Romayne Gallagher - Academia.edu (original) (raw)
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Papers by Romayne Gallagher
Canadian Family Physician, 2010
Medical Hypotheses, Sep 1, 2020
Canadian family physician Medecin de famille canadien, 2018
Canadian Family Physician Medecin De Famille Canadien, Mar 1, 2007
Canadian Medical Association Journal
Journal of Palliative Care
Health Services Insights
The narrative of the opioid crisis is that ill-informed and careless prescribing by physicians ha... more The narrative of the opioid crisis is that ill-informed and careless prescribing by physicians has led to increases in opioid-related harms including overdose deaths. Focusing on reducing the access to prescribed opioids without treating substance use disorder has led to increases in use of heroin and illicitly produced fentanyl. Overall prescribing of opioids has declined causing collateral damage to those who use opioids appropriately to reduce pain and improve function. The complexity of this issue requires a change in focus and broad changes in society's approach to substance abuse and mental health.
Canadian family physician Medecin de famille canadien, 2018
BMC Palliative Care, 2016
Background: This article reports on the concept of "communicating prognostic uncertainty" which e... more Background: This article reports on the concept of "communicating prognostic uncertainty" which emerged from a mixed methods survey asking family members to rank their satisfaction in seven domains of hospital end-of-life care. Methods: Open-ended questions were embedded within a previously validated survey asking family members about satisfaction with end-of-life care. The purpose was to understand, in the participants' own words, the connection between their numerical rankings of satisfaction and the experience of care. Results: Our study found that nearly half of all family members wanted more information about possible outcomes of care, including knowledge that the patient was "sick enough to die". Prognostic uncertainty was often poorly communicated, if at all. Inappropriate techniques included information being cloaked in confusing euphemisms, providing unwanted false hope, and incongruence between message and the aggressive level of care being provided. In extreme cases, these techniques left a legacy of uncertainty and suspicion. Family members expressed an awareness of both the challenges and benefits of communicating prognostic uncertainty. Most importantly, respondents who acknowledged that they would have resisted (or did) knowing that the patient was sick enough to die also expressed a retrospective understanding that they would have liked, and benefitted, from more prognostic information that death was a possible or probable outcome of the patient's admission. Family members who reported discussion of prognostic uncertainty also reported high levels of effective communication and satisfaction with care. They also reported long-term benefits of knowing the patient was sick enough to die. Conclusion: While a patient who is sick enough to die may survive to discharge, foretelling with family members in potential end of life contexts facilitates the development of a shared and desired prognostic awareness that the patient is nearing end of life.
Journal of Gastroenterology, Pancreatology & Liver Disorders, 2016
Canadian Family Physician Medecin De Famille Canadien, Apr 1, 2006
This article has been peer reviewed. Cet article a fait l' objet d'une révision par des pairs.
Canadian Family Physician Medecin De Famille Canadien, 2010
Journal of Pain and Palliative Care Pharmacotherapy, 2005
Oxygen is used frequently to relieve dyspnea in patients with advanced illness. The objective of ... more Oxygen is used frequently to relieve dyspnea in patients with advanced illness. The objective of this study was to critically appraise the scientific basis for oxygen therapy as a therapeutic intervention to manage dyspnea at rest in patients with advanced disease. A systematic search of all relevant databases was done using MeSH terms and appropriate key words. Both investigators reviewed 294 citations and possible articles were retrieved. Using the inclusion and exclusion criteria of the research question, five articles were found to be relevant to the question. The articles were graded according to the study design and qualitatively compared. No systematic reviews of the intervention exist. Study designs were case series and case control studies. These primary studies had small samples and did not have matched or cohort controls, therefore providing only level 4 evidence. There was only a total of 83 patients and the majority of the patients were hypoxic and already on oxygen. This systematic review and critical appraisal found low-grade scientific evidence that oxygen and airflow improve dyspnea in some patients with advanced disease at rest. However, there is no evidence to identify which patients will benefit from airflow or supplemental oxygen or to determine when to use airflow versus supplemental oxygen. Further research is required to provide scientific evidence to evaluate oxygen and airflow effectiveness and determine the place of oxygen and airflow in the management of dyspnea at rest in patients with advanced disease.
