• The Journal of Korean Society for Radiation Therapy
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• v.29 no.2
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• pp.109-117
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• 2017

Objectives: The purpose of this study was to evaluate the change of body shape and the patient alignment state during image-guided volumetric modulated arc therapy in head and neck cancer patients, Materials and Methods: We performed a image-guided volumetric modulated arc therapy plan for 89 patients with head and neck cancer who underwent curative radiotherapy. Ten of them were evaluated for set up error. The landmarks of the ramus, chin, posterior neck, and clavicle were specified using ARIA software (Offline review), and the positional difference was analyzed. Results: The re-CT simulation therapy was performed in 60 men with $17{\pm}4$ cycles of treatment. The weight loss rate was $-6.47{\pm}3.5%$. 29 women performed re-CT simulation at $17{\pm}5$ cycles As a result, weight loss rate was $-5.73{\pm}2.7%$. The distance from skin to C1, C3, and C5 was measured, and both clavicle levels were observed to measure the skin shrinkage changes. The skin shrinkage standard deviations were C1 (${\pm}0.44cm$), C3 (${\pm}0.83cm$), and C5 (${\pm}1.35cm$), which is about 1 mm shrinkage per 0.5 kg reduction. Skin shrinkage according to the number of treatments was 1 ~ 4 fractions (no change), 5 ~ 13 fractions (-2 mm), 14 ~ 22 fractions (-4 mm) and 23 ~ 30 fractions (-6 mm). Conclusion: When the body shape changes about 5 mm, the central dose starts to differ about 3 % or more. Therefore, the CT simulation treatment for the adaptive therapy should be additionally performed. In addition, it is necessary to actively study the CT simulation therapy method and set up method of the lower neck and to examine the use of a new immobilization device.

• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.109-116
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• 2021

Purpose: The purpose of this study is to evaluate the usefulness of Surface-Guided Patient Setup by comparing the patient positioning accuracy when image-guided radiation therapy was used for Markerless patients(unmarked on the skin) using Surface-Guided Patient Setup and Marker patients(marked on the skin) using Laser-Based Patient Setup. Materials And Methods: The position error during IGRT was compared between a Markerless patient initially set up with SGPS using an optical surface scanning system using three cameras and a Marker patient initially set up with LBPS that aligns the laser with the marker drawn on the patient's skin. Both SGPS and LBPS were performed on 20 prostate cancer patients and 10 Stereotactic Radiation Surgery patients, respectively, and SGPS was performed on an additional 60 breast cancer patients. All were performed IGRT using CBCT or OBI. Position error of 6 degrees of freedom was obtained using Auto-Matching System, and comparison and analysis were performed using Offline-Review in the treatment planning system. Result: The difference between the root mean square (RMS) of SGPS and LBPS in prostate cancer patients was Vrt -0.02cm, Log -0.02cm, Lat 0.01cm, Pit -0.01°, Rol -0.01°, Rtn -0.01°, SRS patients was Vrt 0.02cm, Log -0.05cm, Lat 0.00cm, Pit -0.30°, Rol -0.15°, Rtn -0.33°. there was no significant difference between the two regions. According to the IGRT standard of breast cancer patients, RMS was Vrt 0.26, Log 0.21, Lat 0.15, Pit 0.81, Rol 0.49, Rtn 0.59. Conclusion:. As a result of this study, the position error value of SGPS compared to LBPS did not show a significant difference between prostate cancer patients and SRS patients. In the case of additionally performed SGPS breast cancer patients, the position error value was not large based on IGRT. Therefore, it is considered that it will be useful to replace LBPS with SGPS, which has the great advantage of not requiring patient skin marking..

• The Korean Society of Law and Medicine
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• v.17 no.1
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• pp.299-346
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• 2016

