• Health Policy and Management
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• v.27 no.2
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• pp.167-176
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• 2017

Background: This study aimed to analyze the impact of community health care resources on the place of death of older adults with dementia compared to those with cancer in South Korea, using public administrative big data. Methods: Based on a literature review, we selected person- and community-level variables that can affect older people's decisions about where to die. Data on place-of-death and person-level attributes were obtained from the 2013 death certification micro data from Statistics Korea. Data on the population and economic and health care resources in the community where the older deceased resided were obtained from various open public administrative big data including databases on the local tax and resident population statistics, health care resources and infrastructure statistics, and long-term care (LTC) insurance statistics. Community-level data were linked to the death certificate micro data through the town (si-gun-gu) code of the residence of the deceased. Multi-level logistic regression models were used to simultaneously estimate the impacts of community as well as individual-level factors on the place of death. Results: In both the dementia (76.1%) and cancer (87.1%) decedent groups, most older people died in the hospital. Among the older deceased with dementia, hospital death was less likely to occur when the older person resided in a community with a higher supply of LTC facility beds, but hospital death was more likely to occur in communities with a higher supply of LTC hospital beds. Similarly, among the cancer group, the likelihood of a hospital death was significantly lower in communities with a higher supply of LTC facility beds, but was higher in communities with a higher supply of acute care hospital beds. As for individual-level factors, being female and having no spouse were associated with the likelihood of hospital death among older people with dementia. Conclusion: More than three in four older people with dementia die in the hospital, while home is reported to be the place of death preferred by Koreans. To decrease this gap, an increase in the supply of end-of-life (EOL) care at home and in community-based service settings is necessary. EOL care should also be incorporated as an essential part of LTC. Changes in the perception of EOL care by older people and their families are also critical in their decisions about the place of death, and should be supported by public education and other related non-medical, social approaches.

• Fire Science and Engineering
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• v.32 no.4
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• pp.50-59
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• 2018

Recently, huge life losses occurred in the elderly long-term medical care fires due to lack of escape safety. As part of the measures to enhance the effectiveness of fire escape safety, while they prolong the available safe egress time (ASET) of non fire compartments, a measure to shorten fire-fighter's arrival time by fire alarm notifying device should be implemented in these facilities. The four categories from the aspects of fire prevention/protection engineering were provided with the necessary component technologies for carrying out these helper-guided evacuations. Fire prevention engineered technology was presented by two provisions; one for ensuring small compartment sections by installing the fire rated wall between bed rooms and another for ensuring the fire retardant or/and non-flammable performance of finishing materials. Also fire protection engineered technology was presented by two items; one for imposing cooling effects by sprinklers and another for providing automatic fire alarm notifying functions to fire stations. In order to improve the escape safety of these facilities in Korea, alternative revisions may presented by considering insufficient provisions in the architectural/fire law provisions by analyzing the provisions of Japanese and domestic laws in detail.

• Quality Improvement in Health Care
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• v.5 no.2
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• pp.324-334
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• 1998

Background : Strategic planning is an organizationwide or systemwide, ongoing look into the future usually of 2~3 years, based on objective analysis of the current environment and trends, but it can incorporate both short-term and long-term goals. The strategic planning process includes external analysis, internal analysis, issue analysis, development of mission, vision and values, and lastly development of organizational goals and objectives. As a part of the strategic quality planning process, certain service lines, important organizationwide functions, or key processes supporting these functions can be prioritized to expedite and roll out certain strategic goals. This is called strategic quality initiatives. Methods : We organized a quality improvement team, a subgroup of 21st century vision planning corps of our medical center, and pursued QI activities for improvement of healthcare environment, particularly in the admission setting. We developed a strategic quality initiative based on the results of patient satisfaction surveys, and carried out functions of self-directed work team. Results : The strategic goal was to be the benchmark for peer group hospitals in Korea for providing cost-effective best-practice. The QI team included 3 medical doctors, 1 nurse, 1 social worker, and 1 QI consultant as well as many operational members to support services and quality initiatives met every Tuesday for 18 weeks. Outcome objectives were to improve patient satisfaction score. The issues included in the objectives were comfort, temperature, noise, cleanliness of the admission wards, quality and education of patient meals, matters regarding the admission process, and an appurtenant facility such as restaurant or convenience store. Every issue was discussed and recommendations, conclusions and opportunities were implemented. Conclusions : By developing a strategic quality initiative as a part of the strategic quality planning process, and pursuing a self-directed work team, certain sen/ice lines, important organizationwide functions, or key processes supporting these functions can be improved effectively within a short period. Strategic quality initiatives serve to support, or roll out, certain strategic goals that are relevant to performance improvement and development of specific measurable outcome objectives, and associated performance measure for each initiative. Each strategic quality initiative should include a statement of intent outcome objectives, and performance measures. We will come back with follow up of the strategic quality initiative, for improvement of healthcare environment, and results of patient satisfaction re-survey.

