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

The performance of an ICD system depends, in part, on the effectiveness with which the lead system functions. Engineering trade-offs are made during the design of a lead to optimize one or more performance characteristics: e.g., lead handling, fatigue life, size, and optimized therapy delivery. To assure low defibrillation thresholds, careful attention must be taken during the design process to prevent these trade-offs from hampering the lead's therapy effectiveness. Four basic design rules are described that capture many of the engineering concepts that will enhance a lead's efficacy: (1) minimize electrode pullback, (2) deliver current to the apex, (3) minimize energy loss in the lead, and (4) use large, efficient electrodes. These rules speak to optimizing delivery of current to the heart and efficiency of the lead and electrode interface. When the lead performs its function well, the complete ICD system of the heart, lead, and implantable pulse generator will provide optimal safety margins for device implant and an increased number of patients that can be implanted with a single-lead system.
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PMID:Implantable cardioverter defibrillator lead technology: improved performance and lower defibrillation thresholds. 777 19

Neurasthenia was described and explained in very mechanistic terms, at the end of the 19th century, by G.M. Beard to account for physical and mental exhaustion and for varied somatic troubles imputed to failure of too much solicited nervous resources. This concept was then universally adopted and gave rise to diverse interpretations, among which was the Freud's one. Later, in Occident, came a deterioration, the diagnostic of neurasthenia giving way to those of anxious or affective disorders. In the same time, at least for ideological and cultural reasons, the concept remained lively in Russia and in Asia. During the last decade the western psychiatry has been led to accept that there are clinical situations focussed on fatigue and fatigability, even if it coined for them new terminologies (post-infectious fatigue, chronic fatigue syndrome, etc.) and while DSMs keep on ignoring neurasthenia, the ICD 10 gives it an important place.
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PMID:[Neurasthenia, yesterday and today]. 784 49

A randomized, double-blind study examining the effectiveness and tolerance of a standardized hypericum preparation when compared to maprotiline was performed in a group of 102 patients with depression, in accordance with ICD-10, F 32.1. The study was conducted in the offices of neurology and psychiatry specialists. The patients received, over a period of 4 weeks, either 3 x 300 mg of the hypericum extract or 3 x 25 mg maprotiline pills of identical appearance. Effectiveness was determined using the Hamilton Depression Scale (HAMD), the Depression Scale according to von Zerssen (D-S), and the Clinical Global Impression Scale (CGI). The total score of the HAMD scale dropped during the 4 weeks of therapy in both treatment groups by about 50%. The mean values of the D-S scale and the CGI scale showed similar results, and after 4 weeks of therapy, no significant differences in either treatment group were noticed. The onset of the effects occurred up to the second week of treatment, but were observed earlier with maprotiline than with the hypericum extract. On the other hand, maprotiline treatment resulted in more cases of tiredness, mouth dryness, and heart complaints.
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PMID:Effectiveness and tolerance of the hypericum extract LI 160 compared to maprotiline: a multicenter double-blind study. 785 3

From 686 patients attending primary care physicians, 77 were identified by a screening procedure as having chronic fatigue. Of these, 65 were given a comprehensive psychological, social and physical evaluation. Seventeen cases (26%) met criteria for the chronic fatigue syndrome. Forty-seven (72%) received an ICD-9 diagnosis of whom 23 had neurotic depression, with a further 5 meeting criteria for neurasthenia. Forty-nine were 'cases' as defined by the revised Clinical Interview Schedule (CIS-R), and 42 if the fatigue item was excluded. Psychiatric morbidity was more related to levels of social stresses than was severity of fatigue. The main difference between these subjects and those examined in hospital settings is that the former are less liable to attribute their symptoms to wholly physical causes, including viruses, as opposed to social or psychological factors. Identification and management of persistent fatigue in primary care may prevent the secondary disabilities seen in patients with chronic fatigue syndromes.
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PMID:Chronic fatigue in primary care attenders. 813 22

