Palliative surgery in the do-not-resuscitate patient: ethics and practical suggestions for management.

Palliative care in the United States has made tremendous strides in the last decade. One of the most perplexing issues arises when a palliative care patient presents to the operating room with an already existing do-not-resuscitate (DNR) order. This article describes the most common conflicting issues that may arise and provides guidance to surgeons, anesthesiologists, patients, and their primary physicians to reach satisfactory resolution and optimal care.

Living in the electronic age: musings on nearly two decades in Cyberspace.

My journey through Cyberspace began about 20 years ago with an introduction to e-mail. A few years later, I had the good fortune of working with artificial intelligence engineers who were developing information retrieval techniques and expert systems. By serendipity this led to an early introduction to the World Wide Web (www) and the use of Web browsers as tools for gathering information, long before the Internet became commercialized.

Pain management in palliative care oncology patients.

Palliative care is an interdisciplinary approach to relieving aversive symptoms in people with life-threatening illnesses; it aims to improve the lives of patients and their loved ones, the "patient-family unit." Palliative care should occur in parallel with all other medical interventions. Indeed, good symptom management is important in helping patients cope with the unpleasantness associated with potentially curative or life-prolonging interventions; it is absolutely essential near the end of life.

Ethical considerations at the end of life in the intensive care unit.

Intensive care units (ICUs) confront the healthcare system with end-of-life situations and ethical dilemmas surrounding death. It is necessary for all providers who treat dying patients to have a working knowledge of the philosophical principles that are fundamental to biomedical ethics. Those principles, however, are insufficient for compassionate care.

The American Medical Association "Pain Management: the Online Series".

There is a growing number of Internet based programs on pain management. Many of them offer continuing medical education credits (CMEs). "Pain Management: The Online Series" from the American Medical Association (AMA) is a recent addition.

A prototypical gateway to the World Wide Web: Making sense of pain relief.

The World Wide Web site entitled Making Sense of Pain Relief is described. This site, intended for consumers, was created by the American Chronic Pain Association, American Pain Foundation and National Pain Foundation. Other websites directly linked to this site are listed.

World Wide Web resources for cancer support groups.

World Wide Web (internet) resources that pertain to cancer support groups, especially pain and symptom control, are listed and reviewed. How to start using these services; services for patients, families, and friends; disease-specific websites; and other types of electronic information repositories are discussed.

The International Association for Hospice and Palliative Care Website.

The Website of the International Association for Hospice and Palliative Care is reviewed. The Association newsletter, resources, links, access to the IAHPC Manual of Palliative Care 2nd Edition, frequently asked questions, and other useful information are provided on this site.

The web site of the center to advance palliative care.

The web site of the Center to Advance Palliative Care is reviewed. This is an excellent resource containing resources that address financial tutorials and customizable Excel worksheets, development and marketing tools, particularly the decision checklists, satisfaction tools, the information on tracking and reporting outcomes, bereavement tools and a press kit.

An annotated guide to pain and palliative care on the World Wide Web.

Two dozen leading sites on the World Wide Web that pertain to pain management and palliative care are listed and described. Strengths and limitations are discussed.