was also measured in vitro br equilibrium dialysis method. The mean Peak serum concentrations of $7.4{\mu}g/ml$ and $16.4{\mu}/ml$ were obtained at 30 min. after administration of cefoperazone at doses of 20 mg/kg and 50 mg/kg respectively. The tissue concentrations of cefoperazone measured at 30 and 60 min. were highest in kidney. And the concentrations of the drug in kidney, liver and small intestine were much higher than in blood. Urinary and fecal excretion over 24 hours after injetcion ranged form 12.5% to 15.0% in urine and from 19.6% to 25.0% in feces, indicating that the gastrointestinal system is more important than renal system for the excretion of cefoperazone. The extent of binding to human plasma protein measured by equilibrium dialysis was $76.3%{\sim}76.9%$, which was somewhat lower than the others utilizing centrifugal ultrafiltration method. 4) Animal pharmacodynamics Central nervous system : Effects of cefoperazone on the spontaneous movement and general behavioral patterns of rats, the pentobarbital sleeping time in mice and the body temperature in rabbits were observed. Single intraperitoneal injections at doses of $500{\sim}2,000mg/kg$ in rats did not affect the spontaneous movement ana the general behavioral patterns of the animal. Doses of $125{\sim}500mg/kg$ of cefoperazone injected intraperitonealy in mice neither increased nor decreased the pentobarbital-induced sleeping time. In rabbits the normal body temperature was maintained following the single intravenous injections of $125{\sim}2,000mg/kg$ dose. Respiratory and circulatory system: Respiration rate, blood pressure, heart rate and ECG of anesthetized rabbits were monitored for 3 hours following single intravenous injections of cefoperazone at doses of $125{\sim}2,000mg/kg$. The respiration rate decreased by $3{\sim}l7%$ at all the doses of cefoperazone administered. Blood pressure did not show any changes but slight decrease from 130/113 to 125/107 by the highest dose(2,000 mg/kg) injected in this experiment. The dosages of 1,000 and 2,000 mg/kg seemed to slightly decrease the heart rate, but it was not significantly different from the normal control. All the doses of cefoperazone injected were not associated with any abnormal changes in ECG findings throughout the monitering period. Autonomic nervous system and smooth muscle: Effects of cefoperazone on the automatic movement of rabbit isolated small intestine, large intestine, stomach and uterus were observed in vitro. The autonomic movement and tonus of intestinal smooth muscle increased at dose of $40{\mu}g/ml$ in small intestine and at 0.4 mg/ml in large intestine. However, in stomach and uterine smooth muscle the autonomic movement was slightly increased by the much higher doses of 5-10 mg/ml. Blood: In vitro osmotic fragility of rabbit RBC suspension was not affected by cefoperazone of $1{\sim}10mg/ml$. Doses of 7.5 and 10 mg/ml were associated with 11.8% and 15.3% prolongation of whole blood coagulation time. Liver and kidney function: When measured at 3 hours after single intravenous injections of cefoperaonze in rabbits, the values of serum GOT, GPT, Bilirubin, TTT, BUN and creatine were not significantly different from the normal control. 5) Safety evaluation Acute toxicity: The acute toxicity of cefoperazone was studied following intraperitoneal and intravenous injections to mice(A strain, 4 week old) and rats(Sprague-Dawler, 6 week old). The LD_(50)'s of intraperitonealy injected cefoperazone were 9.7g/kg in male mice, 9.6g/kg in female mice and over 15g/kg in both male and female rats. And when administered intravenously in rats, LD_(50)'s were 5.1g/kg in male and 5.0g/kg in female. Administrations of the high doses of the drug were associated with slight inhibition of spontaneous movement and convulsion. Atdominal transudate and intestinal hyperemia were observed in animals administered intraperitonealy. In rats receiving high doses of the drug intravenously rhinorrhea and pulmonary congestion and edema were also observed. Renal proximal tubular epithelial degeneration was found in animals dosing in high concentrations of cefoperazone. Subacute toxicity: Rats(Sprague-Dawley, 6 week old) dosing 0.5, 1.0 and 2.0 g/kg/day of cefoperazone intraperitonealy were observed for one month and sacrificed at 24 hours after the last dose. In animals with a high dose, slight inhibition of spontaneous movement was observed during the experimental period. Soft stool or diarrhea appeared at first or second week of the administration in rats receiving 2.0g/kg. Daily food consumption and weekly weight gain were similar to control during the administration. Urinalysis, blood chemistry and hematology after one month administration were not different from control either. Cecal enlargement, which is an expected effect of broad spectrum antibiotic altering the normal intestinal microbial flora, was observed. Intestinal or peritoneal congestion and peritonitis were found. These findings seemed to be attributed to the local irritation following prolonged intraperitoneal injections of hypertonic and acidic cefoperazone solution. Among the histopathologic findings renal proximal tubular epithelial degeneration was characteristic in rats receiving 1 and 2g/kg/day, which were 10 and 20 times higher than the maximal clinical dose (100 mg/kg) of the drug. 6) Human pharmacokinetics Serum concentrations and urinary excretion were determined following a single intravenous injection of 1g cefoperazone in eight healthy, male volunteers. Mean serum concentrations of 89.3, 61.3, 26.6, 12.3, 2.3, and $1.8{\mu}g/ml$ occured at 1,2,4,6,8 and 12 hours after injection respectively, and the biological half-life was 108 minutes. Urinary excretion over 24 hours after injection was up to 43.5% of administered dose.