The Chronic-Fatigue-Syndrome (CFS) has been first described in 1988 and has been also in Germany recently more frequently diagnosed. It is similar to a lot of other terms, especially to "neurasthenia", which has been introduced 1869 from Beard and is now again content of ICD-10. CFS is defined by primary and secondary criteria, which are however largely subjective. There are no objective signs. It is unknown if this syndrome represents a disease entity of its own. The explanation is either exclusive organic based on immunological and virological findings or exclusive psychogenic as a special form of anxiety psychosis. Possibly are both factors involved as part of "psycho-neuro-immunology". CFS is increased subject of medical certification. It has been tried to give a practical guidance to the assessment of CFS.
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PMID:[Expert assessment of chronic fatigue syndrome]. 865 55

Objective and subjective sleep and awakening quality as well as daytime vigilance of insomniac patients with generalized anxiety disorder (GAD) were investigated, as compared with normal controls. Forty-four outpatients (25 females, 19 males), aged 24-65 (mean 43) years, diagnosed with non-organic insomnia (ICD-10: F 51.0), related to mild GAD (F 41.1), with a Hamilton anxiety (HAMA) score of 22 +/- 6 and a Zung self-rating anxiety (SAS) score of 37 +/- 6 were included. After 1 adaptation night, sleep induction, maintainance and architecture were measured objectively by polysomnography, subjective sleep and awakening quality were assessed by self-rating scales and visual analog scales, objective awakening quality was measured by a psychometric test battery, and diurnal tiredness was measured by a 3-min vigilance-controlled EEG (V-EEG) and a 4-min resting EEG mapping. In polysomnography patients demonstrated-as compared with normals-significantly increased wake time during the total sleep period and more early-morning awakening, decreased total sleep and sleep efficiency. Subjective sleep quality was deteriorated as well, as were well-being, drive, mood, and wakefulness in the morning. In noopsychic performance, GAD patients did rather well in attention, concentration, attention variability, and numerical memory, while fine-motor activity and reaction time were deteriorated. In psychophysiology, critical flicker frequency was decreased in the morning, while muscle strength, blood pressure and pulse rate showed no differences. EEG mapping during the late morning hours (10.00-12.00 h) demonstrated hypervigilance in the V-EEG, while in the resting recording an increased sleep pressure was detected. The latter was correlated significantly to the SAS score, but less so to the observer-rated Hamilton anxiety score. Our findings suggest that CNS hypervigilance and hyperarousal, as actual symptoms of GAD, lead to nocturnal insomnia, which in turn may cause-as a consequence of sleep pressure not slept off-diurnal tiredness.
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PMID:Nonorganic insomnia in generalized anxiety disorder. 1. Controlled studies on sleep, awakening and daytime vigilance utilizing polysomnography and EEG mapping. 931 44

Depression and reduced sexual functioning have been identified as problems following ICD placement. We examined these issues, and multiple other quality-of-life measures, and their relationship to ICD and ICD discharge. Patients were 64 +/- 11 years old, 72% male, and had undergone ICD 20 +/- 14 months previously. Fifty-eight patients responded to a confidential biopsychosocial questionnaire. Positive attitudes toward the procedure increased from 52% before to 76% after implantation. Satisfaction correlated most strongly with less anger (P = 0.002, r = 0.45), less worry about ICD size (P = 0.007, r = 0.38), less sadness (P = 0.01, r = 0.37), and perceived better health (P = 0.01, r = 0.35). Of these ICD patients, 20%-58% reported measures of depression, and sexual frequency was reduced in 45%. Despite successful ICD placement, health concern increased in 62% of the respondents. Thirty-nine percent attended support groups; 96% found them very helpful. Mean number of ICD discharges described by responders was 5 +/- 11. Fifty percent of our sample reported > or = 1 shock; equal numbers had 1, 2-5, 6-10, and more than 10 shocks. Sixty-two percent of men had at least one discharge compared to 13% of women. After controlling for cardiac clinical variables, experiencing > or = 1 ICD shock was strongly associated with anxiety about family (odds ratio = 7.3), reduced new activities (odds ratio = 6.9), increased sadness (odds ratio = 6.2), and health worry (odds ratio = 5.8). Experiencing > or = 5 ICD shocks was strongly associated with increased health concern (odds ratio = 13.6), increased sadness (odds ratio = 12.5), increased fatigue (odds ratio = 6.1), current sadness (odds ratio = 5.8), and increased nervousness (odds ratio = 5.3). ICD implantation powerfully affects quality-of-life. Postimplantation health concern is paradoxically increased despite improvement in actual health. Negative emotions are associated with defibrillator discharge.
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PMID:Psychosocial outcome after ICD implantation: a current perspective. 963 62

