Fatigue Management Strategies Research Articles

The self-reported causes of sleepiness in shift-working tram and truck drivers

Identifying the causes of sleepiness in various safety-critical work environments is necessary for implementing more efficient fatigue management strategies. In transportation, little is known about drivers’ own perceptions of these causes. Therefore, we instructed shift-working tram (n = 23) and long-haul truck drivers (n = 52) to report at the end of their shifts what made them sleepy if they felt so. These self-reports, measured on-duty sleepiness, and sleep amounts were recorded on every shift over a period of 2–3 weeks per driver. The causes of sleepiness were queried with smartphone applications and sleep logs. Sleepiness was measured with the Karolinska Sleepiness Scale (KSS) and sleep with wrist-worn actigraphs. Data were analyzed using generalized estimating equations. Sleep loss and insufficient rest breaks were commonly reported as causing sleepiness among the tram drivers, whereas time of day and sleep loss were the leading causes among the truck drivers. Other causes, such as traffic or cabin conditions, were not frequently mentioned. During morning, day, and evening shifts, the truck drivers were less likely to report insufficient rest breaks as causing sleepiness than the tram drivers. Similarly, during morning shifts, the truck drivers were less likely to attribute their sleepiness to sleep loss. In shifts with drives reporting severe sleepiness (KSS ≥ 7 at least once, 18–21% of shifts), sleep loss was significantly reported as causing sleepiness among both groups. Reporting insufficient rest breaks was associated with severe sleepiness among the tram drivers, whereas time of day showed the same among the truck drivers. The results highlight the need for addressing sleep-related fatigue in transportation and provide directions for future research with regard to secondary causes of sleepiness.

Addressing fatigue in medical residents with biomathematical fatigue modeling.

Fatigue in resident physicians has been identified as a factor that contributes to burnout and a decline in overall wellbeing. Fatigue risk exists because of poor sleep habits and demanding work schedules that have only increased due to the COVID‐19 pandemic. At this time, it is important not to lose sight of how fatigue can impact residents and how fatigue risk can be mitigated. While fatigue mitigation is currently addressed by duty hour restrictions and education about fatigue, Fatigue Risk Management Systems (FRMSs) offer a more comprehensive strategy for addressing these issues. An important component of FRMS in other shiftwork industries, such as aviation and trucking, is the use of biomathematical models to prospectively identify fatigue risk in work schedules. Such an approach incorporates decades of knowledge of sleep and circadian rhythm research into shift schedules, taking into account not just duty hour restrictions but the temporal placement of work schedules. Recent research has shown that biomathematical models of fatigue can be adapted to a resident physician population and can help address fatigue risk. Such models do not require subject matter experts and can be applied in graduate medical education program shift scheduling. It is important for graduate medical education program providers to consider these alternative methods of fatigue mitigation. These tools can help reduce fatigue risk and may improve wellness as they allow for a more precise fatigue management strategy without reducing overall work hours.

Self-Report Fatigue Management for Instrumental Musicians: A Delphi Survey.

Mismanagement of fatigue and playing load have been consistently identified as risk factors for playing-related pain and injuries. Studies in sport demonstrate that fatigue management strategies can predict and prevent overuse syndromes and related injuries through consistent assessment of playing load and physical/psychological stress. Self-report strategies show particular responsiveness to both the short and long-term impacts of training. No equivalent fatigue management strategies exist for musicians. Establish key items and feasibility parameters to inform the development of a self-report fatigue management tool for musicians. A working party of international experts in musicians' medicine was invited to complete a two-phase Delphi survey. In Phase I, working party members rated established items from sport (REST-Q subscales with demonstrated responsiveness to both acute and chronic training stresses) with respect to relevance and prospective utility for musicians. Members could also propose additional items and were asked to indicate a maximum feasible questionnaire length. In Phase II, working party members ranked top performing items from Phase I. Consensus best items were determined based on Phase II rankings. A 28-member working party was assembled (15 clinicians, 13 researchers). Of 20 researcher proposed items and 58 working party proposed items, 5 items met consensus criteria: I had pain; I had to play too much; I felt physically fit; I did not get enough sleep; I recovered well physically. A strong majority (89%) of working party members indicated that regular use of a fatigue questionnaire with up to 10 items is feasible. Key questionnaire items and feasibility parameters for a novel fatigue management tool for musicians are established. Future research in musicians is needed to validate study results and this novel fatigue management tool.

