Medical Advisor
Prof Dympna Waldron MD FRCPI
Prof of Palliative Medicine Saolta Hospitals Group/ National University of Galway, Ireland.
Decades of research into 'Individual Quality of Life (QoL)', Symptom Bother, Symptom Interference with QoL and Response Shift in outcome measurement. As individuals we re-calibrate and so outcome measures based on 'calibrated outcomes' may be missing the most vital information. People are not machines therefore can re-calibrate over time, what felt terrible a month ago may not seem so bad today and vice versa. This phenomenon is known as 'Response shift'. Recent research used ‘the outcome of SEIQoL/Symptom Bother as a Clinical Tool', with significant results, cited in the USA as ‘Top Story of 2020 for metastatic breast cancer’. Interest in research into the role of opioids around sepsis. We were first to identify and present results reflecting that 'opioid toxicity in an otherwise stable patients heralds imminent sepsis'. The hypothesis is that our body maybe pouring its own endorphins in preparation for sepsis, thereby the 'external' opioids become temporarily redundant. Also publications on Gastrointestinal dysmotility/Aspiration pneumonia and the role of Somatostatin analogues in effective symptom control. Our department has an interest in Lymphedema of lower limbs and the intervention of Thrombolysis and/or stenting to 'open up' the venous pathway to allow the Lymph pathway to drain. Organised 5 International Conferences; Cuisle Beatha, (www.cuislebeatha.ie) The hope was to dispel the myth that our role in patient care is revolving around solely, the 'dying process' and explore disease reversibility from every aspect, helping patients to 'live well despite advanced disease and by doing this help patients to die well when all potential reversibility has been explored'. Interested in Positive versus Negative language at EOL. Recent publications include re-vitalising the role of Methadone of it’s effect on opioid-induced hyperalgesia, Covid-19 at end-of-life, Ketamine, Scopolamine, Akatasia as an under-recognised side-effect of many commonly used anti-emetics in Palliative Care and other complex symptom control cases. Involvement in the use of cannabinoids for nausea, vomiting and anorexia in cancer patients and about to start a Phase 2 trial on use of cannabinoids for same symptom control.
2019 and 2020 publications:
https://spcare.bmj.com/content/bmjspcare/early/2022/11/15/spcare-2022-003986.full.pdf
Dr J. Hayes, Dr M. Azhar, Dr L. Gaffney, Dr E. Mannion, Prof D. Waldron: Retrospective analysis of methadone prescribing trends in palliative patients in an acute hospital setting. BMJ Supp Care
Waldron R, Waldron D, McMahon E, Reilly L, Riain UN, Fleming C, O'Regan A. Mycobacterium goodii pneumonia: An unusual presentation of nontuberculous mycobacterial infection requiring a novel multidisciplinary approach to management. Respiratory medicine case reports. 2019 Jan 1;26:307-9.
Linane H, Connolly F, McVicker L, Beatty S, Mongan O, Mannion E, Waldron D, Byrne D. Disturbing and distressing: a mixed methods study on the psychological impact of end of life care on junior doctors. Irish Journal of Medical Science (1971-). 2019 May;188(2):633-9.
McMahon E, Salmon C, Reilly L, Waldron D, Doherty AM. Depression or Adjustment Disorder? A pilot study to assess stress induced low mood in a high-risk population. InIRISH JOURNAL OF MEDICAL SCIENCE 2019 Jul 1 (Vol. 188, pp. S27-S28).
Salmon C, McMahon E, Reilly L, Waldron D, Doherty AM. Anxiety depression and quality of life screening in palliative medicine: community and hospital pilot study. BMJ Supportive & Palliative Care. 2020 Jul 9.
Mannion, D. E., Gilmartin, P. J., McInerney, D. V., Molony, M. K., Basquille, M. E., & Waldron, P. D. (2020). Exploring the Innate Human Potential for Positive Adaptation in the Face of Impending Mortality: Is there a Response Shift in Subjective Quality of Life over Time in a Group of Patients with Lung Cancer Receiving Palliative Treatment?. International Journal of Innovative Research in Medical Science, 5(05), 160 to 168. https://doi.org/10.23958/ijirms/vol05-i05/880
Mcinnerney V, Mannion E, Molony MK, Reilly L, Waldron D. An Intervention Using Quality of Life and Symptom Information as a Clinical Tool in Patients with Advanced Cancer. International Journal of Innovative Research in Medical Science (IJIRMS). 2019 Aug;4(08).
