Overcoming Fatigue
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Anorexia/Cachexia Heart Failure Symptom Management Guideline for Adults, Age 19 and Older in British Columbia
Anorexia/Cachexia Heart Failure Symptom Management Guideline For adults, age 19 and older in British Columbia What is anorexia? Anorexia is a syndrome characterized by some or all of the following symptoms: loss of appetite, nausea, early satiety, weakness, fatigue, food aversion, and significant physical and/or psychological symptoms. Causes of anorexia are multifactorial and include fatigue, dyspnea, medication side-effects, nausea, depression, anxiety and sodium restricted diets, which may all be found in patients with heart failure. What is cachexia? Cachexia is a syndrome characterized by severe body weight, fat and muscle loss and increased protein catabolism due to underlying disease. The prevalence of cachexia is 16–42% in the heart failure population and is associated with a 50%, 18 month mortality risk independent of variables such as ejection fraction, age and functional ability. How is cachexia diagnosed? Chronic condition with >5% weight loss in <12 months; or body mass index (BMI) <20kg/m2; and 3 out of 5 additional criteria: 1) Fatigue, 2) Decreased muscle strength, 3) Anorexia, 4) Low muscle mass, 5) Abnormal biochemistry *Blood testing to diagnose cachexia in advanced stages of disease is not advocated. Reminder: Malnutrition also affects prognosis in patients with heart failure and is often found in early transitions of the disease. However this symptom management guideline will focus on the assessment and treatment of anorexia and cachexia. Approach to Managing Anorexia/Cachexia Assessment History: When did weight loss begin? How much weight was lost? Obtain baseline (dry) weight. How is [the patients] appetite? What do they eat or drink on a typical day? How has weight loss affected mood? Ask about: nausea, early satiety, dyspnea, poor oral hygiene, dysphagia, malabsorption, bowel habits. -
Cancer Cachexia and Fatigue
CME Palliative care Cancer cachexia and mechanisms (Fig 1). The cachectic Other cachectic factors patient is analogous to an accelerating Cachexia can occur in the absence of car running out of petrol. The anorexia anorexia, suggesting that catabolic fatigue component of cancer cachexia reduces mediators produced by tumour or host fuel supply (by ca 300–500 kcal/day) cells are involved in the cancer cachexia whilst accelerated metabolic cycling Grant D Stewart BSc(Hons) MBChB MRCS(Ed), process.9 Experimental cachexia models drives hypermetabolism (by ca Surgical Research Fellow suggest pro-inflammatory cytokines, 100–200 kcal/day). There are also the Richard JE Skipworth BSc(Hons) MBChB such as tumour necrosis factor- , inter- direct catabolic effects of muscle proteol- α MRCS(Ed), Surgical Research Fellow leukin (IL)-6, IL-1 and interferon- , can ysis and lipolysis. These changes underlie γ Kenneth CH Fearon MBChB(Hons) MD all play a role. Activation of the neuro- a key paradox of cachexia: whilst meta- FRCS(Glas) FRCS(Ed) FRCS(Eng), Professor of endocrine stress response is also thought bolic rate may be increased, overall (or Surgical Oncology to be important. Potential mediators total) energy expenditure is decreased Department of Clinical and Surgical Sciences include increased adrenergic activity, ele- due to a fall in physical activity.7 (Surgery), University of Edinburgh, Royal vated cortisol, low insulin and increased Infirmary, Edinburgh activity of the renin-angiotensin system.1 Anorexia With regard to tumour-specific Clin Med 2006;6:140–3 The anorexia component of cancer cachectic factors, proteolysis-inducing cachexia has both a neurohumoral mech- factor (PIF) is produced by tumours and anism due to disturbance of the central excreted in the urine of patients with Background physiological mechanisms controlling cancer cachexia. -
Workforce Prevention and Influenza Illness Policy Guidelines
Workforce Prevention and Influenza Illness Policy Guidelines This document provides guidance to (Company) _________________ supervisors and employees on how to handle influenza-like illness in the (Company) _________________ workplace. OVERVIEW Influenza is a respiratory disease caused by the influenza virus. Influenza is spread primarily person-to-person through coughing, sneezing, or nasal secretions from infected people, or when someone touches something with flu viruses on it before touching their mouths or noses. Infected people can spread the virus to others even before symptoms develop, and can be contagious for several days after becoming sick. Employees experiencing flu-like symptoms such as fever and chills with cough, sore throat, head and muscle ache, nasal congestion and fatigue should not come to work or should leave work to go home. Employees should stay home and avoid contact with other people until they have no symptoms for 24 hours without medication. Employees can plan to return to work 24 hours after fever subsides, without use of fever lowering medications. Supervisors are responsible for ensuring their staff members to stay away from work when experiencing influenza-like illness. Employees have a duty to practice healthy hygiene habits to prevent the spread of disease, and an expectation of working in an environment free of influenza-like illness. Those with severe symptoms, such as difficulty breathing, or at higher risk for complication from influenza should call their health care provider. If you are an employee who is experiencing flu-like symptoms: • Inform your supervisor that you are experiencing flu-like symptoms and leave the workplace as soon as possible. -
