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Article ; Online: Cancer patients with delirium in the emergency department: A frequent and distressing problem that calls for better assessment.

Lawlor, Peter G

2016 Volume 122, Issue 18, Page(s) 2783–2786

MeSH term(s)	Delirium ; Emergency Service, Hospital ; Humans ; Neoplasms
Language	English
Publishing date	2016--15
Publishing country	United States
Document type	Editorial ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	1429-1
ISSN	1097-0142 ; 0008-543X ; 1934-662X
ISSN (online)	1097-0142
ISSN	0008-543X ; 1934-662X
DOI	10.1002/cncr.30132
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Article ; Online: Implementation of the Richmond Agitation-Sedation Scale (palliative version) on an inpatient palliative care unit.

Bush, Shirley H / Bronicki, Katarzyna / Dionne, Michel / Lelievre, Natasha / Lawlor, Peter G / Kabir, Monisha

BMC palliative care

2023 Volume 22, Issue 1, Page(s) 171

Abstract: Background: The Richmond Agitation-Sedation Scale - Palliative version (RASS-PAL) tool is a brief observational tool to quantify a patient's level of agitation or sedation. The objective of this study was to implement the RASS-PAL tool on an inpatient ... ...

Abstract	Background: The Richmond Agitation-Sedation Scale - Palliative version (RASS-PAL) tool is a brief observational tool to quantify a patient's level of agitation or sedation. The objective of this study was to implement the RASS-PAL tool on an inpatient palliative care unit and evaluate the implementation process. Methods: Quality improvement implementation project using a short online RASS-PAL self-learning module and point-of-care tool. Participants were staff working on a 31-bed inpatient palliative care unit who completed the RASS-PAL self-learning module and online evaluation survey. Results: The self-learning module was completed by 49/50 (98%) of regular palliative care unit staff (nurses, physicians, allied health, and other palliative care unit staff). The completion rate of the self-learning module by both regular and casual palliative care unit staff was 63/77 (82%). The follow-up online evaluation survey was completed by 23/50 (46%) of respondents who regularly worked on the palliative care unit. Respondents agreed (14/26; 54%) or strongly agreed (10/26; 38%) that the self-learning module was implemented successfully, with 100% agreement that it was effective for their educational needs. Conclusion: Using an online self-learning module is an effective method to engage and educate interprofessional staff on the RASS-PAL tool as part of an implementation strategy.
MeSH term(s)	Humans ; Palliative Care/methods ; Inpatients ; Hospice and Palliative Care Nursing ; Intensive Care Units ; Hypnotics and Sedatives/therapeutic use
Chemical Substances	Hypnotics and Sedatives
Language	English
Publishing date	2023-11-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2091556-1
ISSN	1472-684X ; 1472-684X
ISSN (online)	1472-684X
ISSN	1472-684X
DOI	10.1186/s12904-023-01298-y
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Article ; Online: Foreword. The SUNDIPS meeting and papers.

Lawlor, Peter G

Journal of pain and symptom management

2014 Volume 48, Issue 2, Page(s) 157–158

MeSH term(s)	Biomedical Research/methods ; Delirium/diagnosis ; Delirium/epidemiology ; Delirium/physiopathology ; Delirium/therapy ; Humans ; Palliative Care/methods
Language	English
Publishing date	2014-08
Publishing country	United States
Document type	Introductory Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639142-4
ISSN	1873-6513 ; 0885-3924
ISSN (online)	1873-6513
ISSN	0885-3924
DOI	10.1016/j.jpainsymman.2014.05.019
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Zs.A 2252: Show issues

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Article ; Online: Over a third of palliative medicine physicians meet burnout criteria: Results from a survey study during the COVID-19 pandemic.

Boland, Jason W / Kabir, Monisha / Spilg, Edward G / Webber, Colleen / Bush, Shirley H / Murtagh, Fliss / Lawlor, Peter G

Palliative medicine

2023 Volume 37, Issue 3, Page(s) 343–354

Abstract: Background: Palliative medicine physicians may be at higher risk of burnout due to increased stressors and compromised resilience during the COVID-19 pandemic. Burnout prevalence and factors influencing this among UK and Irish palliative medicine ... ...

