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

Chest compressions have saved the lives of countless patients in cardiac arrest as they generate a small but critical amount of blood flow to the heart and brain. This is achieved by direct cardiac massage as well as a thoracic pump mechanism. In order to optimize blood flow excellent chest compression technique is critical. Thus, the quality of the delivered chest compressions is a pivotal determinant of successful resuscitation. If a patient is found unresponsive without a definite pulse or normal breathing then the responder should assume that this patient is in cardiac arrest, activate the emergency response system and immediately start chest compressions. Contra-indications to starting chest compressions include a valid Do Not Attempt Resuscitation Order. Optimal technique for adult chest compressions includes positioning the patient supine, and pushing hard and fast over the center of the chest with the outstretched arms perpendicular to the patient's chest. The rate should be at least 100 compressions per minute and any interruptions should be minimized to achieve a minimum of 60 actually delivered compressions per minute. Aggressive rotation of compressors prevents decline of chest compression quality due to fatigue. Chest compressions are terminated following return of spontaneous circulation. Unconscious patients with normal breathing are placed in the recovery position. If there is no return of spontaneous circulation, then the decision to terminate chest compressions is based on the clinical judgment that the patient's cardiac arrest is unresponsive to treatment. Finally, it is important that family and patients' loved ones who witness chest compressions be treated with consideration and sensitivity.
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PMID:Technique for chest compressions in adult CPR. 2215 1

Mitochondria are dynamic subcellular organelles that convert nutrient intermediates into readily available energy equivalents. Optimal mitochondrial function is ensured by a highly evolved quality control system, coordinated by protein machinery that regulates a process of continual fusion and fission. In this work, we provide in vivo evidence that the ATP-independent metalloprotease OMA1 plays an essential role in the proteolytic inactivation of the dynamin-related GTPase OPA1 (optic atrophy 1). We also show that OMA1 deficiency causes a profound perturbation of the mitochondrial fusion-fission equilibrium that has important implications for metabolic homeostasis. Thus, ablation of OMA1 in mice results in marked transcriptional changes in genes of lipid and glucose metabolic pathways and substantial alterations in circulating blood parameters. Additionally, Oma1-mutant mice exhibit an increase in body weight due to increased adipose mass, hepatic steatosis, decreased energy expenditure and impaired thermogenenesis. These alterations are especially significant under metabolic stress conditions, indicating that an intact OMA1-OPA1 system is essential for developing the appropriate adaptive response to different metabolic stressors such as a high-fat diet or cold-shock. This study provides the first description of an unexpected role in energy metabolism for the metalloprotease OMA1 and reinforces the importance of mitochondrial quality control for normal metabolic function.
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PMID:Loss of mitochondrial protease OMA1 alters processing of the GTPase OPA1 and causes obesity and defective thermogenesis in mice. 2243 42

The development of localized muscle fatigue has classically been described by the nonlinear intensity-endurance time (ET) curve (Rohmert, 1960; El Ahrache et al., 2006). These empirical intensity-ET relationships have been well-documented and vary between joint regions. We previously proposed a three-compartment biophysical fatigue model, consisting of compartments (i.e. states) for active (M(A)), fatigued (M(F)), and resting (M(R)) muscles, to predict the decay and recovery of muscle force (Xia and Frey Law, 2008). The purpose of this investigation was to determine optimal model parameter values, fatigue (F) and recovery (R), which define the "flow rate" between muscle states and to evaluate the model's accuracy for estimating expected intensity-ET curves. Using a grid-search approach with modified Monte Carlo simulations, over 1 million F and R permutations were used to predict the maximum ET for sustained isometric tasks at 9 intensities ranging from 10% to 90% of maximum in 10% increments (over 9 million simulations total). Optimal F and R values ranged from 0.00589 (F(ankle)) and 0.0182 (R(ankle)) to 0.00058 (F(shoulder)) and 0.00168 (R(shoulder)), reproducing the intensity-ET curves with low mean RMS errors: shoulder (2.7s), hand/grip (5.6s), knee (6.7s), trunk (9.3s), elbow (9.9s), and ankle (11.2s). Testing the model at different task intensities (15-95% maximum in 10% increments) produced slightly higher errors, but largely within the 95% prediction intervals expected for the intensity-ET curves. We conclude that this three-compartment fatigue model can be used to accurately represent joint-specific intensity-ET curves, which may be useful for ergonomic analyses and/or digital human modeling applications.
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PMID:A three-compartment muscle fatigue model accurately predicts joint-specific maximum endurance times for sustained isometric tasks. 2257 69