There were also various decisions made in medical area in 2015. In the case that an inmate in a sanatorium was injured due to the reason which can be attributable to the sanatorium and the social welfare foundation that operates the sanatorium request treatment of the patient, the court set the standard of fixation of a party in medical contract. In the case that the family of the patient who was declared brain dead required withdrawal of meaningless life sustaining treatment but the hospital rejected and continued the treatment, the court made a decision regarding chargeable fee for such treatment. When it comes to the eye brightening operation which received measure of suspension from the Ministry of Health and Welfare for the first time in February, 2011, because of uncertainty of its safety, the court did not accept the illegality of such operation itself, however, ordered compensation of the whole damage based on the violation of liability for explanation, which is the omission of explanation about the fact that the cost-effectiveness is not sure as it is still in clinical test stage. There were numerous cases that courts actively acknowledged malpractices; in the cases of paresis syndrome after back surgery, quite a few malpractices during the surgery were acknowledged by the court and in the case of nosocomial infection, hospital's negligence to cause such nosocomial infection was acknowledged by the court. There was a decision which acknowledged malpractice by distinguishing the duty of installation of emergency equipment according to the Emergency Medical Service Act and duty of emergency measure in emergency situations, and a decision which acknowledged negligence of a hospital if the hospital did not take appropriate measures, although it was a very rare disease. In connection with the scope of compensation for damage, there were decisions which comply with substantive truth such as; a court applied different labor ability loss rate as the labor ability loss rate decreased after result of reappraisal of physical ability in appeal compared to the one in the first trial, and a court acknowledged lower labor ability loss rate than the result of appraisal of physical ability considering the condition of a patient, etc. In the event of any damage caused by malpractice, in regard to whether there is a limitation on liability in fee charge after such medical malpractice, the court rejected the hospital's claim for setoff saying that if the hospital only continued treatments to cure the patient or prevent aggravation of disease, the hospital cannot charge Medical bills to the patient. In regard to the provision of the Medical Law that prohibit medical advertisement which was not reviewed preliminarily and punish the violation of such, a decision of unconstitutionality was made as it is a precensorship by an administrative agency as the deliberative bodies such as Korean Medical Association, etc. cannot be denied to be considered as administrative bodies. When it comes to the issue whether PRP treatment, which is commonly performed clinically, should be considered as legally determined uninsured treatment, the court made it clear that legally determined uninsured treatment should not be decided by theoretical possibility or actual implementation but should be acknowledged its medical safety and effectiveness and included in medical care or legally determined uninsured treatment. Moreover, court acknowledged the illegality of investigation method or process in the administrative litigation regarding evaluation of suitability of sanatorium, however, denied the compensation liability or restitution of unjust enrichment of the Health Insurance Review & Assessment Service and the National Health Insurance Corporation as the evaluation agents did not cause such violation intentionally or negligently. We hope there will be more decisions which are closer to substantive truth through clear legal principles in respect of variously arisen issues in the future.

• Korean Journal of Environment and Ecology
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• v.37 no.4
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• pp.302-314
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• 2023

This study aims to explore the direction for Korea's effective response to Target 3 (30by30), which can be said to be the core of the Kunming-Montreal Global Biodiversity Framework (K-M GBF) of the Convention on Biological Diversity (CBD), to find the direction of systematic OECM (Other Effective area-based Conservation Measures) discovery at the national level through a survey of global conceptual review and expert perception of OECM. This study examined ① the use of Korean terms related to OECM, ② derivation of determining criteria reflecting global standards, ③ deriving types of potential OECM candidates in Korea, and ④ considerations for OECM identification and reporting to explore the direction for identifying systematic, national-level OECM that complies with global standards and reflects the Korean context. First, there was consensus for using Korean terminology that reflects the concept of OECM rather than simple translations, and it was determined that "nature coexistence area" was the most preferred term (12 people) and had the same context as CBD 2050 Vision of "a world of living in harmony with nature." This study suggests utilizing four criteria (1. No protected areas, 2. Geographic boundaries, 3. Governance/management, and 4. Biodiversity value) that reflect OECM's core characteristics in the first-stage selection process, carrying out the consensus-building process (stage 2) with the relevant agencies, and adding two criteria (3-1 Effectiveness and sustainability of governance and management and 4-1 Long-term conservation) and performing the in-depth diagnosis in stage 3 (full assessment for reporting). The 28 types examined in this study were generally compatible with OECMs (4.45-6.21/7 points, mean 5.24). In particular, the "Conservation Properties (6.21 points)" and "Conservation Agreements (6.07 points)", which are controlled by National Nature Trust, are shown to be the most in line with the OECM concept. They were followed by "Buffer zone of World Natural Heritage (5.77 points)", "Temple Forest (5.73 points)", "Green-belt (Restricted development zones, 5.63 points)", "DMZ (5.60 points)", and "Buffer zone of biosphere reserve (5.50 point)" to have high potential. In the case of "Uninhabited Islands under Absolute Conservation", the response that they conformed to the protected areas (5.83/7 points) was higher than the OECM compatibility (5.52/7 points), it is determined that in the future, it would be preferable to promote the listing of absolute unprotected islands in the Korea Database on Protected Areas (KDPA) along with their surrounding waters (1 km). Based on the results of a global OECM standard review and expert perception survey, 10 items were suggested as considerations when identifying OECM in the Korean context. In the future, continuous research is needed to identify the potential OECMs through site-level assessment regarding these considerations and establish an effective in-situ conservation system at the national level by linking existing protected area systems and identified OECMs.

