Historical Notes on the Founding of the Surgical Palliative Care Society.

The latter half of the twentieth century witnessed the emergence of the hospice movement as a response to the increasing medicalization of death and the associated suffering. Palliative care, a term coined by the Canadian urologic surgeon Balfour Mount, represents an expansion of hospice philosophy upstream within the health care system extending to the care of hospitalized patients with life-threatening illnesses. This article offers a brief history of the development of surgical palliative care, i.

Spirituality in Surgery-A Double-Edged Scalpel.

Investigating, respecting, and working with surgical patients' spiritualities is as critical a skill as the proficient technical performance of operations. When spirituality is ignored, sacred patient values remain undiscovered, authentic trust is hindered, and healthy shared decision-making processes suffer. These are instances when the other edge of the spiritual scalpel comes back to cut us as surgeons, but more importantly, upon withdrawal of spiritual understanding, it deeply injures our patients and their families.

Providers' and Administrators' Perceptions of Complementary and Integrative Health Practices Across the Veterans Health Administration.

Objectives: Use of complementary and integrative health (CIH) therapies is being promoted by the Veterans Health Administration (VA), but promotion may not equate to adoption. The purpose of this study was to explore whether perceptions regarding CIH at one VA medical center (VAMC) were similar to perceptions from a sample of other VAMCs.

Design: This article reports a subset of qualitative findings from a mixed-methods study.

Perceptions of other integrative health therapies by Veterans with pain who are receiving massage.

Veterans are increasingly using complementary and integrative health (CIH) therapies to manage chronic pain and other troubling symptoms that significantly impair health and quality of life. The Department of Veterans Affairs (VA) is exploring ways to meet the demand for access to CIH, but little is known about Veterans' perceptions of the VA's efforts. To address this knowledge gap, we conducted interviews of 15 inpatients, 8 receiving palliative care, and 15 outpatients receiving CIH in the VA.

Rethinking autonomy: decision making between patient and surgeon in advanced illnesses.

Patients with advanced illness such as advanced stage cancer presenting with the need for possible surgical intervention can be some of the most challenging cases for a surgeon. Often there are multiple factors influencing the decisions made. For patients they are facing not just the effects of the disease on their body, but the stark realization that the disease will also limit their life.

Perceptions of providers and administrators in the Veterans Health Administration regarding complementary and alternative medicine.

Background: The integration of complementary and alternative medicine (CAM) therapies into a large organization such as the Veterans Health Administration (VHA) requires cultural change and deliberate planning to ensure feasibility and buy-in from staff and patients. At present, there is limited knowledge of VHA patient care providers' and administrators' viewpoints regarding CAM therapies and their implementation.

Objectives: Our purpose was to qualitatively examine knowledge, attitudes, perceived value and perceived barriers, and/or facilitators to CAM program implementation among VHA providers and administrators at a large VHA facility.

Integrating massage therapy within the palliative care of veterans with advanced illnesses: an outcome study.

Aims: To describe the integration of massage therapy into a palliative care service and to examine the relationship between massage and symptoms in patients with advanced illnesses.

Methods: Between April 1, 2009, and July 31, 2010, 153 patients received massage at the VA Ann Arbor Health Care System. Data on pain, anxiety, dyspnea, relaxation, and inner peace were collected pre and post massage.

Spirituality and religion in the care of surgical oncology patients with life-threatening or advanced illnesses.

Spiritual and religious concerns often become of central importance in the care of surgical oncology patients confronted with their mortality. Unfortunately, surgeons are often ill prepared or reluctant to address the spiritual and religious needs of their patients. In this article, working definitions of spirituality versus religiosity will be developed in the context of the three largest monotheistic religions in America: Christianity, Islam, and Judaism.

Ethical issues in end-of-life care.

Technical advances in the care of advanced illness have created ethical challenges for physicians, patients, and families at the end of life. In the effort to survive longer, they are often confronted with difficult choices regarding medical advances that may inadvertently prolong suffering and the dying process rather than bring healing and recovery. Four major principles of medical ethics assist patients, families, and their physicians in making meaningful and morally acceptable choices with respect to care at the end of life: the Hippocratic principles of nonmaleficence and beneficence, as well as the more recently developed principles of autonomy and justice.

Social connectedness and patient recovery after major operations.

Background: Social connectedness is thought to play an important role in overall health and well being. We hypothesized that social network size and other measures of social connectedness would predict perceived pain intensity, unpleasantness, and anxiety in veterans recovering after major thoracic or abdominal operations and influence postoperative complications and length of stay.

Study Design: Six hundred five patients from two Veterans Affairs' medical centers who participated in a randomized controlled trial of massage as adjuvant treatment for postoperative pain were the subjects of this study.

Acute postoperative pain management using massage as an adjuvant therapy: a randomized trial.

Hypothesis: Adjuvant massage therapy improves pain management and postoperative anxiety among many patients who experience unrelieved postoperative pain. Pharmacologic interventions alone may not address all of the factors involved in the experience of pain.

Design: Randomized controlled trial.

Spiritual issues in surgical palliative care.

The key points of this article are: Spirituality gives meaning and purpose to life. Spiritual issues that may lie dormant for many years often surface at the end of life. Not all people are religious, but all are spiritual.

Massage as adjuvant therapy in the management of acute postoperative pain: a preliminary study in men.

Background: Opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Complementary medicine techniques used as adjuvant therapies have the potential to improve pain management and palliate postoperative distress.

Study Design: This prospective randomized clinical trial compared pain relief after major operations in 202 patients who received one of three nursing interventions: massage, focused attention, or routine care.

Low-dose sulfur mustard primes oxidative function and induces apoptosis in human polymorphonuclear leukocytes.

Although considerable work has focused on understanding the processes of direct tissue injury mediated by the chemical warfare vesicant, sulfur mustard (2,2'-bis-chloroethyl sulfide; SM), relatively little is known regarding the mechanisms of secondary injury caused potentially by the acute inflammatory response that follows SM exposure. Polymorphonuclear leukocytes (PMNs) play a central role in the initiation and propagation of inflammatory responses that, in some cases, result in autoimmune tissue damage. The potential for PMN-derived tissue damage following SM exposure may, in part, account for the protracted progression of the injury before it resolves.

Expanding the avenues for addressing patient safety.

The Safety Case Management Committee, initiated in 1999, is a core component of the safety program at the Department of Veterans Affairs Medical Center in Ann Arbor. It is one of several approaches the facility uses to address error prevention or to contain its damaging effects.

The safety checklist program: creating a culture of safety in intensive care units.

Background: In 1999 the VA Ann Arbor Healthcare System began a safety checklist program to help build a culture of safety among nurses, respiratory therapists, and unit maintenance providers in the intensive care units (ICUs). Program objectives were to (a) create the opportunity for each participating staff member to view his or her work and unit environment in a broader safety context; (b) establish clear, concise, and measurable standards that staff would identify and value as important safety factors; (c) develop a data collection methodology that would minimize confirmation bias; and (d) correct safety deficits immediately.

Data Management: Staff measure compliance with safety standards twice daily and record results on a form specifically designed for the project.