Computer-triggered reminders alerting physicians on every potentially harmful drug-drug-interaction (DDI) induce alert fatigue due to frequent messages of limited clinical relevance. On demand DDI-checks, however, are not commonly used by physicians. Optimal strategies for sustained quality assurance have to consider patients' risk factors and focus on the most significant DDIs only. An approach is proposed based on the analysis of concurrent prescription of potassium-sparing diuretics and potassium supplements (CPPP), which are the most frequent DDIs classified as contraindicated. Although the frequency of monitoring potassium serum levels declined during prolonged periods of CPPP, the likelihood of observing a hyperkalaemia increased. The median treatment period of CPPP was 3.3 days, whereas hyperkalaemia occurred after a median observation time of 4.5 days of CPPP. Thus, computer-triggered reminders for ordering potassium serum levels may be indicated if monitoring has been discontinued after 48h of CPPP.
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PMID:Clinical decision support for monitoring drug-drug-interactions and potassium-increasing drug combinations: need for specific alerts. 2287

Optimal oncologic care of older men with prostate cancer, including effective prevention and management of the disease and treatment side effects (so-called best supportive care measures) can prolong survival, improve quality of life, and reduce depressive symptoms. In addition, the proportion of treatment discontinuations can be reduced through early reporting and management of side effects. Pharmacologic care may be offered to manage the side effects of androgen-deprivation therapy and chemotherapy, which may include hot flashes, febrile neutropenia, fatigue, and diarrhea. Nonpharmacologic care (e.g., physical exercise, acupuncture, relaxation) has also been shown to benefit patients. At the Georges Pompidou European Hospital, the Program of Optimization of Chemotherapy Administration has demonstrated that improved outpatient follow-up by supportive care measures can reduce the occurrence of chemotherapy-related side effects, reduce cancellations and modifications of treatment, reduce chemotherapy wastage, and reduce the length of stay in the outpatient unit. The importance of supportive care measures to optimize management and outcomes of older men with advanced prostate cancer should not be overlooked.
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PMID:The importance of supportive care in optimizing treatment outcomes of patients with advanced prostate cancer. 2301 82

Heart failure and coronary artery disease share many risk factors. Coronary artery disease often pre-dates the development of heart failure with reduced ejection fraction. A diagnosis of heart failure should be considered in any patient with a history of coronary artery disease who presents with breathlessness, ankle oedema or fatigue. Several therapies, such as renin-angiotensin antagonists and B blockers, have been proven to improve survival in patients with heart failure with reduced ejection fraction but evidence for effectiveness in heart failure with preserved ejection fraction is lacking. The management of heart failure and coronary artery disease overlaps considerably but can also be conflicting. Optimal risk factor management is key to preventing progression to heart failure in patients with coronary artery disease.
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PMID:Heart failure therapy in patients with coronary artery disease. 2354 May 85

Optimal therapeutic decision-making requires integration of patient-specific and therapy-specific information at the point of care, particularly when treating patients with complex cardiovascular conditions. The formidable task for the prescriber is to synthesize information about all therapeutic options and match the best treatment with the characteristics of the individual patient. Computerized decision support systems have been developed with the goal of integrating such information and presenting the acceptable therapeutic options on the basis of their effectiveness, often with limited consideration of their safety for a specific patient. Assessing the safety of therapies relative to each patient is difficult, and sometimes impossible, because the evidence required to make such an assessment is either imperfect or does not exist. In addition, many of the alerts sent to prescribers by decision-support systems are not perceived as credible, and 'alert fatigue' causes warnings to be ignored putting patients at risk of harm. The CredibleMeds.org and BrugadaDrugs.org websites are prototypes for evidence-based sources of safety information that rank drugs for their risk of a specific form of drug toxicity-in these cases, drug-induced arrhythmias. Broad incorporation of this type of information in electronic prescribing algorithms and clinical decision support could speed the evolution of safe personalized medicine.
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PMID:Assessing cardiovascular drug safety for clinical decision-making. 2359 Dec 68