McInerney V, Mannion E, Moses A, Molony K, Waldron D. A Guide to Selecting a Measurement Tool for Quality of Life Assessment. population.;16:18-20. Med Clin Res. (2019) May 7;4(5):1-6.
Basquille, E., McKenna, V., Houlihan, A., Molony, K., McInerney, D. V., Mannion, D. E., Barton, D. J., & Waldron, P. D. (2020). An Exploration of the needs of a Cardiac Rehabilitation Population using a Subjective Quality-of-Life Measure. International Journal of Innovative Research in Medical Science, 5(06), 189 to 200. https://doi.org/10.23958/ijirms/vol05-i06/889
Kelly L, O’Shea N, Azhar M, Gaffney L, Beatty S, Brennock J, Mannion E, Waldron D. Patients with Covid-19 at the End of Life. Age. 2021;79(69):86.
D Waldron, A Stenson, N O Shea, D Lappin, M Bell. Phone Photograph confirms source of pain in a semiconscious dying patient: ‘A picture paints a thousand words.’, (in print Int J of Clinical and Medical images)
Shockney L. 2020 Top Stories in Metastatic Breast Cancer: Chemotherapy at the End of Life We Can Do Better by Our Patients. Oncology. 2020 (dec17 ). Reference to JCO publication ( In: American Society of Clinical Oncology; 2015 below).
Some relevant older publications:
Waldron D, O'Boyle CA, Kearney M, Moriarty M, Carney D. Quality-of-life measurement in advanced cancer: assessing the individual. Journal of Clinical Oncology. 1999 Nov;17(11):3603-11.
McInerney VB, Waldron D, Mannion E. Using individual quality-of-life information as a clinical tool in patients with advanced cancer. In: American Society of Clinical Oncology; 2015
Mannion, E., Gilmartin, J., Donnellan, P., Keane, M., & Waldron, D. (2014). Effect of chemotherapy on quality of life in patients with non-small cell lung cancer. Supportive Care in Cancer, 22(5), 1417-1428. doi:10.1007/s00520-014-2148-9,1
O’Sullivan GJ, Waldron D, Mannion E, Keane M, Donnellan PP. Thrombolysis and iliofemoral vein stent placement in cancer patients with lower extremity swelling attributed to lymphedema. Journal of Vascular and Interventional Radiology. 2015 Jan 1;26(1):39-45.
Colleran M, Walsh D, Mannion E, Waldron D. Advanced cancer and sexuality-the hidden dilemma. Pscyho-oncology. 2015 Apr;24.
Gorman KM, Cary H, Gaffney L, Forman E, Waldron D, Al-Delami F, Lynch BJ, King MD, Allen NM. Status dystonicus due to missense variant in ARX: Diagnosis and management. European Journal of Paediatric Neurology. 2018 Sep 1;22(5):862-5.
Murtagh C, Mannion E, Flaherty G, Weldron D. End-of-life enhancement: a novel introduction of medical students to palliative medicine. Journal of palliative medicine. 2012 Sep 1;15(9):965-6.
Waldron D, Grummell M, Daniels F, Mannion E. A retrospective review to test the hypothesis that “opioid toxicity”, developing in an otherwise stable patient heralds imminent sepsis. Palliative Medicine. 2008 Jun;22.
