PubMed Health⌕ Search

Biomedical subjects

Geoffrey P Dunn

Publications and source records attributed to Geoffrey P Dunn.

13 recordsLinked to original sources
PubMed2006

Palliative care: a promising philosophical framework for gastroenterology.

Since the 1970s, much has happened to establish palliative care asa health philosophy that will enrich the practice of gastroenterology;conversely, developments in gastroenterology have already improved palliative care. Several recent concepts from the field of gastroenterology such as "the second brain" and "intestinal failure" fit well within the conceptual framework of palliative care. This type of synergy will ultimately encourage the application of this philosophy to a much broader spectrum of patients than those deemed to be at "end of life." This broader spectrum of care can be described as palliative gastroenterology.

Gastroenterology↗
PubMed2006

Palliating patients who have unresectable colorectal cancer: creating the right framework and salient symptom management.

The last phases of colorectal malignant illness may be the most challenging and saddening for all involved, but they offer opportunities to become the most rewarding. This transformation of hopelessness to fulfillment requires a willingness by surgeon, patient, and patient's family to trust one another to realistically set goals of care, stick together, and not let the treatment of the disease become a surrogate for treating the suffering that characterizes grave illness.

Colorectal Neoplasms↗
PubMed2005

Surgical palliative care: an enduring framework for surgical care.

Thomas R. Russell [49], Executive Director of the ACS pointed out ina recent editorial that the culture of surgery is changing and evolving, along with long-held values. He notes, "No longer is it 'my' patient, but it is 'our'patient." This shared responsibility for the surgical patient is not without peril, although this ethic has a positive application in the interdisciplinary model of palliative care. The principle of autonomy suggests that the patient, himself, shares some responsibility for a good QOL outcome. Although the focus of his remarks is fundamental change in residency training, his comments apply equally to the norms of surgical practice,especially palliative care: "We can start by building a sense of mutual respect for the broad range of individuals [including the patient and his family] involved in the care of our surgical patients, from nurses to allied health care professionals, from anesthesiologists to environmental service workers. As surgeons we must improve our communication and leadership skills, so these individuals will view us in a more positive light." Surgical palliative care is a philosophy of care that can answer this challenge. Surgeons have always been up to the challenges of their era. They never have disappointed those whom they serve in their degree of courage,practicality, and innovation, but the changing landscape of illness and culture offer new opportunities for other insights and strengths to emerge.

Attitude of Health Personnel↗
PubMed2005

Transplantation and palliative care: the convergence of two seemingly opposite realities.

One of the authors once asked a great transplant surgeon what came to his mind when asked about palliative care. He had two answers: the first,was somewhat simplistic; the second was profound. He said that this type of service was helpful in the ICU when there was not much more to be done surgically for a patient who was dying; the second, was a story about an individual whom he had transplanted three times (who survived!) because he and his team did not want the patient and family to give up hope. The second answer is fundamentally more in keeping with the philosophy of palliative care, despite the extraordinary specific circumstances. The surgeon demonstrated ongoing presence and non abandonment. This patient was palliated, although few surgeons could have accomplished this by doing two retransplantations! Fortunately, for the less gifted and lucky, there are many ways in which to continue a meaningful presence to an ailing or dying patient on a transplant service that do not require a transplantation procedure. One wonders why palliative care and transplantation have not been more formally acquainted in the past given the extensive overlap of the populations served, the nature of the day-to-day problems, and the intensity of the commitment to the patient. The time is ripe for a formal mutual acquaintance between palliative care specialists and transplant teams,perhaps in the format of a work group that is similar to the work groups that promoted excellence in palliative care, such as the End Stage Renal Disease Workgroup, that were grant funded by the Robert Wood Johnson Foundation. The fields of transplantation and palliative care have a treasure trove of experience that is lacking in the other that could be exchanged profitably with a great sense of satisfaction for all.

Attitude to Health↗
PubMed2002

Surgical palliation in advanced disease: recent developments.

Despite many valuable technical innovations for the relief of suffering in advanced disease over the past few years, only recently have surgical oncologists attempted to more clearly define palliation. Previous definitions have been misleading, creating confusion about the merits of surgery in many situations and difficulty in posing questions for future prospective clinical trials. This report outlines recent progress in identifying and refining a philosophy of palliative surgery that would align it with the consensus of nonsurgical opinion summarized by the 1990 World Health Organization definition of palliative care and the emerging consensus among the medical specialties in the United States concerning principles of care at the end of life. Selected controversies and recent innovations, as well as guidelines for palliative surgery, are discussed.

Humans↗