Sleep disorders are common in patients with Parkinson's disease (PD), and preliminary work has suggested viable treatment options for many of these disorders. For rapid eye movement sleep behavior disorder, melatonin and clonazepam are most commonly used, while rivastigmine might be a useful option in patients whose behaviors are refractory to the former. Optimal treatments for insomnia in PD have yet to be determined, but preliminary evidence suggests that cognitive-behavioral therapy, light therapy, eszopiclone, donepezil, and melatonin might be beneficial. Use of the wake-promoting agent modafinil results in significant improvement in subjective measures of excessive daytime sleepiness, but not of fatigue. Optimal treatment of restless legs syndrome and obstructive sleep apnea in PD are not yet established, although a trial of continuous positive airway pressure for sleep apnea was recently completed in PD patients. In those patients with early morning motor dysfunction and disrupted sleep, the rotigotine patch provides significant benefit.
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PMID:Treatment of the sleep disorders associated with Parkinson's disease. 2427 58

Psychological states experienced by athletes prior to injured, best and worst performances were investigated retrospectively using a mixed methodology. Fifty-nine athletes volunteered to complete an individualized assessment of performance states based on the Individual Zones of Optimal fFunctioning (IZOF) model. A subsection (n = 30) of participants completed a standardized psychometric scale (Brunel Mood Rating Scale: BRUMS), retrospectively describing how they felt before best, worst, and injured performances. IZOF results showed similar emotion states being identified for injured and best performances. Analysis of BRUMS scores indicated a significant main effect for differences in mood by performance outcome, with post-hoc analyses showing best performance was associated with lower scores on depression and fatigue and higher vigor than injured performance and worst performance. Worst performance was associated with higher fatigue and confusion than injured performance. Results indicate that retrospective emotional profiles before injured performance are closer to successful performance, than unsuccessful, and confirm differences between successful and unsuccessful performance. Qualitative and quantitative approaches used to retrospectively assess pre-performance emotional states before three performance outcomes, produced complimentary findings. Practical implications of the study are discussed. Key PointsPsychological states experienced by athletes prior to injured, best and worst performances were investigated retrospectively using a mixed methodology.Results indicate that retrospective emotional profiles before injured performance are closer to successful performance, than unsuccessful, and confirm differences between successful and unsuccessful performance, a finding that occurred using both methods.Future research should further examine the emotional antecedents of injury and that applied sport psychologists recognize the potential risk of injury associated with emotional profiles typically linked with best performance.
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PMID:Emotional States of athletes prior to performance-induced injury. 2450 52

This study aimed to evaluate the effects of low-level laser therapy (LLLT) immediately before tetanic contractions in skeletal muscle fatigue development and possible tissue damage. Male Wistar rats were divided into two control groups and nine active LLLT groups receiving one of three different laser doses (1, 3, and 10 J) with three different wavelengths (660, 830, and 905 nm) before six tetanic contractions induced by electrical stimulation. Skeletal muscle fatigue development was defined by the percentage (%) of the initial force of each contraction and time until 50 % decay of initial force, while total work was calculated for all six contractions combined. Blood and muscle samples were taken immediately after the sixth contraction. Several LLLT doses showed some positive effects on peak force and time to decay for one or more contractions, but in terms of total work, only 3 J/660 nm and 1 J/905 nm wavelengths prevented significantly (p < 0.05) the development of skeletal muscle fatigue. All doses with wavelengths of 905 nm but only the dose of 1 J with 660 nm wavelength decreased creatine kinase (CK) activity (p < 0.05). Qualitative assessment of morphology revealed lesser tissue damage in most LLLT-treated groups, with doses of 1-3 J/660 nm and 1, 3, and 10 J/905 nm providing the best results. Optimal doses of LLLT significantly delayed the development skeletal muscle performance and protected skeletal muscle tissue against damage. Our findings also demonstrate that optimal doses are partly wavelength specific and, consequently, must be differentiated to obtain optimal effects on development of skeletal muscle fatigue and tissue preservation. Our findings also lead us to think that the combined use of wavelengths at the same time can represent a therapeutic advantage in clinical settings.
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PMID:Effects of pre-irradiation of low-level laser therapy with different doses and wavelengths in skeletal muscle performance, fatigue, and skeletal muscle damage induced by tetanic contractions in rats. 2465 50


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