Category: Management

Chronic fatigue report delayed as row breaks out over content

The government’s long awaited report on the treatment of chronic fatigue syndrome could be in jeopardy after four key members resigned from the working group.

The move throws doubt on the validity of the report, which was due to be published in the first week of January. As the BMJ went to press, the chief medical officer, Liam Donaldson, had postponed its launch on 4 January 2002.

A total of 10 people from the original working group have resigned for various reasons since it was set up in 1998. The most recent resignations were highlighted in a written question by the Countess of Mar to health minister Lord Hunt on 17 December.

Two psychiatrists, a public health doctor, and a nurse therapist have resigned, saying that the report plays down the psychological and social aspects of the condition and concentrates on a medical model. Two patients are understood to have also resigned recently.

The group was set up to consider how best the NHS could care for people with the syndrome, also known as myalgic encephalomyelitis or “ME.”

But with so little still known about what causes the syndrome, how to diagnose it, and how best to treat it, it is understood that the report fails to provide the straightforward answers doctors may have hoped for.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121974/

 

Source: Eaton L. Chronic fatigue report delayed as row breaks out over content. BMJ. 2002 Jan 5;324(7328):7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121974/ (Full article)

 

Interventions for the treatment and management of chronic fatigue syndrome: a systematic review

Erratum in: JAMA 2002 Mar 20;287(11):1401.

Abstract:

CONTEXT: A variety of interventions have been used in the treatment and management of chronic fatigue syndrome (CFS). Currently, debate exists among health care professionals and patients about appropriate strategies for management.

OBJECTIVE: To assess the effectiveness of all interventions that have been evaluated for use in the treatment or management of CFS in adults or children.

DATA SOURCES: Nineteen specialist databases were searched from inception to either January or July 2000 for published or unpublished studies in any language. The search was updated through October 2000 using PubMed. Other sources included scanning citations, Internet searching, contacting experts, and online requests for articles.

STUDY SELECTION: Controlled trials (randomized or nonrandomized) that evaluated interventions in patients diagnosed as having CFS according to any criteria were included. Study inclusion was assessed independently by 2 reviewers. Of 350 studies initially identified, 44 met inclusion criteria, including 36 randomized controlled trials and 8 controlled trials.

DATA EXTRACTION: Data extraction was conducted by 1 reviewer and checked by a second. Validity assessment was carried out by 2 reviewers with disagreements resolved by consensus. A qualitative synthesis was carried out and studies were grouped according to type of intervention and outcomes assessed.

DATA SYNTHESIS: The number of participants included in each trial ranged from 12 to 326, with a total of 2801 participants included in the 44 trials combined. Across the studies, 38 different outcomes were evaluated using about 130 different scales or types of measurement. Studies were grouped into 6 different categories. In the behavioral category, graded exercise therapy and cognitive behavioral therapy showed positive results and also scored highly on the validity assessment. In the immunological category, both immunoglobulin and hydrocortisone showed some limited effects but, overall, the evidence was inconclusive. There was insufficient evidence about effectiveness in the other 4 categories (pharmacological, supplements, complementary/alternative, and other interventions).

CONCLUSIONS: Overall, the interventions demonstrated mixed results in terms of effectiveness. All conclusions about effectiveness should be considered together with the methodological inadequacies of the studies. Interventions which have shown promising results include cognitive behavioral therapy and graded exercise therapy. Further research into these and other treatments is required using standardized outcome measures.

Comment in:

Measuring the quality of trials of treatments for chronic fatigue syndrome. [JAMA. 2001]

Chronic fatigue syndrome–trials and tribulations. [JAMA. 2001]

Review: behavioural interventions show the most promise for chronic fatigue syndrome. [Evid Based Nurs. 2002]

Review: behavioral interventions show the most promise for the chronic fatigue syndrome. [ACP J Club. 2002]

Review: cognitive behavioural therapy and graded exercise show the most promise for chronic fatigue syndrome. [Evid Based Ment Health. 2002]

 

Source: Whiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD, Ramírez G. Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. JAMA. 2001 Sep 19;286(11):1360-8. http://www.ncbi.nlm.nih.gov/pubmed/11560542

 

Approaches to coping with chronic fatigue syndrome (CFS)

Abstract:

The 1994 approach to the definition of Chronic Fatigue Syndrome (CFS) describes a severe disorder with unknown etiology and pathophysiology. It results in substantial reduction in previous levels of occupational, educational, social, or personal activities. Most patients cannot continue their usual lifestyle. No causal treatments or other therapies suitable for all patients exist so far.