Hyperhidrosis: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins
Toxins 2013, 5, 821-840; doi:10.3390/toxins5040821 OPEN ACCESS toxins ISSN 2072-6651 www.mdpi.com/journal/toxins Review Hyperhidrosis: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins Amanda-Amrita D. Lakraj 1, Narges Moghimi 2 and Bahman Jabbari 1,* 1 Department of Neurology, Yale University School of Medicine; New Haven, CT 06520, USA; E-Mail: [email protected] 2 Department of Neurology, Case Western Reserve University; Cleveland, OH 44106, USA; E-Mail: [email protected] * Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel.: +1-203-737-2464; Fax: +1-203-737-1122. Received: 12 February 2013; in revised form: 27 March 2013 / Accepted: 12 April 2013 / Published: 23 April 2013 Abstract: Clinical features, anatomy and physiology of hyperhidrosis are presented with a review of the world literature on treatment. Level of drug efficacy is defined according to the guidelines of the American Academy of Neurology. Topical agents (glycopyrrolate and methylsulfate) are evidence level B (probably effective). Oral agents (oxybutynin and methantheline bromide) are also level B. In a total of 831 patients, 1 class I and 2 class II blinded studies showed level B efficacy of OnabotulinumtoxinA (A/Ona), while 1 class I and 1 class II study also demonstrated level B efficacy of AbobotulinumtoxinA (A/Abo) in axillary hyperhidrosis (AH), collectively depicting Level A evidence (established) for botulinumtoxinA (BoNT-A). In a comparator study, A/Ona and A/Inco toxins demonstrated comparable efficacy in AH. For IncobotulinumtoxinA (A/Inco) no placebo controlled studies exist; thus, efficacy is Level C (possibly effective) based solely on the aforementioned class II comparator study. -
Association of Central Hypersomnia and Fatigue in Patients with Multiple Sclerosis: a Polysomnographic Study
Published Ahead of Print on April 30, 2021 as 10.1212/WNL.0000000000012120 Neurology Publish Ahead of Print DOI: 10.1212/WNL.0000000000012120 Association of Central Hypersomnia and Fatigue in Patients With Multiple Sclerosis: A Polysomnographic Study Author(s): 1,2 3 4 Anne-Laure Dubessy, MD, PhD ; Sophie Tezenas du Montcel, MD, PhD ; Frederique Viala, MD ; 5 6 5 Rana ASSOUAD, MD ; Michel Tiberge, MD ; caroline papeix, MD, PhD ; catherine Lubetzki, MD, 5,7 4 2,7 1,7 PhD ; Michel Clanet, MD, PhD ; Isabelle Arnulf, MD, PhD ; Bruno Stankoff, MD, PhD Equal Author Contributions: Isabelle Arnulf and Bruno Stankoff contributed equally to this work Corresponding Author: Anne-Laure Dubessy [email protected] Affiliation Information for All Authors: 1. Neurology Department, Saint Antoine Hospital, AP-HP, Paris; 2. Sleep Disorders Unit and National Reference Center for Narcolepsy and Hypersomnia Pitié- Salpêtrière University Hospital, APHP, Paris; 3.Department of Biostatistics, Pitié-Salpêtrière University Hospital, APHP; 4. Neurology Department, Purpan Hospital, Toulouse, France; 5. Neurology Department, Pitié-Salpêtrière University Hospital, APHP, Paris; 6. Neurophysiology Department, Purpan Hospital, Toulouse; 7. Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris Neurology® Published Ahead of Print articles have been peer reviewed and accepted for publication. This manuscript will be published in its final form after copyediting, page composition, -
Glossary of Terms Related to Patient and Medication Safety
Committee of Experts on Management of Safety and Quality in Health Care (SP-SQS) Expert Group on Safe Medication Practices Glossary of terms related to patient and medication safety Terms Definitions Comments A R P B and translations and references and synonyms accident accident : an unplanned, unexpected, and undesired event, usually with adverse “For many years safety officials and public health authorities have Xconsequences (Senders, 1994). discouraged use of the word "accident" when it refers to injuries or the French : accident events that produce them. An accident is often understood to be Spanish : accidente unpredictable -a chance occurrence or an "act of God"- and therefore German : Unfall unavoidable. However, most injuries and their precipitating events are Italiano : incidente predictable and preventable. That is why the BMJ has decided to ban the Slovene : nesreča word accident. (…) Purging a common term from our lexicon will not be easy. "Accident" remains entrenched in lay and medical discourse and will no doubt continue to appear in manuscripts submitted to the BMJ. We are asking our editors to be vigilant in detecting and rejecting inappropriate use of the "A" word, and we trust that our readers will keep us on our toes by alerting us to instances when "accidents" slip through.” (Davis & Pless, 2001) active error X X active error : an error associated with the performance of the ‘front-line’ operator of Synonym : sharp-end error French : erreur active a complex system and whose effects are felt almost immediately. (Reason, 1990, This definition has been slightly modified by the Institute of Medicine : “an p.173) error that occurs at the level of the frontline operator and whose effects are Spanish : error activo felt almost immediately.” (Kohn, 2000) German : aktiver Fehler Italiano : errore attivo Slovene : neposredna napaka see also : error active failure active failures : actions or processes during the provision of direct patient care that Since failure is a term not defined in the glossary, its use is not X recommended. -
