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Decision fatigue

Bruno Fautrel, Rieke Alten, Bruce Kirkham, Inmaculada de la Torre, Frederick Durand, Jane Barry, Thorsten Holzkaemper, Walid Fakhouri, Peter C Taylor
Current guidelines for the management of rheumatoid arthritis (RA) recommend early treatment and a treat-to-target goal of remission or low disease activity. Over the past decade, this approach has been extremely successful in reducing disease activity and joint damage in patients with RA. At the same time, however, overall patient perception of well-being appears to have decreased with respect to outcome measures considered important by patients themselves, such as pain, fatigue, physical function and quality of life...
March 21, 2018: Rheumatology International
Lora J Wu, Philippa H Gander, Margo van den Berg, T Leigh Signal
BACKGROUND: Many civilian aviation regulators favor evidence-based strategies that go beyond hours-of-service approaches for managing fatigue risk. Several countries now allow operations to be flown outside of flight and duty hour limitations, provided airlines demonstrate an alternative method of compliance that yields safety levels "at least equivalent to" the prescriptive regulations. Here we discuss equivalence testing in occupational fatigue risk management. We present suggested ratios/margins of practical equivalence when comparing operations inside and outside of prescriptive regulations for two common aviation safety performance indicators: total in-flight sleep duration and psychomotor vigilance task reaction speed...
April 1, 2018: Aerospace Medicine and Human Performance
Sabine Landau, Richard Emsley, Graham Dunn
BACKGROUND: Random allocation avoids confounding bias when estimating the average treatment effect. For continuous outcomes measured at post-treatment as well as prior to randomisation (baseline), analyses based on (A) post-treatment outcome alone, (B) change scores over the treatment phase or (C) conditioning on baseline values (analysis of covariance) provide unbiased estimators of the average treatment effect. The decision to include baseline values of the clinical outcome in the analysis is based on precision arguments, with analysis of covariance known to be most precise...
March 1, 2018: Clinical Trials: Journal of the Society for Clinical Trials
Angela Ju, Mark Unruh, Sara Davison, Juan Dapueto, Mary Amanda Dew, Richard Fluck, Michael Germain, Sarbjit V Jassal, Gregorio Obrador, Donal O'Donoghue, Michelle A Josephson, Jonathan C Craig, Andrea Viecelli, Emma O'Lone, Camilla S Hanson, Braden Manns, Benedicte Sautenet, Martin Howell, Bharathi Reddy, Caroline Wilkie, Claudia Rutherford, Allison Tong
Fatigue is one of the most highly prioritized outcomes for patients and clinicians, but remains infrequently and inconsistently reported across trials in hemodialysis. We convened an international Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) consensus workshop with stakeholders to discuss the development and implementation of a core outcome measure for fatigue. 15 patients/caregivers and 42 health professionals (clinicians, researchers, policy makers, and industry representatives) from 9 countries participated in breakout discussions...
March 15, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
K A Honn, J M Hinson, P Whitney, H P A Van Dongen
In around-the-clock operations, reduced alertness due to circadian misalignment and sleep loss causes performance impairment, which can lead to catastrophic errors and accidents. There is mounting evidence that performance on different tasks is differentially affected, but the general principles underlying this differentiation are not well understood. One factor that may be particularly relevant is the degree to which tasks require executive control, that is, control over the initiation, monitoring, and termination of actions in order to achieve goals...
March 14, 2018: Accident; Analysis and Prevention
Vincent Di Fazio, Sarah M R Wille, Stefan W Toennes, Janelle H P van Wel, Johannes G Ramaekers, Nele Samyn
Using the Belgian Drugs and Driving procedure, 36% of the cocaine positive oral fluid (OF) screening results were not confirmed in plasma. This study investigates the impact of the choice of screening devices and confirmation matrix on the detection of cocaine use. An UPLC-MS/MS method quantifying cocaine, benzoylecgonine (BZE), and other basic drugs in OF was developed and validated. This method monitored OF samples obtained either from a roadside (n =12) or a double-blind controlled study with cocaine users (n=10) who were given either a capsule containing 300 mg of cocaine-HCl or a placebo...