Canadian Family Physician, Dec 1, 2011
Yolande, une femme de 88 ans, est transférée de son centre d'hébergement à un hôpital de soins ai... more Yolande, une femme de 88 ans, est transférée de son centre d'hébergement à un hôpital de soins aigus pour prendre en charge des problèmes de confusion et de niveau de conscience réduit. Elle a des antécédents de démence, de diabète non insulinodépendant, d'ostéoporose avec fractures de compression, de légère insuffisance rénale chronique et d'hypertension. À son admission, on pose un diagnostic de pneumonie d'inhalation dans le lobe inférieur droit et elle est traitée avec des antibiotiques d'abord par voie intraveineuse puis orale. On explique à la famille de Yolande que la pneumonie est causée par une aspiration secondaire à des problèmes de déglutition. La famille signale que la quantité de nourriture prise par leur mère a baissé constamment et ils s'inquiètent que le personnel de la résidence n'ait pas le temps de la nourrir.
Cmaj Canadian Medical Association Journal, Aug 20, 2002
Cmaj Canadian Medical Association Journal, Dec 14, 1999
Canadian Family Physician Medecin De Famille Canadien, Dec 1, 2003
INTRODUCTION To describe an approach to assessment and treatment of dyspnea. SOURCES OF INFORMATI... more INTRODUCTION To describe an approach to assessment and treatment of dyspnea. SOURCES OF INFORMATION New level I evidence can guide management of dyspnea in advanced illness. Assessment and use of adjuvant medications and oxygen relies on level II and III evidence. MAIN MESSAGE Opioids are first-line therapy for managing dyspnea in advanced illness. They are safe and effective in reducing shortness of breath. Neuroleptics are useful adjuvant medications. Evidence does not support use of oxygen for every patient experiencing dyspnea; it should be tried for patients who do not benefit from first-line medications and nonmedicinal therapies. CONCLUSION Opioids relieve dyspnea and are indicated as first-line treatment for dyspnea arising from advanced disease of any cause. RÉSUMÉ INTRODUCTION Proposer une démarche pour l'évaluation et le traitement de la dyspnée. SOURCES D'INFORMATION Il existe de nouvelles preuves de niveau I pour orienter le traitement de la dyspnée observée à un stade avancé de certaines maladies. L'évaluation de la dyspnée et l'utilisation des médications adjuvantes reposent sur des preuves de niveaux II et III. PRINCIPAL MESSAGE Les opiacés sont des médicaments de premier recours pour soulager la dyspnée dans les maladies terminales. Ils réduisent l'essoufflement de façon sure et efficace. Les neuroleptiques sont également utiles comme médicaments adjuvants. L'utilisation de l'oxygène chez tous les patients souffrant de dyspnée n'est pas supportée par les données actuelles; un essai avec l'oxygène est toutefois indiqué chez ceux qui n'obtiennent pas d'amélioration avec la médication de premier recours ou les traitements non médicinaux. CONCLUSION Les opiacés réduisent la dyspnée et ils doivent être utilisés en premier recours dans la dyspnée observée au stade avancé de diverses maladies. This article has been peer reviewed. Cet article a fait l'objet d'une évaluation externe.
The Clinical Journal of Pain, 2007
This paper represents an expert-based consensus statement on pain assessment among older adults. ... more This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.
Textbook of Palliative Medicine, 2009
Journal of Alzheimer S Disease Jad, Dec 29, 2011
The assessment and management of behavioral and psychological symptoms of dementia (BPSD) in mode... more The assessment and management of behavioral and psychological symptoms of dementia (BPSD) in moderate to severe Alzheimer's disease (AD) can be challenging, and ethical dilemmas often arise. Clinicians often perceive a disconnect between evidence-based guidelines and the challenges of treating BPSD in moderate to severe AD. Reconciliation of salient ethical issues can help bridge this disconnect. In view of the fact that AD is a progressive and ultimately fatal disease, and given that there are often competing considerations when managing BPSD in moderate to severe AD, we propose a palliative care approach that prioritizes the recognition of personhood and the preservation of dignity. We present case illustrations, discuss the concepts of dignity and personhood during palliative care in AD, and encourage the use of the bioethical grid in navigating complex clinical challenges.