“Take 3” Actions to Fight The
Flu is a serious Flu-like symptoms include: contagious disease ■ fever that can lead to ■ cough hospitalization. ■ sore throat ■ runny or stuffy nose ■ body aches ■ headache CDC Says ■ chills ■ fatigue “ Take 3” Some people also may have vomiting and diarrhea. People Actions may be infected with the flu, To Fight The Flu and have respiratory symptoms without a fever. For more information, visit Department of Health and www.cdc.gov/flu Human Services or call 800-CDC-INFO. Centers for Disease Control and Prevention September 2014 CS251488-A CDC urges you to take the following actions to protect yourself and others from influenza (the flu): # Take time # Take everyday preventive # Take flu antiviral 1 to get 2 actions to stop the 3 drugs if your doctor a flu vaccine. spread of germs. prescribes them. ■ CDC recommends a yearly flu vaccine as the first and ■ Try to avoid close contact with sick people. ■ If you get the flu, antiviral drugs can treat most important step in protecting against flu viruses. your illness. ■ If you are sick with flu-like illness, CDC recommends ■ While there are many different flu viruses, the flu that you stay home for at least 24 hours after ■Antiviral drugs are different from antibiotics. vaccine protects against the viruses that research your fever is gone except to get medical care or They are prescription medicines (pills, liquid suggests will be most common. for other necessities. Your fever should be gone or an inhaled powder) and are not available without the use of a fever-reducing medicine. over-the-counter. -
Healthy Sleep Habits for Older Children and Teens
Healthy Sleep Habits for Older Children and Teens Sleep is important at all ages. Sleep problems are common among many children and teens and can affect their focus while at school, work, or home. Not enough sleep (sleep deprivation) can also affect their mood, behavior, emotional health, and weight. Almost one-fourth of all children have some type of sleep problem. Poor sleep habits are often to blame. But sometimes the cause is a medical condition. The American Academy of Sleep Medicine and the American Academy of Pediatrics recommend that children get the following amount of sleep every day: Gradeschoolers 6 to 12 years get 9 to 12 hours Teens aged 13 to 18 get 8 to 10 hours. As a child gets older and reaches puberty, sleep patterns may change. Your child may want to sleep longer in the mornings and stay awake later at night, even though the time needed to wake up for school does not change. What to do Make it a family priority to get enough sleep. Set clear limits, such as what time lights must be turned off. Have a bedtime routine. - Do relaxing things to help wind down, like taking a bath, listening to music, or reading a book. - Create a soothing environment. Make sure the room is not too cold or too hot and dim the lights. It is okay to use a nightlight. - Spend some special time with your child before turning the lights off. Stick to topics that will not upset him or her. - Set an alarm clock for the morning wake-up time. -
History & Physical Format
History & Physical Format SUBJECTIVE (History) Identification name, address, tel.#, DOB, informant, referring provider CC (chief complaint) list of symptoms & duration. reason for seeking care HPI (history of present illness) - PQRST Provocative/palliative - precipitating/relieving Quality/quantity - character Region - location/radiation Severity - constant/intermittent Timing - onset/frequency/duration PMH (past medical /surgical history) general health, weight loss, hepatitis, rheumatic fever, mono, flu, arthritis, Ca, gout, asthma/COPD, pneumonia, thyroid dx, blood dyscrasias, ASCVD, HTN, UTIs, DM, seizures, operations, injuries, PUD/GERD, hospitalizations, psych hx Allergies Meds (Rx & OTC) SH (social history) birthplace, residence, education, occupation, marital status, ETOH, smoking, drugs, etc., sexual activity - MEN, WOMEN or BOTH CAGE Review Ever Feel Need to CUT DOWN Ever Felt ANNOYED by criticism of drinking Ever Had GUILTY Feelings Ever Taken Morning EYE OPENER FH (family history) age & cause of death of relatives' family diseases (CAD, CA, DM, psych) SUBJECTIVE (Review of Systems) skin, hair, nails - lesions, rashes, pruritis, changes in moles; change in distribution; lymph nodes - enlargement, pain bones , joints muscles - fractures, pain, stiffness, weakness, atrophy blood - anemia, bruising head - H/A, trauma, vertigo, syncope, seizures, memory eyes- visual loss, diplopia, trauma, inflammation glasses ears - deafness, tinnitis, discharge, pain nose - discharge, obstruction, epistaxis mouth - sores, gingival bleeding, teeth, -