Therefore it was intended to identify approaches to an effective disease management by the long time escort and observation of a CFS support group. CFS should be diagnosed according to the actual CDC guidelines. Conditions with similar symptoms explaining chronic fatigue have to be ruled out first. Then an individually shaped disease management comprising of different components plays a central role in the coping process. Medical long time care performed by a general practitioner and the membership in a suitable support group are integrated within this approach.

 

Source: Stark FM, Sobetzko HM. Approaches to coping with chronic fatigue syndrome (CFS). Zentralbl Hyg Umweltmed. 1999 Aug;202(2-4):179-90. http://www.ncbi.nlm.nih.gov/pubmed/10507127

 

Managing chronic fatigue syndrome: overview and case study

Abstract:

1. The basic principles of envelope theory are explained. By not overexerting themselves, people with CFS can avoid the setbacks and relapses that commonly occur in response to overexertion while increasing their tolerance to activity. 2. By collecting time series data on fluctuations in energy levels, important clinical observations can be made in respect to a client’s unique condition and experience with CFS.

 

Source: Jason LA, Melrose H, Lerman A, Burroughs V, Lewis K, King CP, Frankenberry EL. AAOHN J. 1999 Jan;47(1):17-21. http://www.ncbi.nlm.nih.gov/pubmed/10205371

 

How I manage chronic fatigue syndrome

About 12 years ago, I was asked to do a domicillary visit to see a 10 year old girl who in the spring had taken her secondary school entrance examination; caught a heavy cold with a persistent sore throat, which was taking a long time to clear; had a perpetual headache; dizziness on standing; extreme tiredness, which became worse if she tried to do anything; paraesthesia of the hands and feet intermittently; and disturbed sleep. Her general practitioner suggested postural hypotension, but I could find little abnormal except for some unsteadiness when she tried to walk. Routine haematological and biochemical tests were normal, as was computed tomography of her head. The physiotherapist that I referred her to reported that their attempts to mobilise her were actually making her worse, and wondered if she had a neuromuscular disease.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717724/pdf/v079p00375.pdf

 

Source: Franklin A. How I manage chronic fatigue syndrome. Arch Dis Child. 1998 Oct;79(4):375-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717724/pdf/v079p00375.pdf (Full article)

 

What we know about chronic fatigue syndrome and its relevance to the practicing physician

Abstract:

A number of recent reports have emphasized laboratory abnormalities, clinical tests, and therapeutic approaches that appear to have great promise in the evaluation and management of chronic fatigue syndrome (CFS). Because of the heterogeneity of CFS, the cost of many of these assays and procedures, and the frequent lack of skilled consultants able to apply relevant sophisticated procedures, the solo healthcare provider is often left with uncertain options in patient management. This article summarizes current approaches to patient management, utilizing available information relevant to CFS.

 

Source: Levine PH. What we know about chronic fatigue syndrome and its relevance to the practicing physician. Am J Med. 1998 Sep 28;105(3A):100S-103S. http://www.ncbi.nlm.nih.gov/pubmed/9790490.

 

Chronic fatigue syndrome and fibromyalgia. Dilemmas in diagnosis and clinical management

Abstract:

There has been a resurgence of interest in recent years in both chronic fatigue syndrome and fibromyalgia. These perplexing and common clinical conditions are a source of significant patient morbidity and frame one of the more enduring dilemmas of contemporary Western medical thought, namely the ambiguous interface between mind and body. In this article, the current definitions are reviewed, and a framework for an emerging psychobiological model of these syndromes is presented. These issues are synthesized into a pragmatic approach to clinical management.