• The Korean Journal of Air & Space Law and Policy
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• v.1
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• pp.193-222
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• 1989

The purpose of this study is to review the rights and duties of cargo owners, the party to the contract of international carriage of goods by air under the Warsaw Convention System and the IATA conditions. It is generally known that air freight is the most-cost mode of transportation. However, should there be considerations of total distribution cost, the use of air freight leads exporters to be advantageous in physical distribution. The Warsaw Convention System defined and limited the rights and duties of cargo owners and air carriers paticipating in the international carriage of goods, but it does not regulate every aspect of air transportation. Therefore, the unregulated parts are governed by national laws and by individual contracts of carriage. The International Air Transport Association(lATA), a worldwide organization of airlines, has formulated model conditions of contract for the carriage of cargo. These models are not uniformly followed but they serve as a basis for many of the individual standard form of contracts prepared by air carriers. The contract of air carriage of goods is a contract of adhesion, 'the consignor recognizing and accepting the conditions laid down by the carrier'. There are consignors and carriers as the parties to the contract of international carriage of goods. In addition to his basic right, implied in Warsaw Convention Article 18 and 19, to require devery of the goods in good condition and at the date agreed upon, the consignor has the right to dispose the goods in the course of the journey up to the moment when the consignee is entitled to require delivery. If it is impossible to carry out the orders of the consignor, the carrier must so inform him forthwith. The right conferred on the consignor ceases at the moment when that of the consignee begins in accordance with Warsaw Convention Article 13. Nevertheless, if the consignee declines to accept the air waybill or the goods, or if he cannot be communicated with, the consignor resumes his right of disposition. Unless it is otherwise agreed, it is the duty of the carrier to give notice to the consignee as soon as the goods arrive. The consignee is entitled, on arrival of the goods at the place of destination, to require the carrier to hand over to him the air waybill and to deliver the goods to him, on payment of the charges due and on complying with the conditions of carriage set out in the air waybill. The air waybill is supposed to be made out by the consignor. If the carrier makes it out, he is deemed, subject to proof to the contrary, to have done so on behalf of the consignor, whether there is one air waybill or several, each must be made out in three original parts. The first is for the carrier, the second is for the consignee, and the the third is handed to the consignor when the shipment has been accepted. The consignor is responsible for the correctness of the particulars and statement concerning the cargo appearing in the air waybill. Each of the original parts of the air waybill has evidential value and possession of his part is a condition for the exercise by the consignor or consignee of his rights under the contract of carriage. Hague Protocol set forth in Article 9 that nothing in this. Convention prevents the issue of a negotiable air waybill, but Montreal Additional Protocol No. 4 deleted this article. All charges applicable to a shipment are payable in cash at the time of acceptance thereof by the carrier in case of a prepaid shipment or at the time of delivery thereof by the carrier in case of a collect shipment. The carrier shall have lien the cargo for unpaid charges and, in the event of non-payment thereof, shall have the right to dispose of the cargo at public or private sale and pay itself out of the proceeds of such sale any and all such amounts. In conclusion, the Warsaw Convention System has the character of ambiguity in various respects, not only in the part of the forms of documents but also in conditions of contract. Accordingly, the following propositions might be considered: (1) If the carrier does not obey the orders of the consignor for the disposition of the goods without proper reasons, he will be liable strictly for any damage which may be caused thereby to the cargo owner. The special agreement and carrier's conditions of carriage which limit unreasonably the consignor's right of disposition of the goods will be nullified. (2) The instrument of the Warsaw Convention System which is not yet in force(Montreal Additional Protocol No. 4) would considerably simplfy the processing and keeping of computerized records of the carriage. Until this instrument enters into force, the airlines will be faced with practical problems preventing them to substitute computerized data processing techniques for the formal issuance of the documents. Accordingly, Montreal Additional Protocol No. 4 should become effective as soon as posisble. From a practical point of view in the international trade, the issuance of negotiable air waybill should be permitted for the security of the bank.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.20
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• pp.23-62
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• 2003