Toxic or environmental exposures have been suggested as a possible cause of symptoms reported by Gulf War veterans. To further explore this hypothesis, we analyzed findings in 18,495 military personnel evaluated in the Department of Defense Comprehensive Clinical Evaluation Program. The program was established in 1994 to evaluate Persian Gulf veterans eligible for Department of Defense medical care who had health concerns after service in the Persian Gulf during Operation Desert Shield/Desert Storm. The evaluation included a structured clinical assessment, a physician-administered symptom checklist, and a patient questionnaire addressing self-reported exposures, combat experiences, and work loss. Among 18,495 patients examined, the most common symptoms were joint pain, fatigue, headache, memory or concentration difficulties, sleep disturbances, and rash. Symptom onset was often delayed, with two-thirds of symptoms not developing until after individuals returned from the Gulf War and 40% of symptoms having a latency period exceeding one year. There was no association between individual symptoms and patient demographics, specific self-reported exposures, or types of combat experience. Increased symptom counts were associated with work loss, the number of self-reported exposures, the number of types of combat experience, and certain ICD-9 diagnostic categories, particularly psychological disorders. Prolonged latency of symptom onset and the lack of association with any self-reported exposures makes illness related to toxic exposure less likely.
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PMID:Symptoms in 18,495 Persian Gulf War veterans. Latency of onset and lack of association with self-reported exposures. 1057 Apr 96

Work-related stress and burnout has been observed in primary school teachers in many countries. Functional deficits have been related to certain psychosomatic diagnoses and the work environment. We have compared 100 teachers with a matched group of non-teachers according to diagnostic differences, all attending a 4 week resident stay at a vocational rehabilitation centre in 1993-5. Seventy-five percent were women. The use of ICD-9 diagnoses and a five-dimensional functional diagnostic tool were compared. The five dimensions were defined along the following axes: work environment, family relations, health, personal economy and leisure time activity. There were no significant differences between ICD-9 diagnostic groups between teachers and non-teachers. Indefinite diagnostic entities (fatigue, chronic myalgia, fibromyalgia, etc.) were used in more than half of residents in both groups. Definite musculo-skeletal disorders were the second most prominent diagnosis. On the five-dimensional functional diagnostic tool teachers scored significantly worse than non-teachers on the family relations axis, and on a sum score of all axes. The difference was mainly present in women. The study suggests that work-related stress and signs of burnout in teachers may be higher than in other employees, but the factors contributing to this may be found outside the work environment.
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PMID:Functional diagnosis as a tool in rehabilitation: a comparison of teachers and other employees. 981 56

Alberta was the first province in Canada to mandate reporting of hospital-based emergency services. This reporting is based on a workload measurement system that groups emergency visits into five discreet workload levels/classes driven by ICD-9-CM diagnoses. Other related workload measurement variables are incorporated, including admissions, transfers, maintenance monitoring, nursing and non-nursing patient support activities, trips, staff replacement, and personal fatigue and delay. The methodology used to design the reporting system has been subjected to extensive testing, auditing and refinement. The results of one year of province-wide data collection yielded approximately 1.5 million emergency visits. These data reveal consistent patterns/trends of workload that vary by hospital size and type. Although this information can assist in utilization management efforts to predict and compare workload and staffing levels, the impetus for establishing this system derived from its potential for funding hospital-based emergency services. This would be the first time that such services would be funded on a systemic, system-wide basis whereby hospitals would be reimbursed in relation to workload. This proposed funding system would distribute available funding in a consistent, fair and equitable manner across all hospitals providing a similar set of services, thus achieving one of the key goals of the Alberta Acute Care Funding Plan. Ultimately, this proposed funding methodology would be integrated into a broader Ambulatory Care Funding system currently being developed in Alberta.
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PMID:Development, testing and implementation of an emergency services methodology in Alberta. 1014 20


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