Survey of Emergency Medical Ethics in Korea

PURPOSE: Ethical problems are common in the emergency department (ED)- much more common than is usually recognized. However, the difficult ethical dilemmas and unique aspects of ethics in emergency medicine have not been thoroughly discussed in the context of Korean emergency medicine. The purpose of this study is to evaluate the degree of general recognition of emergency medical ethics, as well as attitude toward several difficult ethical dilemmas among emergency physicians. METHODS: This is a qualitative study by survey. By using a questionnaire, we surveyed on emergency physicians working in teaching- hospitals in Korea in August 2007. RESULTS: The survey response rate was 30%, and there were 192 total respondents to the questionnaire. The results are as follows. Eighty-one percent of respondents said that they had trouble with difficult ethical dilemmas, 74% of respondents said that they need to be educated or trained to improve ethical decision-making capacity, and 58% of respondents said that they will use emergency ethical guideline actively if they are established. The ethical values that emergency physicians must possess, according to the survey responses, are agility, a sense of vocation, and prudence. With respect to questions about ending a patient's life, we found that emergency physicians have a tendency to ignore a patient's desires not to start CPR. Finally, in relation to colleagues and other professionals, many respondents said that they will take action to correct their medical errors. CONCLUSION: Study and development of emergency medical ethics will be greatly helpful to many emergency physicians. Further study and discussion must be pursued in order to establish ethical guideline.

The Outcome of Philadelphia Chromosome-Positive Adult ALL: Characteristics and Prognosis / Journal of the Korean Cancer Association, 대한암학회지

The Philadelphia (Ph) chromosome is a well- known chromosome abnormality in adults with B-lineage ALL, and is associated with a poor prognosis. This study compared the clinical manifestations and prognosis in adult Ph-positive and Ph-negative ALL patients. MATERIALS AND METHODS: We retrospectively analyzed the clinical records of adult patients newly diagnosed as B-lineage ALL, between January 1995 and February 2001. Fifty five patients were included in this study. We divided the patients into Ph-positive and Ph-negative groups. RESULTS: Eighteen of the 55 patients (32.7%) were found to have the Ph chromosome. At initial diagnosis, the Ph-positive patients had higher circulating leukocyte counts, lower platelet counts and had a greater tendency to bleed, than the Ph-negative group. The complete remission rates were 83.3% and 83.8% for the Ph-positive and the Ph-negative groups, respectively. Four of the Ph-positive, and 13 of the Ph-negative, patients underwent allogenic bone marrow transplantation. The median follow-up for the surviving patients was 39.3 months. The three-year survival rates were 10.4% and 51.8% for the Ph-positive and the Ph-negative groups, respectively. The median disease-free survival was 7.7 months for the Ph-positive group, but did not reach the median value in the Ph-negative group. Among the Ph-positive patients, age was the only factor that had an impact on the disease outcome. CONCLUSION: In adult B-lineage ALL, the Ph-positive patients had similar complete remission rates to other patients; however, the remission was of shorter duration, with a higher relapse rate in the Ph-positive patients. More effective treatments are needed to improve the survival of the Ph-positive patients.