The Law amending the Conflict of Laws Act of the Republic of Korea ("Korea"), which had taken two years to prepare, was promulgated on April 7, 2001 and finally took effect as of July 1, 2001. Accordingly, the old earlier Conflict of Laws Act which was called "Seoboesabeop" in Korean ("Prior Act"Old Act) was replaced by the new Conflict of Laws Act called "Gukjesabeop" in Korean ("New Act"). In fact the Old Act Prior Act was promulgated in 1962, but it was regarded as outdated from the moment of its promulgation. However, since the Old Act because it was modeled after the chapter of the Private International Law of the Einfuehrungsgesetz zum Buergerlichen Gesetzbuch (EGBGB) of the Federal Republic of Germany ("German PIL") and the Japanese Private International Law ("Japanese PIL") which had been promulgated toward the end of the 19th century., the Old Act was viewed as outdated from the moment of its promulgation. As a result of the drastic change of the environment for international trade of which that has taken took place in parallel with the global information technology revolution on a global basis, the scope of issues to be addressed which should be resolved by the conflict of laws principles has been remarkably expanded, and various new issues of an entirely which are quite new in its type and nature have arisen been raised. In the field of conflict of laws in its narrow sense, a revolution or crisis of the traditional conflict of laws has been brought about by the advent in the United States rise of a the new methodology for of the conflict of laws, of the United States of America and in the process of overcoming the such crisis the conflict of laws of the European continent has undergone substantial changes such as the diversification of the connecting principles, the expansion of the principle of party autonomy and the consideration of the value of the substantive law to protect socio-economically weaker parties of. The Prior Act, which was based on However, with the mechanical connecting principles and contained various outdated the inappropriate provisions, the Old Act could not cope with the issues raised by the internationalization and globalization of the Korean society. Furthermore In addition, the Old Act Prior Act was regarded as insufficient in that it lacked rules on international jurisdiction to adjudicate, or international adjudicatory jurisdiction, whereas the expectation of the public was that the Conflict of Laws a Act should function as the "Basic Law of the International Legal Relationships"encompassing rules on international jurisdiction given the increase of international disputes. Furthermore the private international law has also attracted more attention from the Korean At the beginning of the new Millennium, thanks to the promulgation of the New Act, I believe that Korea has succeeded in achieving the modest goal of reflecting in the its codification substantial parts of the major developments of the private international law which the leading advanced continental European countries had achieved during the last century. The New Act has followed the approach of the traditional conflict of laws of the European continent. It is a product of the efforts to eliminate the then existing problems of the Prior Old Act and to adapt the Korean private international law regime to the standard of international conventions and national laws of advanced countries. Unlike the Prior Old Act which was heavily dependent upon the prior Japanese PIL and the prior German PIL, the New Act has been prepared by taking into full account the Rome Convention, the Swiss PIL, the new German PIL which took effect in 1986 and various conventions adopted by the Hague Conference. Therefore, the New Act has substantially reduced dependence upon the Japanese PIL and the German PIL, and has gained relatively greater universal validity. The fact that the New Act expressly declares that the determination of international jurisdiction is a matter of conflict of laws is a clear sign that it has departed from the German tradition which confines the conflict of laws principles to choice of laws rules, and moved toward a broader and more practical approach widely accepted in the area of conflict of laws. It is hoped, and I am personally confident, that the New Act will be able to achieve its intended objectives in the 21st century as the basic law for the ever-increasing legal relationships with a foreign element.

