Physicians' attitude toward the withdrawal of life-sustaining treatment: A comparison between Korea, Japan, and China.

End-of-life care decision making has become a matter of serious ethical and legal concern in the three Far East Asian Countries of China, Japan, and Korea. Researchers in the three countries collaboratively conducted a comparative descriptive study with respect to physicians' perspectives concerning end-of-life care decisions. In spite of cultural similarities, each country has its own unique set of social, cultural, and political circumstances. So the content and scope of policies and laws on end-of-life decision reflect the differing views of people based on their social status, moral values, religious beliefs, and economic status.

A questionnaire survey exploring healthcare professionals' attitudes towards teamwork and safety in acute care areas in South Korea.

OBJECTIVES: Although human factors are important in terms of patient safety, there have been very few reports on the attitudes of healthcare professionals working in acute care settings in South Korea. In the present study, we investigated the attitudes of such professionals, their cultures and their management systems. DESIGN: A questionnaire survey with 65 items covering nine themes affecting patient safety. Nine themes were compared via a three-or-more-way analysis of variance, with interaction, followed by multiple comparisons among several groups. SETTING: Intensive care units, emergency departments and surgical units of nine urban hospitals. PARTICIPANTS: 592 nurses and 160 physicians. INTERVENTION: None. OUTCOME MEASURES: Mean scores using a five-point scale and combined response scores for each of the nine themes. RESULTS: The mean score for information-sharing was the highest (3.78±0.49) and that for confidence/assertion was the lowest (2.97±0.34). The mean scores for teamwork, error management, work value, organisational climate, leadership, stress and fatigue level, and error/procedural compliance were intermediate. Physicians showed lower scores in leadership and higher scores in information-sharing than nurses. Respondents with 24 months or less of a clinical career showed higher scores in leadership, stress and fatigue, and error scores and lower scores in work value than more experienced respondents. CONCLUSIONS: Our results suggest that medical personnel in Korea are relatively reluctant to disclose error or assert their different opinions with others. Many did not adequately recognise the negative effects of fatigue and stress, attributed errors to personal incompetence, and error-management systems were inadequate. Discrepancies in leadership and information-sharing were evident between professional groups, and leadership, stress, fatigue level, work value and error scores varied with the length of work experience. These can be used as baseline data to establish training programmes for patient safety in Korea.

The importance of victim chest exposure during cardiopulmonary resuscitation: a simulation study.

BACKGROUND: During cardiopulmonary resuscitation (CPR), inaccurate positioning of the rescuer's hand might damage internal organs due to compression around the xiphoid process. OBJECTIVE: This study aimed to determine whether exposing the victim's chest during CPR would help adequate positioning of a rescuer's hand on the chest. METHODS: This simulation study included 187 participants. We gave them four photographs each of exposed chests and unexposed chests. Participants were then asked to mark a cross at the center of the chest (CoC) and at the inter-nipple line (INL), and we measured the width of participants' palms to estimate the range of hand contact with the victim's chest. Finally, we compared the position and distribution of the CoC and INL markings and analyzed whether the hand contact range on the victim's chest involved the xiphoid process. RESULTS: The participants' CoC markings were similar regardless of whether the pictures showed an exposed or unexposed chest (p = 0.638). However, the level of INL marking was significantly lower in pictures of an exposed chest (p < 0.001). When exposing the chest, the distribution of markings was narrower for both CoC (p = 0.001) and INL (p < 0.001). The proportion of CoC markings involving the xiphoid process were lower when the chest was exposed (10.7%) than when was clothed (12.3%) (p < 0.001). Similarly, INL markings involving the xiphoid process followed the same trend in exposed vs. unexposed chest images (0% vs. 1.6%, respectively). CONCLUSIONS: Exposing the chest during CPR can improve the rescuer's ability to recognize the CoC and INL, leading to more intense chest compression and reducing the risk of inaccurate compression.

Characteristics of intentional fall injuries in the ED.

INTRODUCTION: This study was conducted to examine the characteristics of intentional fall injuries and the factors associated with their prognosis. METHODS: The study included 8992 patients with unintentional falls from a height (nonintentional group) and 144 patients with intentional falls from a height (intentional group). General and clinical characteristics were compared between the 2 groups. Intentional fall cases were divided into severe and nonsevere groups, and the factors associated with severe injury were evaluated by comparing these groups. RESULTS: The most common age group was younger than 14 years in the nonintentional group and between 30 and 44 years old in the intentional group. For the nonintentional group, 65% of the patients were male, and 48% were male in the intentional group. Fall heights of more than 4 m were most common in the intentional group. Discharge was the most common result in the nonintentional group; however, death before arrival at the emergency department (ED) or during ED treatment occurred in 54.9% of patients in the intentional group. In the severe injury group within the intentional group, patients were older, and the height of the fall was higher. Factors associated with severe injury in the intentional group included being a high school graduate rather than a college graduate and greater fall height. CONCLUSION: The risk of severe injury increased with fall height in the intentional group, and a high school level of education rather than a college level of education was associated with more severe injury.