Abstract	Background: Palliative medicine physicians may be at higher risk of burnout due to increased stressors and compromised resilience during the COVID-19 pandemic. Burnout prevalence and factors influencing this among UK and Irish palliative medicine physicians is unknown. Aim: To determine the prevalence of burnout and the degree of resilience among UK and Irish palliative medicine physicians during the COVID-19 pandemic, and associated factors. Design: Online survey using validated assessment scales assessed burnout and resilience: The Maslach Burnout Inventory Human Services Survey for Medical Personnel [MBI-HSS (MP)] and the Connor-Davidson Resilience Scale (CD-RISC). Additional tools assessed depressive symptoms, alcohol use, and quality of life. Setting/participants: Association of Palliative Medicine of UK and Ireland members actively practising in hospital, hospice or community settings. Results: There were 544 respondents from the 815 eligible participants (66.8%), 462 provided complete MBI-HSS (MP) data and were analysed. Of those 181/462 (39.2%) met burnout criteria, based on high emotional exhaustion or depersonalisation subscales of the MBI-HSS (MP). A reduced odds of burnout was observed among physicians who worked ⩽20 h/week (vs 31-40 h/week, adjusted odds ratio (aOR) 0.03, 95% confidence interval (CI) 0.002-0.56) and who had a greater perceived level of clinical support (aOR 0.70, 95% CI 0.62-0.80). Physicians with higher levels of depressive symptoms had higher odds of burnout (aOR 18.32, 95% CI 6.75-49.73). Resilience, mean (SD) CD-RISC score, was lower in physicians who met burnout criteria compared to those who did not (62.6 (11.1) vs 70.0 (11.3); Conclusions: Over one-third of palliative medicine physicians meet burnout criteria. The provision of enhanced organisational and colleague support is paramount in both the current and future pandemics.
MeSH term(s)	Humans ; Pandemics ; Palliative Medicine ; Quality of Life ; COVID-19/epidemiology ; Physicians/psychology ; Surveys and Questionnaires ; Burnout, Professional/epidemiology ; Burnout, Professional/psychology
Language	English
Publishing date	2023-02-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639247-7
ISSN	1477-030X ; 0269-2163
ISSN (online)	1477-030X
ISSN	0269-2163
DOI	10.1177/02692163231153067
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Article ; Online: Delirium: non-pharmacological and pharmacological management.

Boland, Jason W / Lawlor, Peter G / Bush, Shirley H

BMJ supportive & palliative care

2019 Volume 9, Issue 4, Page(s) 482–484

Language	English
Publishing date	2019-07-30
Publishing country	England
Document type	Journal Article
ISSN	2045-4368
ISSN (online)	2045-4368
DOI	10.1136/bmjspcare-2019-001966
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Article ; Online: Potentially Inappropriate Prescribing in Long-Term Care and its Relationship With Probable Delirium.

Webber, Colleen / Milani, Christina / Bjerre, Lise M / Lawlor, Peter G / Bush, Shirley H / Watt, Christine L / Pugliese, Michael / Knoefel, Frank / Casey, Genevieve / Momoli, Franco / Thavorn, Kednapa / Tanuseputro, Peter

Journal of the American Medical Directors Association

2023 Volume 25, Issue 1, Page(s) 130–137.e4

Abstract: Objectives: This study examined potentially inappropriate prescribing (PIP) of medication and its association with probable delirium among long-term care (LTC) residents in Ontario, Canada.: Design: Population-based cross-sectional study using ... ...