March 10, 2018: Drug Testing and Analysis
Harpreet Singh, Amanda J Walker, Laleh Amiri-Kordestani, Joyce Cheng, Shenghui Tang, Pamela Balcazar, Kimberly Barnett-Ringgold, Todd R Palmby, Xianhua Cao, Nan Zheng, Qi Liu, Jingyu Yu, William F Pierce, Selena R Daniels, Rajeshwari Sridhara, Amna Ibrahim, Paul G Kluetz, Gideon M Blumenthal, Julia A Beaver, Richard Pazdur
On July 17, 2017, the Food and Drug Administration (FDA) approved neratinib (NERLYNX, Puma Biotechnology, Inc) for the extended adjuvant treatment of adult patients with early-stage HER2-overexpressed/amplified breast cancer, to follow adjuvant trastuzumab-based therapy. Approval was based on data from ExteNET, a randomized, double-blind, placebo-controlled multicenter trial. Women with early-stage HER2-positive breast cancer and within two years of completing adjuvant trastuzumab were randomized to neratinib (n=1420) or placebo (n=1420) for one year...
March 9, 2018: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
Eileen Yoshida, Shirley Fei, Karen Bavuso, Charles Lagor, Saverio Maviglia
BACKGROUND:  Well-functioning clinical decision support (CDS) can facilitate provider workflow, improve patient care, promote better outcomes, and reduce costs. However, poorly functioning CDS may lead to alert fatigue, cause providers to ignore important CDS interventions, and increase provider dissatisfaction. OBJECTIVE:  The purpose of this article is to describe one institution's experience in implementing a program to create and maintain properly functioning CDS by systematically monitoring CDS firing rates and patterns...
January 2018: Applied Clinical Informatics
Satabdi Mitra, Aditya Prasad Sarkar, Dibakar Haldar, Asit Baren Saren, Sourav Lo, Gautam Narayan Sarkar
Background: Perceived stress and burnout are by-products of powerless responsibility imposed on resident doctors. Emotional intelligence (EI) works as an adapting and coping tool. Objective: The objective of this study is to find out the role of work-related perceived stress on burnout and influence of EI on it. Methods: A descriptive cross-sectional study was conducted from February to April 2016 among 63 resident doctors of different departments of Bankura Sammilani Medical College and Hospital...
January 2018: Indian Journal of Public Health
Janet M Y Cheung, Delwyn J Bartlett, Carol L Armour, Bandana Saini, Tracey-Lea Laba
BACKGROUND: Despite the rapid development of effective treatments, both pharmacological and non-pharmacological, insomnia management remains suboptimal at the practice interface. Patient preferences play a critical role in influencing treatment outcomes. However, there is currently a mismatch between patient preferences and clinician recommendations, partly perpetuated by a limited understanding of the patients' decision-making process. OBJECTIVES: The aim of our study was to empirically quantify patient preferences for treatment attributes common to both pharmacological and non-pharmacological insomnia treatments...
March 3, 2018: Patient
Guido Giunti, Vasiliki Mylonopoulou, Octavio Rivera Romero
BACKGROUND: Multiple sclerosis (MS) is one of the world's most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change...
March 2, 2018: JMIR MHealth and UHealth
Jonas Blomberg, Carl-Gerhard Gottfries, Amal Elfaitouri, Muhammad Rizwan, Anders Rosén
Myalgic encephalomyelitis (ME) often also called chronic fatigue syndrome (ME/CFS) is a common, debilitating, disease of unknown origin. Although a subject of controversy and a considerable scientific literature, we think that a solid understanding of ME/CFS pathogenesis is emerging. In this study, we compiled recent findings and placed them in the context of the clinical picture and natural history of the disease. A pattern emerged, giving rise to an explanatory model. ME/CFS often starts after or during an infection...
2018: Frontiers in Immunology
Lundy R Gunn, Robert Tunney, Kimberly Kelly
BACKGROUND:  Medication alert overrides remain persistently high over the past decade, influenced by factors such as "alert fatigue" and lack of provider acceptance. OBJECTIVE:  We compared the aggregate rate of fluoroquinolone (FQ) prescribing for the treatment of acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections (UTIs) in adult inpatients prior to (historical control group) and after (prospective intervention group) implementation of a program requiring indication when ordering FQ antibiotics in combination with a nonmodal best-practice alert regarding the latest U...