• Korean Journal of Air-Conditioning and Refrigeration Engineering
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• v.26 no.12
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• pp.605-619
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• 2014

This article reviews the papers published in the Korean Journal of Air-Conditioning and Refrigeration Engineering during 2013. It is intended to understand the status of current research in the areas of heating, cooling, ventilation, sanitation, and indoor environments of buildings and plant facilities. Conclusions are as follows. (1) The research works on the thermal and fluid engineering have been reviewed as groups of fluid machinery, pipes and relative parts including orifices, dampers and ducts, fuel cells and power plants, cooling and air-conditioning, heat and mass transfer, two phase flow, and the flow around buildings and structures. Research issues dealing with home appliances, flows around buildings, nuclear power plant, and manufacturing processes are newly added in thermal and fluid engineering research area. (2) Research works on heat transfer area have been reviewed in the categories of heat transfer characteristics, pool boiling and condensing heat transfer and industrial heat exchangers. Researches on heat transfer characteristics included the results for general analytical model for desiccant wheels, the effects of water absorption on the thermal conductivity of insulation materials, thermal properties of Octadecane/xGnP shape-stabilized phase change materials and $CO_2$ and $CO_2$-Hydrate mixture, effect of ground source heat pump system, the heat flux meter location for the performance test of a refrigerator vacuum insulation panel, a parallel flow evaporator for a heat pump dryer, the condensation risk assessment of vacuum multi-layer glass and triple glass, optimization of a forced convection type PCM refrigeration module, surface temperature sensor using fluorescent nanoporous thin film. In the area of pool boiling and condensing heat transfer, researches on ammonia inside horizontal smooth small tube, R1234yf on various enhanced surfaces, HFC32/HFC152a on a plain surface, spray cooling up to critical heat flux on a low-fin enhanced surface were actively carried out. In the area of industrial heat exchangers, researches on a fin tube type adsorber, the mass-transfer kinetics of a fin-tube-type adsorption bed, fin-and-tube heat exchangers having sine wave fins and oval tubes, louvered fin heat exchanger were performed. (3) In the field of refrigeration, studies are categorized into three groups namely refrigeration cycle, refrigerant and modeling and control. In the category of refrigeration cycle, studies were focused on the enhancement or optimization of experimental or commercial systems including a R410a VRF(Various Refrigerant Flow) heat pump, a R134a 2-stage screw heat pump and a R134a double-heat source automotive air-conditioner system. In the category of refrigerant, studies were carried out for the application of alternative refrigerants or refrigeration technologies including $CO_2$ water heaters, a R1234yf automotive air-conditioner, a R436b water cooler and a thermoelectric refrigerator. In the category of modeling and control, theoretical and experimental studies were carried out to predict the performance of various thermal and control systems including the long-term energy analysis of a geo-thermal heat pump system coupled to cast-in-place energy piles, the dynamic simulation of a water heater-coupled hybrid heat pump and the numerical simulation of an integral optimum regulating controller for a system heat pump. (4) In building mechanical system research fields, twenty one studies were conducted to achieve effective design of the mechanical systems, and also to maximize the energy efficiency of buildings. The topics of the studies included heating and cooling, HVAC system, ventilation, and renewable energies in the buildings. Proposed designs, performance tests using numerical methods and experiments provide useful information and key data which can improve the energy efficiency of the buildings. (5) The field of architectural environment is mostly focused on indoor environment and building energy. The main researches of indoor environment are related to infiltration, ventilation, leak flow and airtightness performance in residential building. The subjects of building energy are worked on energy saving, operation method and optimum operation of building energy systems. The remained studies are related to the special facility such as cleanroom, internet data center and biosafety laboratory. water supply and drain system, defining standard input variables of BIM (Building Information Modeling) for facility management system, estimating capability and providing operation guidelines of subway station as shelter for refuge and evaluation of pollutant emissions from furniture-like products.

• Journal of Korean Academy of Nursing
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• v.13 no.2
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• pp.22-43
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• 1983