 

Source: Demitrack MA. Chronic fatigue syndrome and fibromyalgia. Dilemmas in diagnosis and clinical management. Psychiatr Clin North Am. 1998 Sep;21(3):671-92, viii. http://www.ncbi.nlm.nih.gov/pubmed/9774804

 

Indications for management in long-term, physically unexplained fatigue symptoms

Abstract:

In meetings arranged by the minister of Public Health, Welfare and Sports between general practitioners and specialists concerning chronic fatigue syndrome (CFS), suggestions for the diagnosis, treatment and assistance and support of patients with protracted physically unexplained fatiguesymptoms, were established in the light of current scientific insight.

The term ‘CFS’ is applicable in cases of fatigue complaints, of at least 6 months’ standing, reported by the patient himself and evaluated medically, for which no physical explanation has been found and which cause considerable disabilities in professional social and/or personal functioning.

The management depends on the duration of the illness. A distinction is made between an acute phase (up to one month after the first consultation; the policy is mostly expectative), a subacute phase (until 6 months after the onset of the complaints and disabilities; the management is aimed at making the patient accept the condition and persuading him or her to make an effort to promote health) and a chronic phase (from 6 months after the onset of the complaints and disabilities; the management is aimed at health-promoting behaviour and cognitions). Further (laboratory) examinations are useful only if the symptoms have not disappeared after one month (this is the case in approximately 20% of the patients); such examinations may be useful in older patients earlier.

It is important that the CFS patient learns to realize that it is useless to continue to spend energy on searching for causes and possible therapies, but that he should try to promote his own health, for instance by means of a quantified programme of activities linked to a time schedule (instead of to a level of fatigue).

Comment in:

Chronic fatigue syndrome. Ned Tijdschr Geneeskd. 1997

Chronic fatigue syndrome. Ned Tijdschr Geneeskd. 1997

 

Source: van der Meer JW, Rijken PM, Bleijenberg G, Thomas S, Hinloopen RJ, Bensing JM. Indications for management in long-term, physically unexplained fatigue symptoms.Ned Tijdschr Geneeskd. 1997 Aug 2;141(31):1516-9. [Article in Dutch] http://www.ncbi.nlm.nih.gov/pubmed/9543738

Managing patients suffering from acute and chronic fatigue

Abstract:

The subjective experience of fatigue is common and debilitating, and affects many individuals in various healthcare settings. The condition requires adequate assessment, innovative planning and interventions, and patient-centred evaluations by the nursing profession. Fatigue, whether acute or chronic, needs to be recognized as a true and valid condition in order for treatment to be successful. There are many considerations to be taken into account when working with the fatigued, and this article suggests how the areas needing most attention may be tackled. Chronic fatigue and acute fatigue can be quite different conditions, requiring different approaches, of which nurses need to be aware. In order to reduce the effects of fatigue on the client, nurses need to fully understand the factors surrounding the phenomenon of fatigue to provide expert care, to help educate the patient, and improve the quality of life.

 

Source: Cook NF, Boore JR. Managing patients suffering from acute and chronic fatigue. Br J Nurs. 1997 Jul 24-Aug 13;6(14):811-5. http://www.ncbi.nlm.nih.gov/pubmed/9283306

 

Chronic fatigue syndrome: an update for clinicians in primary care

Abstract:

Cases of long-standing (6 months or longer) fatigue that are not explained by an existing medical or psychiatric diagnosis are referred to as chronic fatigue syndrome (CFS). CFS is a condition of unknown etiology that presents with a complex array of symptoms in patients with diverse health histories. A diagnosis of CFS is largely dependent upon ruling out other organic and psychologic causes of fatigue. CFS can present the clinician with a unique set of challenges in terms of diagnosis and treatment. A review of recent research suggests that the management of CFS requires an individualized approach for each patient. An historic overview of the condition is presented along with current theories of causation, diagnosis considerations, symptom management, and health promotion strategies.

 

Source: Houde SC, Kampfe-Leacher R. Chronic fatigue syndrome: an update for clinicians in primary care. Nurse Pract. 1997 Jul;22(7):30, 35-6, 39-40 passim. http://www.ncbi.nlm.nih.gov/pubmed/9253014