Family medicine in Hawaii.
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This research investigated complementary and alternative medicine (CAM) use by Hawai'i cancer patients. Thirty-six percent of patients used CAM, most commonly religious/spiritual therapy and herbal treatments. CAM use was linked with younger age, female gender, Catholic religion, and more education. More research is needed to inform decision-making.
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In early 1996, as it became clear that Americans were becoming increasingly concerned about end-of-life care, the leaders of St. Francis Healthcare System (SFHS), Honolulu, convened a meeting at which local people--community and parish representatives as well as healthcare professionals--discussed the matter. The meeting's participants identified 10 issues as essential in end-of-life care: decision making, pain management and comfort care, pastoral and spiritual care, psychosocial care, hospice and home care, cardiopulmonary resuscitation, futility, withholding and withdrawing treatment, artificial nutrition and hydration, physician-assisted suicide and euthanasia. The participants then divided themselves into 10 teams, each of which spent six months studying one of the identified essential issues. In each case, the team reviewed the relevant SFHS policies and procedures and compared them with national standards. The team also interviewed staff members about the policies and procedures, comparing the written versions with actual practices. Each team then wrote a chapter on its assigned issue, after which a core committee wove the chapters into an end-of-life care manual for SFHS. The manual was published in June 1997. The system's leaders currently use the manual to educate staff members in good end-of-life care.
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BACKGROUND: We report on sixteen patients with a left ventricular aneurysm presenting at less than a month following myocardial infarction. METHODS: All patients had significant left anterior descending coronary artery disease, and in eight cases (50%), this was the only significant pathology. Two patients who were treated conservatively, died within three months of infarction. RESULTS: Of the fourteen surgically treated patients, one died. There have been two late deaths, one at ten months and the other at four years postinfarction. Patients who present early after infarction, usually have a large anterior aneurysm, requiring early surgical repair with ventricular aneurysmectomy and revascularization. This group of patients showed a higher risk for major complications (such as thrombo-embolism, arrhythmias) and/or death. Emergency coronary artery bypass surgery may prove beneficial in the prevention of aneurysm formation by revascularizing the viable but ischemic tissue in that area.