• Korean Journal of Clinical Pharmacy
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• v.25 no.4
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• pp.254-263
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• 2015

Objectives: The present study assessed the prevalence of the potentially inappropriate medication (PIM) use in Korean elderly patients with Parkinson's disease. In addition, this study examined risk factors that affect PIM use. Method: A retrospective, observational study was conducted using Korean National Health Insurance claims database of 2009. PIM use in Parkinson's disease patients aged 65 years or older was examined based on 2012 Beers Criteria. Multivariable logistic regression was conducted to identify risk factors for PIM use. Results: Among 5,277 elderly patients with Parkinson's disease, 88.9% of patients used PIM(s) at least once. The average number of PIM items used per patient was 4.2. PIM use ratio, the proportion of total amount of PIMs to all medications per patient, was 12.6%. Frequently used PIM therapeutic classes were benzodiazepines (32.7%), first-generation antihistamines (19.2%), and prokinetics (17.5%). Individual PIMs most commonly used included chlorpheniramine (11.4%), levosulpiride (10.9%), diazepam (9.0%), and alprazolam (7.6%). Women (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.11-1.16), medical aid (OR 1.18, 95% CI 1.15-1.21), and long-term facilities (OR 2.43, 95% CI 2.22-2.65) were shown to be risk factors associated with PIM use. Of particular, wide variation in PIM use was associated with the types of healthcare facility. Conclusion: The PIM prevalence was very high in elderly Parkinson's disease patients. Nationally effective and systematic efforts to identify and prevent PIM use should be made to ensure patient safety and to improve quality of care in the elderly.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.13 no.2
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• pp.159-175
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• 2018

The purpose of this study was to identify the factors that could overcome the crisis and adversity of the nursing care provider through understanding the effect of job adaptation on the turnover intention of the nursing care provider and to contribute to the various problems of the nursing care provider in the long term. In order to confirm this as an empirical research task, risk factors and protection factors, general characteristics of the survey subjects, job adaptation and turnover intention were selected, and the risk factors and protective factors of caregivers' As a mediator. So Seoul. The results of the questionnaire survey were as follows: 291 caregivers in the elderly medical welfare facilities in Gyeonggi area. First, as the relationship between the risk factors and protective factors of occupational caregivers and occupational adaptation were more severe, the higher the maladjustment of the workplace culture, the more the job satisfaction and organizational commitment were adversely affected. The emotional support, The higher the information support, the more satisfied and satisfied the job. Second, the relationship between the risk factors of the caregiver and the protective factors and the turnover intention, the higher the conflict of caregivers, the more unstable the workplace, the more difficult it is to adapt to work culture, Respectively. Finally, as a result of verifying the mediating effect of occupational adaptation on the relationship between risk factors and protective factors and turnover intention of caregivers, job satisfaction, which is a sub-factor of job adaptation, It is shown that they play mediating roles only in the relationship between stress and turnover intention, and do not play a mediating role in the relationship between protective factor self - efficacy and social support and turnover intention. In other words, if caregivers feel satisfaction about their job, they can be less stressed on their jobs, improve their self-efficacy, and have a positive attitude toward social support. Also, it was found that the more the caregiver 's immersion into the organization, the less job stress and turnover intention decreased, but the self - efficacy and social support perception were not influenced. Based on this, the director of the facility should strive to stabilize the operation of the facility and provide high-quality services by seeking ways to improve conflict resolution and adaptation to the workplace culture so that nursing care workers can adapt to their work. And it is required to develop active management strategies and institutional support for improving job satisfaction and organizational commitment of caregivers.

• Journal of vocational education research
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• v.35 no.4
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• pp.19-46
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• 2016

The purpose of this study is to analyze the curriculum implementation of the Nursing-Specialized Vocational High School by researching on operation, organization and environment of the program of Nursing. This study aims to improve the curriculum of the Nursing-Specialized Vocational High School. This study has analyzed previous existing studies, Link of School info, Educational Statistics and data indicating establishment, operation and curriculum of the department of Nursing which have been collected from web sites of institutions and associations relevant to Nurse Education. The major results of this study are as follows: 1) As of the first semester of the year 2016, out of a total of thirty eight Specialized Vocational High Schools and Meister High Schools in the country, 6.4% of the schools have nursing educational programs. These schools have established the programs under various names, such as Health Nursing, Dental Health Nursing, Nursing, Nursing and Medical Tourism, Accounting in Nursing and Nursing Management, etc. Since 2012, enrollment rates have increased while post-graduation employment rates have decreased, with the average employment rate of Specialized Vocational High School graduates having reached up to 46% by 2015. 2) The Nursing-Specialized Vocational High School aims to create skilled Nurses Assistant such as Nurse Aide and Care giver. The program is successful in providing necessary courses to acquire required certification and proficient field experience but requires revisional changes in order to create a long-term program of sufficient qualification. The official requirement of 780 hours of field practice was completed during the three educational breaks from the first year of high school to the second year, while the curriculum was conducted separately in the field hospitals. 3) An average of two laboratory classrooms were available based on the facility requirement standard of Cities and Provinces Educational Policies. In order to secure proficient instructors of Nursing education, establishment of specific indicated subjects, regional placement, in-service education, research and supervision are essential for establishing excellence and continual improvement.