January 2018: Applied Clinical Informatics
Sumanta Kumar Pal, Jean Hoffman-Censits, Hanzhe Zheng, Constanze Kaiser, Darren Tayama, Joaquim Bellmunt
BACKGROUND: Atezolizumab (anti-programmed death-ligand 1) was approved in the USA, Europe, and elsewhere for treatment-naive and platinum-treated locally advanced/metastatic urothelial carcinoma (mUC). OBJECTIVE: To report efficacy and safety from an atezolizumab expanded access study. DESIGN, SETTING, AND PARTICIPANTS: This single-arm, open-label study enrolled 218 patients at 36 US sites. Key eligibility criteria included progression during/following ≥1 platinum-based chemotherapy for mUC or in perioperative setting (progression within 12 mo) and Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2...
February 22, 2018: European Urology
Gráinne Sheill, Emer M Guinan, Nicola Peat, Juliette Hussey
Metastatic disease is a frequent complication of advanced cancer, with bone representing one of the most common sites of metastatic occurrence. Patients with bone metastases receive long-term systemic treatments which have a significant attritional impact on muscle strength, fatigue and physical functioning. Physical rehabilitation involving exercise and physical activity prescription has a considerable role in counteracting these changes however exercise is often perceived as a contraindication in the presence of bone metastases due to concerns about aggravating skeletal related events...
February 20, 2018: PM & R: the Journal of Injury, Function, and Rehabilitation
S C M Heemskerk, A H Rotteveel, M A Benninga, C I M Baeten, A A M Masclee, J Melenhorst, S M J van Kuijk, C D Dirksen, S O Breukink
PURPOSE: The evidence regarding the (cost-)effectiveness of sacral neuromodulation (SNM) in patients with therapy-resistant idiopathic slow-transit constipation is of suboptimal quality. The Dutch Ministry of Health, Welfare and Sports has granted conditional reimbursement for SNM treatment. The objective is to assess the effectiveness, cost-effectiveness, and budget impact of SNM compared to personalized conservative treatment (PCT) in patients with idiopathic slow-transit constipation refractory to conservative treatment...
February 22, 2018: International Journal of Colorectal Disease
Susan Hassmiller, Ani Bilazarian
OBJECTIVE: The aims of this study were to illustrate the quality, safety, cost-effectiveness, and ethics of consumer engagement initiatives and identify promising practices and leadership strategies used by nursing leaders. METHODS: A literature review was performed with supplementary interviews conducted with 25 key nursing informants including nursing executives and chief nursing officers at acute care hospitals, community health centers, policy institutions, and quality and safety organizations...
February 21, 2018: Journal of Nursing Administration
Wietske C M Schimmel, Eline Verhaak, Patrick E J Hanssens, Karin Gehring, Margriet M Sitskoorn
BACKGROUND: Gamma Knife radiosurgery (GKRS) is increasingly applied in patients with multiple brain metastases and is expected to have less adverse effects in cognitive functioning than whole brain radiation therapy (WBRT). Effective treatment with the least negative cognitive side effects is increasingly becoming important, as more patients with brain metastases live longer due to more and better systemic treatment options. There are no published randomized trials yet directly comparing GKRS to WBRT in patients with multiple brain metastases that include objective neuropsychological testing...
February 21, 2018: BMC Cancer
B M Varghese, E Dent, M Chilver, S Cameron, N P Stocks
Acute respiratory infections cause significant morbidity and mortality accounting for 5.8 million deaths worldwide. In Australia, influenza-like illness (ILI), defined as cough, fever and fatigue is a common presentation in general practice and results in reduced productivity and lost working days. Little is known about the epidemiology of ILI in working-age adults. Using data from the ASPREN influenza surveillance network in Australia (2010-2013) we found that working-age adults made up 45.2% of all ILI notifications with 55% of samples positive for at least one respiratory virus...
February 21, 2018: Epidemiology and Infection
Patrick Delisle-Houde, Nathan A Chiarlitti, Ryan E R Reid, Ross E Andersen
Hockey player's body composition and physical fitness are suggested to influence coaching decisions regarding on-ice playing time. The purpose of this study was to explore the relationship between seasonal body composition changes, off-ice pre-season testing and on-ice metrics. Twenty-one Canadian collegiate hockey players (22.70 ± 1.30 years old, 181.0 ± 5.92 cm, 86.52 ± 6.41 kg) underwent off-ice physical testing at the beginning of their season, and had one total body dual energy x-ray absorptiometry scan at the beginning and end of the season...
February 14, 2018: Journal of Strength and Conditioning Research
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