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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fatigue is a common symptom among cancer patients and the general population. Due to its subjective nature, fatigue has been difficult to effectively and efficiently assess. Modern computerized adaptive testing (CAT) can enable precise assessment of fatigue using a small number of items from a fatigue item bank. CAT enables brief assessment by selecting questions from an item bank that provide the maximum amount of information given a person's previous responses. This article illustrates steps to prepare such an item bank, using 13 items from the Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-F) as the basis. Samples included 1022 cancer patients and 1010 people from the general population. An Item Response Theory (IRT)-based rating scale model, a polytomous extension of the Rasch dichotomous model was utilized. Nine items demonstrating acceptable psychometric properties were selected and positioned on the fatigue continuum. The fatigue levels measured by these nine items along with their response categories covered 66.8% of the general population and 82.6% of the cancer patients. Although the operational CAT algorithms to handle polytomously scored items are still in progress, we illustrated how CAT may work by using nine core items to measure level of fatigue. Using this illustration, a fatigue measure comparable to its full-length 13-item scale administration was obtained using four items. The resulting item bank can serve as a core to which will be added a psychometrically sound and operational item bank covering the entire fatigue continuum.
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PMID:Item banking to improve, shorten and computerize self-reported fatigue: an illustration of steps to create a core item bank from the FACIT-Fatigue Scale. 1367 94

The presence of a painful, disabling chronic disease may have implications for perceived ability to fulfill a parenting role. The purpose of this research was to examine the realities of parenting from the perspectives of mothers, fathers and grandparents with arthritis using a combination of methods: a cross sectional survey and in-depth focus group discussions. There was consensus that pain, fatigue and restricted physical functioning combined to interfere with the parenting role. Overall, approximately 35% of the sample had experienced difficulties attributed to arthritis. A gender difference emerged with women reporting more difficulties in relation to caring for babies and toddlers, whereas men reported more problems as children grew older. Key themes concerned: physical limitations; practical and caring issues; social factors; emotional response; hereditary risks and safety issues. Perceived inability to fulfill parenting roles resulted in feelings of frustration, guilt, anger and depression. A number of positive outcomes were mentioned including children's increased awareness of the needs of others. Limitations of the methodological approach adopted are discussed.
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PMID:Does arthritis influence perceived ability to fulfill a parenting role? Perceptions of mothers, fathers and grandparents. 1452 41

Viral hepatitides are common diseases of modern man in both industrialized and developing countries, with a varying prevalence of particular types and mode of transmission. In current medicine, viral hepatitides are classified in the A-E nomenclature, differentiating viruses that can be etiologically defined with certainty on the basis of serum markers and hepatitides exhibiting all clinical and laboratory characteristics of viral hepatitis but of as yet nondemonstrable causative agents, classified in the non-A, non-E hepatitis group. Two issues are of high relevance in the pathogenesis of viral hepatitides: route of transmission (fecal-oral or parenteral) and basic mechanism of hepatocyte lesion. Although all hepatitis viruses replicate within the hepatocyte, the exact mechanism of hepatocyte necrosis has not yet been fully elucidated, i.e. direct cytotoxicity or hepatoprogressive immune response mediated primarily by the specific cytotoxic CD8 lymphocytes. Depending on the site of entry, the virus replicates in the adjacent lymphatic tissue for some time, followed by primary viremia, virus replication in the lymphoreticular organs (lymph nodes, liver, spleen), and eventual entry in the target cells--hepatocytes, accompanied by a varying grade of necrosis and inflammatory reaction. The clinical and laboratory signs of the disease correspond to the degree of liver necrosis and are not specific for particular types of viral hepatitis. The most frequent symptoms common to all types of viral hepatitis of moderate severity include elevated body temperature persisting for days, fatigue, gradual loss of appetite, nausea, dull pain and discomfort on DRL, vomiting, multiple loose stools, dark urine, jaundice of the skin and mucosa, and light stools. Generally, the ultimate outcome of the disease is elimination of the virus and complete recovery, however, a fulminant course with lethal outcome or transition to chronic disease may also occur, making viral hepatitides a major public health problem worldwide. In classical infectology, four clinical stages of the disease have been described: incubation or preclinical stage characterized by intensive virus replication; prodromal or preicteric stage with pronounced general symptoms of infection; icteric stage; and stage of recovery. The stages may show great interindividual variation in length and severity. The development of molecular technologies over the last decade has greatly contributed to better understanding of the pathogenesis of viral hepatitides and allowed for appropriate monitoring of the effect of antiviral therapy. However, major disadvantage of these tests is their high cost. The basic clinical characteristics of and diagnostic options for particular types of viral hepatitis are described, with special reference to the latest important concepts on the disease pathogenesis.
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PMID:[Clinical aspects and diagnosis of viral hepatitis]. 1458 62