1. Need for and Purpose of the Study. There is an increasing demand for curriculum improvement of the Korean Army Nursing Academy (KANA), since it was upgraded into 4-year institution of higher learning from 3-year one. In particular, it is strongly advocated that the KANA needs the outside expertise for its curriculum improvement-namely not only from the internal military view of points but also from the viewpoints of professional educational society, In line with such a necessity for the study, this study was aimed at 1) analyzing the current actual practices of KANA'S curriculum, 2) investigating the desired practices of KANA'S curriculum, and 3) identifying the discrepancy between the actual and desired practices of curriculum. 2. Problems for the Study This study had 4 problems to be answeared as follows: 1) What are the actual curriculum practices of KANA? 2) What are the desired curriculum practices of KANA? 3) How are the extents of perception of actual and desired curriculum different in four groups (student, faculty & administrator, nurse, and medical doctor in militay hospital) ? 4) What are the restraining forces that impede the change from actual to desired curriculum practices? 5) What are the relationships of curriculum component,』 in actual and desired curriculum practices? 3. Methods and Procedures This study was conducted by means of document analysis in addition to literature review and by means of needs assessment questionnaire which was developed by the researcher. The questionnaire included 62 statments with 7 questions for demographic data collection. The needs assessment questionnaire was managed to a total of 243 subjects (100 students, 46 faculty & administrators, 55 nurses, and 42 medical doctors), The collected data were treated using SPSS computer system so as to calculate mean scores, standard deviations, and correlation coefficients. The significance test was made through t-test and one-way ANOVA. The statistical significance level was set at both .05 and .01 level. 4. Major findings The major findings in this study are as follows: 1) The score of desired practices was significantly greater than that of actual practices, representing a strong need for curriculum betterment. 2) There were significant differences in the perceptions of actual practices as well as desired practices among four groups (student, faculty & administrater, nurse, and medical doctor). 3) The most frequently selected restraining forces were army's inherent character, economical limitation, and educational expertise limitations. 4) Such variables as sex, position attachment to the KANA and grade made a statistically significant effect on the perception of desired curriculum practice, while the variables like marrige, position, and military class made it on the perception of actual curriculum practice. 5) The coefficients among the curriculum components were lower in perception of the actual curriculum practices than those in the desired practices. 5. Conclusions The conclusions based on the major findings of this study are as follows: 1) The current curriculum development procedure of the KANA is not consistent with the theoretical frame of systematic development sarategy of curriculum. 2) There are wide conflicts among the groups who are supposed to participate in curriculnm development, concerning the actual and desired practices of KANN'S curriculum. 3) A great deal of need for curriculum improvement for the KANA is clearly felt, and in particular, in the process of teaching and learning. 4) Each component of curriculum is not intergrated into a whole development procedure, being segregated each other. 5) For better curriculum improvement, such restraining forces as financial and professional limitations should be eliminated. 6. Recommendations 1) For Further Research a. There is a need to replicate this study after in-depth statistical analysis of each item of need assessment questionnaire, and with more representative subjects. b. A study should be conducted which. has its focus on the analysis of restraining forces for the change from actual to desired curriculum practices of the KANA. 2) For KANA'S Curriculum Improvement a. There is a need to promote the professional expertise of the participants in curriculum development and the communication among them. b. It is desirable to establish an institution or section of administration, which is soley in charge of curriculum development. c. To better develop KANA's curriculum not only faculty and administrators but also students should be encouraged to participate in development process, while the military medical doctors' participation should be carefully considered.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.13 no.2
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• pp.111-119
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• 2013

Purpose: Mucopolysaccharidosis type I (MPS I) is a lysosomal storage disorder caused by deficiency of the enzyme ${\alpha}$-L-iduronidase, which leads to a broad spectrum of multisystemic manifestations. Short stature and decreased growth velocity are prominent features of MPS I. The aim of the present study was to evaluate the effect of enzyme replacement therapy (ERT) on growth of Korean MPS I patients from a single center. Methods: Height data were obtained by retrospective chart review of 10 Korean patients with MPS I who had received ERT for a minimum of 3 years. Height was expressed as standard deviation scores (SDS) based on normative data. Annual growth rates were calculated before and during ERT. A piecewise regression model was used to analyze height z-scores before and after treatment. Individual analysis was performed for impact of phenotype [(severe (Hurler) versus attenuated (Hurler-Scheie, Scheie)] on growth. Results: Annual growth was 3.3 cm (z-score= -0.21) in the year before ERT and 6.2 cm (z-score= 0.17), 5.8 cm (z-score= 0.07), and 3.8 cm (z-score= -0.4) in the first, second, and third years of ERT, respectively. Regression analysis showed improvement in the slope after ERT (difference= 0.04; P=0.022). Estimated slope differences between severe and attenuated phenotypes were statistically significant before (P=0.001) and after treatment (P<0.0001), although no significant difference was noted when stratified by phenotype. Conclusion: ERT with aldurazyme appears to have a positive impact on linear growth in patients with MPS I.

• 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.