Jonathan R. Gavrin

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. Anesthesia departments should appoint a liaison to surgical and perioperative nursing departments to provide education and create an atmosphere conducive to discussions with palliative care patients about goals of care, including DNR status.

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. Internet content and form are now so omnipresent that they have affected our language in both amusing and utilitarian ways. We are entering an era where social networking, from personal to professional lives, is potentially a vibrant new direction for the Internet. Future articles for this feature will explore how to maximize the utility of the Internet.

Expert Knowledge in Palliative Care on the World Wide Web: Palliativedrugs.Org

ABSTRACT.  In my last Internet-related article, I speculated that social networking would be the coming wave in the effort to share knowledge among experts in various disciplines. At the time I did not know that a palliative care site on the World Wide Web (WWW), palliativedrugs.com, already provided the infrastructure for sharing expert knowledge in the field. The Web site is an excellent traditional formulary but it is primarily devoted to “unlicensed” (“off-label”) use of medications in palliative care, something we in the specialty often do with little to support our interventions except shared knowledge and experience. There is nothing fancy about this Web site. In a good way, its format is a throwback to Web sites of the 1990s. In only the loosest sense can one describe it as “multimedia.” Yet, it provides the perfect forum for expert knowledge and is a “must see” resource. Its existing content is voluminous and reliable, filtered and reviewed by renowned clinicians and educators in the field. Although its origin and structure were not specifically designed for social or professional networking, the Web sites format makes it a natural way for practitioners around the world to contribute to an ever-growing body of expertise in palliative care.

Anesthesia and Postoperative Pain Control

Fractures in the elderly are common. There is frequent need for surgical intervention. Anesthesiologists can safely use a variety of techniques to assist the orthopedic surgeon and help provide the kind of postoperative pain relief that is necessary for patients to recover successfully. General anesthesia, systemic analgesics, and regional techniques for operative anesthesia or postoperative pain relief all represent important tools in the total process, from injury to rehabilitation.

Internet Resources for Professional Continuing Education Credits in Pain and Palliative Care

Fifteen World Wide Web sites that provide continuing education credits for physicians, pharmacists, nurses or other health professionals relating to pain management and palliative care are reviewed.