Opioid-induced sedation is a major complication in patients with cancer pain. This study assessed the effectiveness of donepezil in opioid-induced sedation and related symptoms in patients with cancer pain. Twenty-seven patients who were receiving strong opioids for pain and reported sedation were enrolled. Donepezil 5 mg was given every morning for 7 days. Changes between baseline and Day 7 in sedation, pain, fatigue and other symptoms were evaluated using the Edmonton Symptom Assessment Scale. Fatigue was also measured using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). Overall usefulness of donepezil was measured by the patient at the end of the study. In 20 evaluable patients, sedation, fatigue, anxiety, well-being, depression, anorexia and problems with sleep were significantly improved. Side effects included nausea, vomiting, diarrhea, muscle and abdominal cramps, and anorexia. Overall, however, the treatment was well tolerated. Donepezil appears to improve sedation and fatigue in patients receiving opioids for cancer pain. Randomized controlled trials of this agent are justified.
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PMID:The effect of donepezil on sedation and other symptoms in patients receiving opioids for cancer pain: a pilot study. 1458 55

Rheumatoid arthritis (RA) sufferers number approximately 200 million people around the world. In Korea, there is no accurate statistical information, but 1-2% of the total population have been estimated to be suffering from RA. Current research studies related to RA have been limited to quantitative approaches. In qualitative studies, most research has been focused on one aspect of the experience of patients with RA, such as pain or fatigue. In order to address the problems of patients with chronic disease, like RA, a comprehensive approach should be demanded concerning various aspects of the patient's life in terms of perspectives of the patients with RA. The purpose of this study was to explore and describe the illness experience of women with RA in Korea using a phenomenological methodology. Participants were five women who were diagnosed with RA. The transcripts were analyzed using Colaizzi's (In: Vails, R.S., King, M. (Eds.), Existential Phenomenological Alternatives for Psychology. Oxford University Press, New York, 1978) method. The results of this study identified 8 major theme clusters, which were 'severe pain', 'self-esteem', 'negative feelings', 'reflect the past life', 'concentrate on recovery from disease', 'a comfortable mind in pain', 'support of family and others', and 'new life'. These results may provide important information to establish effective interventions for women with RA, their families, and health providers through understanding various aspects of the lived experience of women with RA. The implications for nursing practice in this area of chronic illness such as RA, should be how patients can be empowered to believe they can take control of their disease and their lives.
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PMID:Lived experience of Korean women suffering from rheumatoid arthritis: a phenomenological approach. 1496 80

Multiple sclerosis (MS) is a chronic disease affecting young adults. The presence of the sometimes-invisible symptoms (loss of vision, fatigue, incontinence) and the episodic nature and uncertainty of symptoms can create a constant sense of vigilance or support the use of denial. Indeed, family, friends, and even nursing support may be elusive, leaving one feeling lonely, frightened, and insecure. The purposes of this research were to investigate the lived experiences of people with MS and examine their needs from their perspectives. Two focus groups included 4 men diagnosed with MS from 2 to 15 years and 6 women diagnosed with MS from 1.5 to 15 years. Four themes were identified. The first theme resonated around feelings that "nobody listened." The second theme, symptom devastation, described the overwhelming presence of symptoms and the difficulty they caused. The third theme was "picking and choosing," or making choices to maintain some control. "Fight your own fight" with self-advocacy and taking charge was the final theme. Even though MS continuously caused challenges and changes interfering with goals, participants described creative solutions. They learned to deal with the denial, refocus their priorities, plan their activities, and choose carefully. They described a litany of being unheard, unimportant, and confused, which led to feelings of dejection, desperation, and depression. Their most poignant need was someone to listen and teach since they identified knowledge as power. The data gathered contribute to knowledge and understanding of people living with MS. Findings support nursing interventions that empower and teach self-management techniques.
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PMID:Focus groups: the lived experience of participants with multiple sclerosis. 1499 6

The purpose of rehabilitation is to restore good physical, mental emotional, social condition and if at all possible efficiency at work in a patient with an obstructive pulmonary disease. The most important aspect of rehabilitation is an individual attitude to each patient. A patient with chronic disease and different degree of failure of the respiratory tract struggles with abnormal lung function i.e. with dyspnoea and general physical weakness. Obviously, a slight disturbance in the function of the respiratory system is almost imperceptible in daily activities, thus patients complain about slight fatigue that recedes after a short rest. The values of basic spirometric indexes FVC, FEV1 are within normal. Only disturbances of the function of peripheral air passages MEF50%VC, MEF25%VC indicate the onset of failure in the distribution of inspired gas and alveolar hypoventilation as well as violation of normal air flow in the peripheral bronchioles whose diameter is less than 2 mm. Anxiety and concern for health appear with increased dyspnoea while doing exercises and within years dyspnoea will accompany daily domestic routine activities. It is known that such factors as pollution of the environment, smoking tobacco, viral infections in childhood, bacterial infections of the respiratory system, prematurity, respiratory distress syndrome (RDS) and different degree of bronchi-pulmonary dysplasia favour the development of chronic obstructive pulmonary disease. The decrease of FEV1 more than 40 ml per year shows the increased respiratory failure. Ventilatory reserves of the respiratory system systematically diminished exceeding the predicted limit 80%. COPD is a chronic progressive disease causing irreparable obstruction of the bronchi. Then changes in the structure of the bronchial tree are seen as well as the increased tension of the smooth muscles which depend on the parasympathetic system. Does the progression of the disease indicate the lack of effective treatment? The sick patient starts doubting about the right diagnosis, medicines, rehabilitation and medical team. It is necessary to analyse and update again therapeutic treatment and rehabilitation. Movement and respiratory rehabilitation, regardless of the degree of COPD severity, has in principle five major tasks: 1. The control, alleviation, delay of pathological processes causing the increased pulmonary failure. 2. Improvement of physical condition. 3. The study of physiotherapy and coping with stress in patients with dyspnoea and progressive disease. 4. Improvement of the standard of life and prolonging lifespan. 5. The decrease of medical care expenses.
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PMID:[Movement rehabilitation, psychotherapy and respiratory rehabilitation in patients with chronic obstructive pulmonary disease]. 1500 10