Sleep Training
Sleep Training What Is Sleep training? Sleep training is more than just a nice way of saying "cry-it-out". Sleep training is a method by which the parent creates an environment for an infant to learn how to maintain sleep. Why do I have to do this? For some infants sleep comes easily and quickly. As soon as the body no longer needs nutrition in the night, the baby sleeps through without any perceived awakenings. Unfortunately, most babies (and some adults) need to be taught to maintain sleep. We all wake up in the middle of the night. Most of us will look at the clock, roll into another position, find the cold side of the pillow and will go back to sleep. The reason we do this is because we have trained ourselves to fall asleep without sleep props and we have trained ourselves to not be alarmed by these awakenings. Many infants need to be taught this skill. Unfortunately, many infants think that they need to eat in the middle of the night. They think that because we have taught them to think that. As newborns they did need to eat in the middle of the night but at some point (probably around 3 months of age) that need no longer existed but since it was habit, it kept going. Your job now is to teach your baby that it is not necessary to eat in the middle of the night and when (s)he comes to wakefulness to go back to sleep without the assistance of a parent. -
How Does Pre-Sleep Usage of LED Screen Technology Affect Sleeping Behavior And
1 How Does Pre-Sleep Usage of LED Screen Technology Affect Sleeping Behavior and Academic Achievement? A dissertation submitted to the Graduate School of the University of Cincinnati In partial fulfillment of the requirements for the degree of Doctor of Philosophy In the Department of Educational Studies College of Education, Criminal Justice, & Human Services by Jessica L. Kestler MS, Ohio University, 2010 BS, Ohio University, 2008 Committee: Linda Plevyak, PhD, Chair Anna F. DeJarnette, PhD Ellen Lynch, PhD 2 Abstract The use of LED technology before bedtime reawakens the brain due to the blue light that emulates daylight. This delays sleep onset causing sleep deprivation, which affects academic achievement for college students. To date, no current studies explore how all three variables are influenced by one another. College students (n =151; mean age= 20.35) were recruited to complete a weekly sleep journal to determine the impact that usage of LED technology has on sleep and the resulting influence on academic achievement. Participants also completed existing measurement questionnaires (Epworth Sleepiness Scale [ESS], Motivated Strategies for Learning Questionnaire [MSLQ], & 3x2 Achievement Goal Theory [AGT]) to assess how sleep deprivation influences daytime sleepiness and motivational strategies for mastery learning and achievement goals. Kolmogorov-Smirnov (K-S) was first conducted to test whether parametric and non- parametric statistics were more applicable for the data. Then, partial least squares structure equation modeling software “SmartPLS”, was used to perform path analysis to examine the significance of the stated hypotheses. Most notably, results indicated that students who reported increased usage of LED light technology before bed reported increased time falling asleep and decreased total sleep duration. -
Guiding Principles for the Diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Guiding Principles for the Diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome The following document is based on input and feedback obtained from a panel of experts using a modified Delphi panel process. These experts were engaged by the Centre for Effective Practice on behalf of the Minis- try of Health and Long-Term Care.1 The following principles represent a suggested approach for the diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in primary care, based on available literature and expert opinion. This resource is intended to help primary care providers diagnose and treat patients with ME/CFS. The key features of ME/CFS are: Fatigue Post-Exertional Malaise • New/defined onset • Worsening of symptoms (e.g. soreness, feeling drained or sick) resulting from minimal physical, • Persistent mental, or cognitive exertion • Not resulting from other diagnoses, medical • Episodes of immobilizing post-exertional physical and/ problems, medications or mental fatigue and/or malaise • Accompanied by malaise and a range of other symptoms Consensus was achieved among the panel to support the use of the Canadian Consensus Definition for ME/ CFS2 or the Institute of Medicine 2015 Criteria for the Diagnosis of ME/CFS.3 Providers may consider using one, or both, of these resources in supporting their diagnosis, depending on their familiarity with ME/CFS.4 Providers may also consider the following in diagnosing patients using these definitions: • Orthostatic intolerance, as listed in the Institute of Medicine definition, may be present in patients but is not essential for a diagnosis of ME/CFS. Similarly, some symptoms listed in the Canadian Consensus Definition (i.e.