Canadian Family Physician, 2010
Medical Hypotheses, Sep 1, 2020
Canadian family physician Medecin de famille canadien, 2018
Canadian Family Physician Medecin De Famille Canadien, Mar 1, 2007
Canadian Medical Association Journal
Journal of Palliative Care
Health Services Insights
The narrative of the opioid crisis is that ill-informed and careless prescribing by physicians ha... more The narrative of the opioid crisis is that ill-informed and careless prescribing by physicians has led to increases in opioid-related harms including overdose deaths. Focusing on reducing the access to prescribed opioids without treating substance use disorder has led to increases in use of heroin and illicitly produced fentanyl. Overall prescribing of opioids has declined causing collateral damage to those who use opioids appropriately to reduce pain and improve function. The complexity of this issue requires a change in focus and broad changes in society's approach to substance abuse and mental health.
Canadian family physician Medecin de famille canadien, 2018
BMC Palliative Care, 2016
Background: This article reports on the concept of "communicating prognostic uncertainty" which e... more Background: This article reports on the concept of "communicating prognostic uncertainty" which emerged from a mixed methods survey asking family members to rank their satisfaction in seven domains of hospital end-of-life care. Methods: Open-ended questions were embedded within a previously validated survey asking family members about satisfaction with end-of-life care. The purpose was to understand, in the participants' own words, the connection between their numerical rankings of satisfaction and the experience of care. Results: Our study found that nearly half of all family members wanted more information about possible outcomes of care, including knowledge that the patient was "sick enough to die". Prognostic uncertainty was often poorly communicated, if at all. Inappropriate techniques included information being cloaked in confusing euphemisms, providing unwanted false hope, and incongruence between message and the aggressive level of care being provided. In extreme cases, these techniques left a legacy of uncertainty and suspicion. Family members expressed an awareness of both the challenges and benefits of communicating prognostic uncertainty. Most importantly, respondents who acknowledged that they would have resisted (or did) knowing that the patient was sick enough to die also expressed a retrospective understanding that they would have liked, and benefitted, from more prognostic information that death was a possible or probable outcome of the patient's admission. Family members who reported discussion of prognostic uncertainty also reported high levels of effective communication and satisfaction with care. They also reported long-term benefits of knowing the patient was sick enough to die. Conclusion: While a patient who is sick enough to die may survive to discharge, foretelling with family members in potential end of life contexts facilitates the development of a shared and desired prognostic awareness that the patient is nearing end of life.
Journal of Gastroenterology, Pancreatology & Liver Disorders, 2016
Canadian Family Physician Medecin De Famille Canadien, Apr 1, 2006
This article has been peer reviewed. Cet article a fait l' objet d'une révision par des pairs.
Canadian Family Physician Medecin De Famille Canadien, 2010
Journal of Pain and Palliative Care Pharmacotherapy, 2005
Oxygen is used frequently to relieve dyspnea in patients with advanced illness. The objective of ... more Oxygen is used frequently to relieve dyspnea in patients with advanced illness. The objective of this study was to critically appraise the scientific basis for oxygen therapy as a therapeutic intervention to manage dyspnea at rest in patients with advanced disease. A systematic search of all relevant databases was done using MeSH terms and appropriate key words. Both investigators reviewed 294 citations and possible articles were retrieved. Using the inclusion and exclusion criteria of the research question, five articles were found to be relevant to the question. The articles were graded according to the study design and qualitatively compared. No systematic reviews of the intervention exist. Study designs were case series and case control studies. These primary studies had small samples and did not have matched or cohort controls, therefore providing only level 4 evidence. There was only a total of 83 patients and the majority of the patients were hypoxic and already on oxygen. This systematic review and critical appraisal found low-grade scientific evidence that oxygen and airflow improve dyspnea in some patients with advanced disease at rest. However, there is no evidence to identify which patients will benefit from airflow or supplemental oxygen or to determine when to use airflow versus supplemental oxygen. Further research is required to provide scientific evidence to evaluate oxygen and airflow effectiveness and determine the place of oxygen and airflow in the management of dyspnea at rest in patients with advanced disease.