Rheumatoid arthritis (RA) is a chronic, generally progressive autoimmune disease that causes functional disability, significant pain and joint destruction, and leads to premature mortality. It is estimated to affect between 0.5 and 1.0% of the adult population worldwide, increases in prevalence with age and affects more women than men. The magnitude of the severe long-term economic consequences of RA has been underestimated in the past. Most patients with the disease require continuous treatment to retard or stop progression and to control disease flares. Many also require surgery, such as total hip or knee replacement. In addition to these direct costs, work disability leads to reduced productivity and early retirement, and as a result, substantial indirect costs. The individual and his or her family must cope with the feeling of loss of contribution to society combined with redefined social roles, and the effects of pain, fatigue, low self-esteem, mental distress and depression. A number of countries in North America and Europe have reported a decline in the incidence of RA in recent years, although geographical differences remain that may be associated with genetic, environmental or cultural factors. Nevertheless, patients with RA have not shared the improvements in survival rates seen with other diseases over the last 40 years, and have a mean reduction in life expectancy of between 5 and 10 years. Disease severity, activity and disability are strongly linked to premature mortality in patients with RA. The high direct and indirect costs associated with RA, together with the substantial morbidity and mortality affecting millions of people worldwide, underline the potential benefits of improved treatments for this chronic disease to patients, their families and society.
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PMID:Epidemiology and burden of illness of rheumatoid arthritis. 1515

The use of highly active antiretroviral therapy (HAART) has served to significantly reduce the mortality of HIV-infected persons. However, this treatment is associated with a host of adverse effects: fatigue, nausea, pain, anxiety and depression. Rather than utilise traditional pharmacological treatments for these effects, many HIV/AIDS patients are utilising adjunct therapies to maintain their quality of life while they undergo treatment. Exercise has consistently been listed as one of the most popular self-care therapies and a small number of studies have been conducted to examine the impact of exercise on the most common self-reported symptoms of HIV and AIDS and the adverse effects of treatment. Although the results are generally positive, there are clear limitations to this work. The existing studies have utilised small samples and experienced high rates of attrition. In addition, the majority of the studies were conducted prior to the widespread use of HAART, which limits the ability to generalise these data. As a result, data from other chronic disease and healthy samples are used to suggest that exercise has the potential to be a beneficial treatment across the range of symptoms and adverse effects experienced by HIV-infected individuals. However, additional research is required with this population to demonstrate these effects.
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PMID:The benefits of exercise training for quality of life in HIV/AIDS in the post-HAART era. 1524 86

Physical inactivity is associated with alteration of normal physiologic processes leading to muscle atrophy, reduced exercise capacity, insulin resistance, and altered energy balance. Bed rest studies in human beings using stable isotopes of amino acids indicate that muscle unloading decreases the turnover rates of muscle and whole-body proteins, with a prevailing inhibition of protein synthesis. In the fasting state, muscle and whole-body nitrogen loss was not accelerated during bed rest. In experimental postprandial states, the amino acid-mediated stimulation of protein synthesis was impaired, whereas the ability of combined insulin and glucose infusion to decrease whole-body proteolysis was not affected by muscle inactivity. Thus, an impaired ability of protein/amino acid feeding to stimulate body protein synthesis is the major catabolic mechanism for the effect of bed rest on protein metabolism. This suggests that a protein intake level greater than normal could be required to achieve the same postprandial anabolic effect during muscle inactivity. Metabolic adaptation to muscle inactivity also involves development of resistance to the glucoregulatory action of insulin, decreased energy requirements, and increased insulin and leptin secretion. These alterations may lead to the development of the metabolic syndrome that is defined as the association of hyperinsulinemia, dyslipidemia, hypertension, hyperglycemia, and abdominal obesity. This cluster of metabolic abnormalities is a risk factor for coronary artery disease and stroke. Evidence indicates that exercise training programs may counteract all of these abnormalities both in healthy sedentary subjects and in patients affected by a variety of chronic disease states.
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PMID:Metabolic consequences of physical inactivity. 1564 7


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