Energy drink: the consumption prevalence, and awareness of its potential health implications among commercial drivers in the Ho municipality of Ghana

BackgroundConsumption of energy drinks has become an escalating global public health problem. The work schedule and irregular sleeping habits of commercial bus drivers make them highly susceptible to getting fatigued, hence most of them consume energy drinks as a fatigue management strategy. However, consumption of energy drinks produces numerous psychomotor side effects that if consumed among drivers puts the traveling public in danger of road accidents. This study sought to assess the prevalence of energy drink consumption and awareness of associated potential health problems among commercial long-distance bus drivers operating from the Ho municipality.MethodsThe study population comprised about 266 commercial bus drivers. This was a cross-sectional study involving 132 participants who completed a structured questionnaire on the participants’ socio-demographic characteristics, frequency of consumption and reasons for consumption. It also included questions to assess the knowledge of the ingredients and side effects of energy drinks. Respondents were selected using a convenience sampling technique. Descriptive analysis and Chi-square test of association were used to analyse the data.ResultsA majority (62.1%) of the drivers had more than 10 years of commercial driving experience. A 75% energy drink consumption prevalence was recorded with driving performance enhancement (78.8%) as the predominant reason for consumption. 7–10 bottles per week were consumed by most (32.2%) of the drivers. Also, 72.0% had poor knowledge of the side effects linked with energy drink consumption as well as the ingredients for preparation.ConclusionEnergy drinks were consumed by the majority of the drivers at the Ho main bus terminal of which most of the drivers had poor knowledge of the potential health problems linked with the consumption of these drinks. The consumption of energy drinks was observed to be higher among the drivers with lower education levels, higher monthly income and those who worked long hours in a day. The Ghana National Road Safety Commission (GNRC) in collaboration with other private road transport unions in Ghana should organize regular seminars for commercial bus drivers on the potential dangers and effects associated with energy drink consumption.

From fatigued to fit: an investigation of the impact of physical exercise in the management of radiotherapy-induced fatigue in prostate cancer patients

AbstractAim:The aim of this paper is to investigate the effectiveness of physical exercise in managing fatigue during radiotherapy for prostate cancer patients. It explores the impact of various physical exercise regimes and their role in the prevention and management of fatigue to help inform best practice.Method:A literature search was conducted on OVID Medline database with a follow-up search on google scholar to include relevant references found during the initial search. Relevant systematic reviews and randomised controlled trials (RCTs) arising from this search were reviewed.Findings:There is evidence to support the notion that physical exercise in all its forms is an effective and safe intervention for fatigue management for prostate cancer patients undergoing radiotherapy. Although widely studied, there is limited evidence of fatigue management strategies being clearly implemented into current radiotherapy practice for patients with prostate cancer. This information is essential to enable therapeutic radiographers to educate prostate cancer patients regarding effective exercise strategies and ensure that fatigue is managed optimally.Conclusion:Further research is required into the optimum physical exercise prescription to reduce radiation-induced fatigue, and standardised best practice guidelines should be developed nationally. A future move toward patient education into physical exercise and wellbeing should be a central component of the therapeutic radiographer role with specialist advice offered by review radiographers, empowering patients to become more physically active during treatment. Therapeutic radiographers have a unique opportunity to educate and promote physical exercise through a holistic wellbeing approach that aims to mitigate fatigue and improve quality of life.

Internet-based cognitive rehabilitation for WORking Cancer survivors (i-WORC): study protocol of a randomized controlled trial

BackgroundCognitive problems are common in non-central nervous system cancer survivors. These problems are perceived as an important contributor to decline in work performance and work ability. Various interventions for cognitive problems have been proposed, but effectiveness regarding work-related outcomes has not yet been established. Effective treatment options to alleviate the adverse influence of cognitive problems on work performance are needed for working cancer survivors. In this paper, we will describe the design of a randomized, controlled, multicenter trial that evaluates the (cost-)effectiveness of an Internet-based cognitive rehabilitation program for occupationally active cancer survivors confronted with cognitive problems.Methods/ designA three-armed randomized controlled trial will be conducted, including two intervention groups (i.e., basic and extensive cognitive rehabilitation program) and one waitlist control group. In total, 261 cancer survivors (18–65 years) who have returned to work and who experience cognitive problems will be recruited. Patients with and without cognitive impairment as established in a neuropsychological assessment will be eligible; stratification will take place based on the presence of this cognitive impairment. The extensive intervention arm will contain a comprehensive training program (including psycho-education, fatigue management, and cognitive strategy training) with individual guidance (blended intervention). The basic intervention arm will contain a brief cognitive training program (including psycho-education and fatigue management) without individual guidance. The primary outcome will be accomplishment of an individually defined work-related treatment goal. Secondary outcomes include, among others, subjective cognitive functioning, work functioning, and quality of life. Primary and secondary outcomes will be measured at baseline (T0) and at 12 weeks (T1) and 26 weeks (T2) post-randomization.DiscussionAbout 40–50% of the cancer patients worldwide are of working age at time of diagnosis. Many of the occupationally active cancer survivors experience cognitive problems. Both from an individual and a societal perspective, it is important to sustain cancer survivors’ employability. An effective treatment to alleviate the impact of cognitive decline and to improve work ability might help cancer survivors to sustain employability.Trial registrationClinicalTrials.gov NCT03900806. Registered on 03 April 2019 (current status: ongoing).

Chronic Illness and Fatigue in Older Individuals: A Systematic Review.