Canadian Family Physician, Dec 1, 2011
Yolande, une femme de 88 ans, est transférée de son centre d'hébergement à un hôpital de soins ai... more Yolande, une femme de 88 ans, est transférée de son centre d'hébergement à un hôpital de soins aigus pour prendre en charge des problèmes de confusion et de niveau de conscience réduit. Elle a des antécédents de démence, de diabète non insulinodépendant, d'ostéoporose avec fractures de compression, de légère insuffisance rénale chronique et d'hypertension. À son admission, on pose un diagnostic de pneumonie d'inhalation dans le lobe inférieur droit et elle est traitée avec des antibiotiques d'abord par voie intraveineuse puis orale. On explique à la famille de Yolande que la pneumonie est causée par une aspiration secondaire à des problèmes de déglutition. La famille signale que la quantité de nourriture prise par leur mère a baissé constamment et ils s'inquiètent que le personnel de la résidence n'ait pas le temps de la nourrir.
Cmaj Canadian Medical Association Journal, Aug 20, 2002
Cmaj Canadian Medical Association Journal, Dec 14, 1999
Canadian Family Physician Medecin De Famille Canadien, Dec 1, 2003
INTRODUCTION To describe an approach to assessment and treatment of dyspnea. SOURCES OF INFORMATI... more INTRODUCTION To describe an approach to assessment and treatment of dyspnea. SOURCES OF INFORMATION New level I evidence can guide management of dyspnea in advanced illness. Assessment and use of adjuvant medications and oxygen relies on level II and III evidence. MAIN MESSAGE Opioids are first-line therapy for managing dyspnea in advanced illness. They are safe and effective in reducing shortness of breath. Neuroleptics are useful adjuvant medications. Evidence does not support use of oxygen for every patient experiencing dyspnea; it should be tried for patients who do not benefit from first-line medications and nonmedicinal therapies. CONCLUSION Opioids relieve dyspnea and are indicated as first-line treatment for dyspnea arising from advanced disease of any cause. RÉSUMÉ INTRODUCTION Proposer une démarche pour l'évaluation et le traitement de la dyspnée. SOURCES D'INFORMATION Il existe de nouvelles preuves de niveau I pour orienter le traitement de la dyspnée observée à un stade avancé de certaines maladies. L'évaluation de la dyspnée et l'utilisation des médications adjuvantes reposent sur des preuves de niveaux II et III. PRINCIPAL MESSAGE Les opiacés sont des médicaments de premier recours pour soulager la dyspnée dans les maladies terminales. Ils réduisent l'essoufflement de façon sure et efficace. Les neuroleptiques sont également utiles comme médicaments adjuvants. L'utilisation de l'oxygène chez tous les patients souffrant de dyspnée n'est pas supportée par les données actuelles; un essai avec l'oxygène est toutefois indiqué chez ceux qui n'obtiennent pas d'amélioration avec la médication de premier recours ou les traitements non médicinaux. CONCLUSION Les opiacés réduisent la dyspnée et ils doivent être utilisés en premier recours dans la dyspnée observée au stade avancé de diverses maladies. This article has been peer reviewed. Cet article a fait l'objet d'une évaluation externe.
The Clinical Journal of Pain, 2007
This paper represents an expert-based consensus statement on pain assessment among older adults. ... more This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.
Textbook of Palliative Medicine, 2009
Journal of Alzheimer S Disease Jad, Dec 29, 2011
The assessment and management of behavioral and psychological symptoms of dementia (BPSD) in mode... more The assessment and management of behavioral and psychological symptoms of dementia (BPSD) in moderate to severe Alzheimer's disease (AD) can be challenging, and ethical dilemmas often arise. Clinicians often perceive a disconnect between evidence-based guidelines and the challenges of treating BPSD in moderate to severe AD. Reconciliation of salient ethical issues can help bridge this disconnect. In view of the fact that AD is a progressive and ultimately fatal disease, and given that there are often competing considerations when managing BPSD in moderate to severe AD, we propose a palliative care approach that prioritizes the recognition of personhood and the preservation of dignity. We present case illustrations, discuss the concepts of dignity and personhood during palliative care in AD, and encourage the use of the bioethical grid in navigating complex clinical challenges.