Rees, J., Clarke, M. G., Waldron, D., O'Boyle, C., Ewings, P., & MacDonagh, R. P. (2005). The measurement of response shift in patients with advanced prostate cancer and their partners. Health and Quality of Life Outcomes, 3(1), 21. doi:10.1186/1477-7525-3-21
Rees J, Waldron D, O'Boyle C, Ewings P, MacDonagh R. Prospective vs retrospective assessment of lower urinary tract symptoms in patients with advanced prostate cancer: the effect of ‘response shift’. BJU international. 2003 Nov;92(7):703-6
Rees, J., Waldron, D., Amp, Apos, Boyle, C., & Macdonagh, R. (2002). Response shift in individualized quality of life in patients with advanced prostate cancer. Clinical Therapeutics, 24, 33-34. doi:10.1016/S0149-2918(02)85111-1
McCarthy D, Waldron D, Moriarty M. 33 Does pilocarpine treatment improve subjective quality of life and zerostomia in head and neck cancer patients following radical radiotherapy?. Radiotherapy and Oncology. 2000(57):S31-2.
Hayes A, Waldron D, “An Evaluation of the effects of Touch Therapy on patient’s Perceptions of their Quality of Life in a Palliative Care setting.” 2000, Report to Dept for Health, Ireland
Waldron D, O’Boyle CA. in, Joyce, Charles Richard Boddington, Hannah M. McGee, and Ciaran A. O'Boyle, eds. Individual quality of life: Approaches to conceptualisation and assessment. Taylor & Francis, 1999. (pp 197-212)
O’Boyle, C. A., & Waldron, D. (1997). Quality of life issues in palliative medicine. Journal of Neurology, 244(4), S18-S25. doi:10.1007/PL0000772
Pearcy, R., et al. "Proxy assessment of quality of life in patients with prostate cancer: how accurate are partners and urologists?." Journal of the Royal Society of Medicine 101.3 (2008): 133-138.
2021 IAPC:
'A Controlled Clinical Trial of the effects of Meditation on patient’s Perceptions of their Quality of Life in an Acute Hospital setting:’
'An exceptionally complex and ethically challenging case of management of cancer pain during twin pregnancy’
'Sixth Cranial Nerve palsy, a manageable problem to avoid severe ‘sea sickness’ secondary to diplopia.’
'Transient episodes of expressive dysphasia and confusion precipitated minutes after administration of intravenous cyclizine: a case series’
'Quality improvement project: bereavement follow-up in an acute hospital during Covid-19 and beyond’
'Multidisciplinary quality improvement (QI) project: Improved management of diabetes in the last days of life’
'Analysis of methadone prescribing for pathological cough in palliative care patients in an acute hospital setting’
'A ‘Point Prevalence’ Pain Study over two days in three Dialysis units in the West of Ireland.’
'Audit: To assess if breakthrough opiate analgesic dose is appropriately calculated for palliative care patients in an acute hospital’
'Effective Management of Refractory Status Epilepticus at End of Life.’
'“The glass coffin”: Akathisia, an insidious yet reversible side effect of anti-emetics.’
'Pain that is Opioid Responsive remains Opioid responsive: The role of Intrathecal Opioid Pumps.’
'"Home is where the heart is": Excellent team work to achieve End-of-Life wishes’
'Radiological guided symptom control in an acute end-of-life setting – A Case Report’
'A retrospective review of 84 patients with cancer receiving venous intervention for secondary lymphoedema.’
'The woman who could not close her eyelids at End-of-Life.’
'Retrospective analysis of methadone prescribed as analgesic for palliative care patients in an acute hospital setting’
'Two occasions when Hospital policy had to be overridden to use intravenous opioids.'
2020 IAPC/EAPC:
https://spcare.bmj.com/content/bmjspcare/early/2022/11/15/spcare-2022-003986.full.pdf
Dr J. Hayes, Dr M. Azhar, Dr L. Gaffney, Dr E. Mannion, Prof D. Waldron: Retrospective analysis of methadone prescribing trends in palliative patients in an acute hospital setting
Dr J. Hayes, Dr M. Azhar, Dr L. Gaffney, Dr E. Mannion, Prof D. Waldron: Case series on management of poorly controlled gastrointestinal bleeding in palliative patients
Dr J. Hayes, Dr M. Azhar, Dr L. Gaffney, Dr E. Mannion, Prof D. Waldron: Audit: To assess if un-necessary medications are discontinued in patients imminently dying
Dr J. Hayes, Dr M. Azhar, Dr L. Gaffney, Dr E. Mannion, Prof D. Waldron: Quality improvement project: bereavement follow-up in an acute hospital during Covid-19 and beyond
Dr J. Hayes, Dr M. Azhar, Dr L. Gaffney, Dr E. Mannion, Prof D. Waldron: The complex management of retroperitoneal bleeding in a palliative patient on therapeutic anticoagulation
Dr J Hayes, Ms Nessa Fahy, Dr A Stenson, Dr S Maher, Dr E Mannion, Dr S Beatty, Prof D Waldron. Transient episodes of expressive dysphasia and confusion precipitated minutes after administration of intravenous cyclizine: a case series
Dr L. Gaffney, Dr J. Hayes, Dr M. Azhar, Dr E. Mannion, Prof D. Waldron: Retrospective Analysis of Ketamine Prescribing in Palliative patients in the acute hospital setting.