Abstract	Objectives: This study examined potentially inappropriate prescribing (PIP) of medication and its association with probable delirium among long-term care (LTC) residents in Ontario, Canada. Design: Population-based cross-sectional study using provincial health administrative data, including LTC assessment data via the Resident Assessment Instrument-Minimum Dataset version 2.0 (RAI-MDS 2.0). Setting and participants: LTC residents in Ontario between January 1, 2016, and December 31, 2019. Methods: We used residents' first RAI-MDS 2.0 assessment in the study period as the index assessment. Probable delirium was identified via the delirium Clinical Assessment Protocol. Medication use in the 2 weeks preceding assessment was captured using medication claims data. PIP was measured using the STOPP/START criteria and 2015 Beers criteria, with residents classified as having 0, 1, 2, or 3+ instances of PIP. Relationships between PIP and probable delirium was assessed via bivariate and multivariable logistic regression models. Results: The study population included 171,190 LTC residents (mean age 84.5 years, 66.8% female, 62.9% with dementia). More than half (51.8%) of residents had 1+ instances of PIP and 21% had 3+ instances of PIP according to the STOPP/START criteria; PIP prevalence was slightly lower when assessed using Beers criteria (36.5% with 1+, 11.1% with 3+). Overall, 3.7% of residents had probable delirium. The prevalence of probable delirium increased as the number of instances of PIP increased, with residents with 3+ instances of STOPP/START PIP being 1.66 times more likely (95% CI 1.56-1.77) to have probable delirium compared to those with no instances of PIP. Similar findings were observed when PIP was measured using the Beers criteria. Central nervous system (CNS)-related PIP criteria showed a stronger association with probable delirium than non-CNS-related PIP criteria. Conclusions and implications: This population-based study highlighted that PIP was highly prevalent in long-term care residents and was associated with an increased prevalence of probable delirium.
MeSH term(s)	Humans ; Female ; Aged, 80 and over ; Male ; Inappropriate Prescribing ; Long-Term Care ; Cross-Sectional Studies ; Ontario/epidemiology ; Delirium/drug therapy ; Delirium/epidemiology
Language	English
Publishing date	2023-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2023.08.019
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Zs.A 5971: Show issues

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Article ; Online: Long-term cognitive impairment after probable delirium in long-term care residents: A population-based retrospective cohort study.

Webber, Colleen / Milani, Christina / Pugliese, Michael / Lawlor, Peter G / Bush, Shirley H / Watt, Christine / Casey, Genevieve / Knoefel, Frank / Thavorn, Kednapa / Momoli, Franco / Tanuseputro, Peter

Journal of the American Geriatrics Society

2023 Volume 72, Issue 4, Page(s) 1183–1190

Abstract: Background: The impact of delirium on cognition has not been well-studied in long-term care (LTC) residents. This study examined changes in cognition 1 year after a probable delirium episode among LTC residents, compared to LTC residents without ... ...

Abstract	Background: The impact of delirium on cognition has not been well-studied in long-term care (LTC) residents. This study examined changes in cognition 1 year after a probable delirium episode among LTC residents, compared to LTC residents without probable delirium. We also evaluated whether the relationship between probable delirium and cognitive change differed according to a diagnosis of dementia. Methods: We conducted a population-based retrospective cohort study using linked health administrative data. The study population included adults aged 65+ residing in LTC in Ontario, Canada and assessed via the Resident Assessment Instrument-Minimum Dataset between January 1, 2016 and December 31, 2018. Probable delirium was ascertained via the delirium Clinical Assessment Protocol on the index assessment. Cognition was measured quarterly using the Cognitive Performance Scale (range 0-6, higher values indicate greater impairment). Cognitive decline up to 1 year after index was evaluated using multivariable proportional odds regression models. Results: Of 92,005 LTC residents, 2816 (3.1%) had probable delirium at index. Residents with probable delirium had an increased odds of cognitive decline compared to those without probable delirium, with adjusted odds ratios of 1.64 (95% confidence interval [CI] 1.35-1.99), 1.56 (95% CI 1.34-1.85), 1.57 (95% CI 1.32-1.86) and 1.50 (95% CI 1.25-1.80) after 1-3, 4-6, 7-9, and 10-12 months of follow-up. Residents with probable delirium and a comorbid dementia diagnosis had the highest adjusted odds of cognitive decline (adjusted odds ratio 5.57, 95% CI 4.79-6.48) compared to those without probable delirium or dementia. Residents with probable delirium were also more likely to die within 1 year than those without probable delirium (52.5% vs. 23.4%). Conclusions: Probable delirium is associated with increased mortality and worsened cognition in LTC residents that is sustained months after the probable delirium episode. Efforts to prevent delirium in this population may help limit these adverse effects.
MeSH term(s)	Humans ; Long-Term Care ; Retrospective Studies ; Delirium/diagnosis ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/complications ; Ontario/epidemiology ; Dementia/diagnosis
Language	English
Publishing date	2023-11-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18675
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Article ; Online: Episodic Cancer Pain: Patient Reporting, Prevalence, and Clinicodemographic Associations at Initial Cancer Pain Clinic Assessment.