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Verification of Gated Radiation Therapy: Dosimetric Impact of Residual Motion (여닫이형 방사선 치료의 검증: 잔여 움직임의 선량적 영향)

  • Yeo, Inhwan;Jung, Jae Won
    • Progress in Medical Physics
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    • v.25 no.3
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    • pp.128-138
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    • 2014
  • In gated radiation therapy (gRT), due to residual motion, beam delivery is intended to irradiate not only the true extent of disease, but also neighboring normal tissues. It is desired that the delivery covers the true extent (i.e. clinical target volume or CTV) as a minimum, although target moves under dose delivery. The objectives of our study are to validate if the intended dose is surely delivered to the true target in gRT and to quantitatively understand the trend of dose delivery on it and neighboring normal tissues when gating window (GW), motion amplitude (MA), and CTV size changes. To fulfill the objectives, experimental and computational studies have been designed and performed. A custom-made phantom with rectangle- and pyramid-shaped targets (CTVs) on a moving platform was scanned for four-dimensional imaging. Various GWs were selected and image integration was performed to generate targets (internal target volume or ITV) for planning that included the CTVs and internal margins (IM). The planning was done conventionally for the rectangle target and IMRT optimization was done for the pyramid target. Dose evaluation was then performed on a diode array aligned perpendicularly to the gated beams through measurements and computational modeling of dose delivery under motion. This study has quantitatively demonstrated and analytically interpreted the impact of residual motion including penumbral broadening for both targets, perturbed but secured dose coverage on the CTV, and significant doses delivered in the neighboring normal tissues. Dose volume histogram analyses also demonstrated and interpreted the trend of dose coverage: for ITV, it increased as GW or MA decreased or CTV size increased; for IM, it increased as GW or MA decreased; for the neighboring normal tissue, opposite trend to that of IM was observed. This study has provided a clear understanding on the impact of the residual motion and proved that if breathing is reproducible gRT is secure despite discontinuous delivery and target motion. The procedures and computational model can be used for commissioning, routine quality assurance, and patient-specific validation of gRT. More work needs to be done for patient-specific dose reconstruction on CT images.

A Study on the Determinants of Consumer-Oriented Nursing Service Quality;SERVQUAL Model based (소비자 중심의 간호서비스 질 결정요인에 관한 연구;SERVQUAL모형을 중심으로)

  • Joo, Mee-Kyoung
    • Journal of Korean Academy of Nursing Administration
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    • v.8 no.1
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    • pp.169-191
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    • 2002
  • As the tendency of the society is centralized into consumers and services, patients are getting to ask better medical services. The consumers influenced from various social surroundings became to have some expectation of nursing service. Compared with their expectation, the quality of the services which they virtually get may be recognized and evaluated. So it is necessary to know exactly what the consumers want in nursing services. The purpose of this study is to examine the determinants which can evaluate the quality of nursing services by researching into consumers' expectation and perception of the nursing services depending on the consumer-oriented attributions on the basis of the model of SERVQUAL. 1,144 of outpatients were selected as the subjects for this research. They used to continuously visit the same hospital after being hospitalized and nursed in 9 hospitals randomly selected among the second-level medical organizations in Seoul from January to February, 2001. The collected data are analyzed into the Descriptive Statistics, t-test, GLM and Multiple Regression through the SAS program. Delphi was used for the research tool and the results of the research are as follows; the determinants in evaluating the quality of nursing services consist of 5 categories such as Tangibility, Reliability, Responsiveness, Assurance, Empathy. The values of Cronbach' $\alpha$ appeared to be 0.96 in the expectation of nursing services, 0.94 in the perception of nursing services and 0.96 in the importance of nursing services. The determinants in the expectation of nursing services were ranged in the order of Assurance, Empathy, Reliability, Responsiveness and Tangibility. And those in the perception of nursing services were in the order of Assurance, Empathy, Reliability, Tangibility and Responsiveness. Those in the importance of nursing service were in the order of Empathy, Assurance, Reliability, Tangibility and Responsiveness. Finally, those in the quality of nursing service were in the order of Tangibility, Responsiveness, Empathy, Reliability and Assurance. Each expectation of nursing services appeared different depending on the subjects' age, gender, clinical department and reason for hospitalization. The hypothesis examined in this research shows that the group having higher personal needs shows meaningful differences in the expectation of nursing services, and the subjects who have had external communication show higher perception of nursing service than uncommunicative ones. After all, we can see that the statistical differences in the perception of nursing services depend on whether the subjects have external communications or not. The determinants in the expectation of nursing services can explain the quality of nursing service up to 14.96%. The statistically meaningful determinants in the expectation could be arranged in the order of Reliability, Assurance and Tangibility. And the more expectation brings about the lower evaluation of the quality of nursing services. The determinants in the perception of nursing service can explain the quality of nursing services up to 29.85%. The statistically meaningful determinants in the perception could be arranged in the order of Responsiveness, Reliability, Tangibility, Empathy, and Assurance. And the more perception brings about the higher evaluation of the quality of nursing services. According to the result of the above research, I would like to propose as follows. As long as this research is oriented to get knowledge of the consumer-oriented nursing services, it should be continued to draw the other elements determining the quality of the nursing services. Furthermore, this research is based upon the Parasuraman, A., et al.'s SERVQUAL Model(1991), which deals only expectation, perception and quality of consumer-oriented nursing services, so it will be necessary to inspect and verify it through the other models containing the offerers of nursing services in the future. On the other hand, as this research evaluates the actual quality of nursing services based on the expectation and perception of nursing services, it can be utilized as fundamental data to develop the marketing strategies and to estimate the qualities as well. I hope this research will be periodically estimated to be the useful data to develop the marketing strategies in the nursing service area.

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