Dr L. Gaffney, Dr J. Hayes, Dr M. Azhar, Dr E. Mannion, Prof D. Waldron: A case of Covid-19 presenting with insomnia, progressing to extreme agitation at End of Life.
Dr M. Azhar, Dr L. Gaffney, Dr J. Hayes, Dr E. Mannion, Dr S Beatty, Prof D. Waldron: Central Pontine and Extrapontine Myelinolysis- A clinical case
Dr M. Azhar, Dr L. Gaffney, Dr J. Hayes, Dr E. Mannion, Dr S Beatty, Prof D. Waldron: Retrospective analysis of phenobarbitone prescribing in palliative patients in acute hospital setting
Dr M. Azhar, Dr L. Gaffney, Dr J. Hayes, Dr E. Mannion, Dr S Beatty, Prof D. Waldron: Assessment and Management Plan of Oral care at End of Life: A Clinical Audit
Dr M. Azhar, Dr N O Shea, Dr E. Mannion, Prof D. Waldron: Case series Night Terrors confused with Opioid Toxicity side effects.
Dr M. Azhar, Dr N O Shea, Dr E. Mannion, Prof D. Waldron: Case series of 2 patients with Gastric outlet obstruction; Management specific to the level of obstruction.
Dr N O Shea, Dr M. Azhar, Dr E. Mannion, Prof D. Waldron: Potentially Inappropriate Medications at End-of-Life: Review of Malignant Referrals to a Hospital Palliative Care Team
2019 IAPC:
Dr N O Shea, Dr M. Azhar, Dr E. Mannion, Dr S Beatty, Prof D. Waldron: Case series of three patients with Amyloid; outling complex symptom control challenges and complex ethical challenge of patient request for organ donation to further scientific knowledge.
Dr N O Shea, Dr M. Azhar, Dr E. Mannion, Dr S Beatty, Prof D. Waldron:Intractable cough with no source found fully settled with low dose methadone: A case to learn from specific d-isomer separate effect of methadone on ‘cough reflex’ centre.
Dr N O Shea, Dr M. Azhar, Dr E. Mannion, Dr S Beatty, Prof D. Waldron:Title: Documentation of Syringe Driver Prescriptions in the Regular Prescription Chart: A Clinical Audit
Developed Handbook during Covid-19:
Dr N O Shea, Dr M. Azhar, Dr E. Mannion, Dr S Beatty, Prof D. Waldron: Symptom Control & Palliative Care: NCHD Handbook Department of Palliative Medicine, University Hospital Galway,
July 2020
GUH Research Day, 2021:
Dr A. Stenson, Dr S. Maher, Dr J. Hayes, Dr S. Beatty, J. Dr E. Mannion, Prof D. Waldron. Radiological guided symptom control in an acute end-of-life setting – A Case Report
Dr S. Maher, Dr A. Stenson, Dr J. Hayes, Dr S. Beatty, J. Dr E. Mannion, Prof D. Waldron “The glass coffin”. Akathisia: a sneaky yet reversible side effect of anti-emetics.
Lisa Kelly, Noreen O’Shea, Mahrukh Azhar, Sharon Beatty, Jennifer Brennock, Eileen Mannion, Dympna Waldron Symptomatology at the end of life with COVID-19Abstracts of the 16th International E-Congress of the European Geriatric Medicine Society. Eur Geriatr Med 11, 1–309 (2020)