Reis-Pina, Paulo / Acharya, Anand / Barbosa, Antonio / Lawlor, Peter G

Pain research & management

2020 Volume 2020, Page(s) 6190862

Abstract: Background: Better understanding of the episodic cancer pain (CP) spectrum, including pains that occur in addition to its conventionally defined breakthrough CP (BTcP) and incident CP (IcP) components, may inform CP assessment and management. This study ...

Abstract	Background: Better understanding of the episodic cancer pain (CP) spectrum, including pains that occur in addition to its conventionally defined breakthrough CP (BTcP) and incident CP (IcP) components, may inform CP assessment and management. This study aimed to determine the prevalence of episodic patient-reported CP and the prevalence and associations of study-defined BTcP (S-BTcP) and IcP (S-IcP) in patients with CP. Methods: In a cross-sectional study at their first CP clinic attendance, participants with CP had the following assessments: Brief Pain Inventory (BPI); Pain Management Index (PMI), with PMI-negative status indicating undertreatment; standardized neuropathic pain component (NPC) status; S-BTcP (no trigger identified) and S-IcP (trigger identified) status, based on a preceding 7-day history of transitory pain flares distinct from background pain, and BPI-Worst or BPI-Now pain intensity ≥ 4. Clinicodemographic variables' association with S-BTcP and S-IcP was examined in logistic regression analyses. Results: Of 371 participants, 308 (83%) had episodic CP by history alone; 140 (37.7%) and 181 (48.8%) had S-BTcP and S-IcP, respectively. Multivariable analyses demonstrated significant ( Conclusions: Episodic or transient patient-reported CP flares often do not meet the more conventional criteria that define BTcP and IcP, the principal episodic CP types. Both BTcP and IcP occur frequently and both are associated with a NPC, higher pain intensity, and less opioid underuse in the management of CP. Further studies are warranted to both better understand the complex presentations of episodic CP and inform its classification.
MeSH term(s)	Adult ; Breakthrough Pain/epidemiology ; Cancer Pain/classification ; Cancer Pain/epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Pain Measurement ; Prevalence
Language	English
Publishing date	2020-05-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041085-2
ISSN	1918-1523 ; 1203-6765
ISSN (online)	1918-1523
ISSN	1203-6765
DOI	10.1155/2020/6190862
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Article ; Online: Authors' Reply.

Reis-Pina, Paulo / Acharya, Anand / Lawlor, Peter G

Journal of pain and symptom management

2018 Volume 56, Issue 1, Page(s) e9–e10

MeSH term(s)	Cancer Pain ; Cross-Sectional Studies ; Humans ; Neoplasms ; Referral and Consultation ; Stress, Psychological
Language	English
Publishing date	2018-04-11
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	639142-4
ISSN	1873-6513 ; 0885-3924
ISSN (online)	1873-6513
ISSN	0885-3924
DOI	10.1016/j.jpainsymman.2018.03.027
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Article ; Online: Moderate to Severe Cancer Pain: Are We Taking Serious Action? The Opioid Prescribing Scenario in Portugal.

Reis-Pina, Paulo / Lawlor, Peter G / Barbosa, António

Acta medica portuguesa

2018 Volume 31, Issue 9, Page(s) 451–453

MeSH term(s)	Analgesics, Opioid/therapeutic use ; Cancer Pain/drug therapy ; Drug Prescriptions ; Humans ; Legislation, Drug ; Pain Management/methods ; Pain Measurement ; Palliative Care ; Portugal
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2018-09-28
Publishing country	Portugal
Document type	Journal Article
ZDB-ID	603078-6
ISSN	1646-0758 ; 0870-399X
ISSN (online)	1646-0758
ISSN	0870-399X
DOI	10.20344/amp.10999
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