BackgroundFatigue is a symptom experienced by 40%–74% of older individuals in the United States. Despite its significance, clinicians face challenges helping individuals to manage or reduce fatigue levels. Some management issues are attributable to the ambiguity around the risk factors, consequences, and the effect of fatigue management strategies.MethodsA literature review was conducted using four databases to identify themes in relation to risk factors, consequences, and management strategies from research studies about fatigue in older individuals with chronic diseases.ResultsFindings on fatigue risk factors, such as age, body mass index, and marital status, were contradictory. There was a positive association between fatigue and comorbidities, depression, and anxiety and a negative relationship between fatigue and physical activity, sleep, educational status, and socioeconomic status. Fatigue was perceived as a state of “feebleness” and negatively impacted individuals’ quality of life. Consequences of fatigue included tiredness, sleepiness, depression, anxiety, worse sense of purpose in life, poor self-care, and an increased β-amyloid load. Predictors of worse fatigue consequences included functional health, symptom burden, subjective health, and self-acceptance. Fatigue management strategies included physical activity, rest, sleep, maintaining normal hemoglobin levels, and acetyl-l-carnitine supplementation.ConclusionThis systematic review is of value to older individuals with chronic illnesses, researchers, and clinicians who strive to improve the quality of life of individuals experiencing fatigue. To prevent undesirable consequences of fatigue, older individuals should be screened for the discussed modifiable risk factors of fatigue. The inconsistencies in the studies reviewed can guide researchers to potential research areas that require further inquiry and exploration to ground future practice on best scientific evidence

Strategies for and Barriers to Fatigue Management Among Acute Care Nurses

Introduction Hospital nurses may experience substantial fatigue, yet there is limited empirical evidence about fatigue management strategies. Aim: The aim of this study was to describe how hospital nurses manage fatigue at home and at work. Methods This descriptive third-phase study of nurses in eight Midwestern hospitals used a maximum variation sampling strategy based on fatigue scores and self-reported medication error and near misses. Participant data from semi-structured interviews were thematically analyzed. Results Barriers to fatigue management included workload, pace, schedule, shift, and nutrition at work, as well as inadequate sleep and competing demands at home. Strategies for fatigue management at work included moving, drinking caffeine, keeping busy, eating, and taking breaks, whereas strategies at home included sleeping, performing activities, and relaxing. Participants suggested organizational approaches to support fatigue management related to staffing and workload, such as breaks, naps, and schedule and shift. Every nurse interviewed reported some degree of fatigue and could describe barriers to fatigue management they encountered. All nurses also could describe attempts to manage fatigue. Conclusions Fatigue management should be part of organizational policy review and nursing education and training to keep nurses and their patients safe and to enable a positive work-life balance.

Éléments structurant les programmes d’activité physique dans la lutte contre le surpoids et l’obésité : état des lieux et suggestions

To date, physical activity (PA) programs for overweight and obese people are built around recommendations established for the general population. However, these people have special characteristics that require adapted coaching. In order to begin this work of recommendations, the objective of this article was to list the criteria usually used to describe and study PA programs for overweight and obese people and its associated postprogram follow-up. A systematic review of both meta-analyses and systematic reviews related to PA programs in the management of overweight and obesity has highlighted that few descriptive elements of programs are systematically reported, and that PA programs are rarely sufficiently detailed to be able to calculate a PA dose or to compare the different programs. These convergences, disparities or gaps in the description of PA programs, led us to initiate a reflection on the interest of these criteria as well as on the interest of their systematization in weight management program design, including PA. We hope that will be a first step towards facilitating the development of recommendations for PA management of overweight and obesity. Novelty Objective: to identify criteria used to describe PA programs in the management of overweight and obesity. Criteria to systematize: data to calculate PA dose; description of program individualization strategy. Criteria to develop: drop-out rate as an indicator of program adaptation; description of fatigue management strategy.

P127 Factors associated with self-reported fatigue in hip and/or knee osteoarthritis: a systematic review

Abstract Background Fatigue is an important, under-researched and poorly understood symptom among hip and/or knee osteoarthritis (OA) populations. To devise the best fatigue management strategy in these populations, it is necessary to evaluate the evidence on risk factors for fatigue. This study aimed to give an overview and evaluate the evidence on the factors associated with fatigue in hip and/or knee OA populations. Methods We conducted a systematic review using MEDLINE, AMED, CINAHL, ProQuest, and Web of Science Core Collections databases from inception to June 2019. Inclusion criteria comprised cross-sectional and longitudinal studies on patients with a diagnosis of hip and/or knee OA, included a measure of self-reported fatigue and studies that performed a subgroup analysis of hip/knee OA from other included populations. Two reviewers simultaneously screened articles for eligibility and extracted the following data: study design, fatigue outcome tool, follow-up time and association between factors and fatigue. The methodological quality of the included studies was assessed using the National Heart, Lung and Blood Institute quality appraisal tool. Study quality and study designs were combined to determine the level of evidence using best-evidence synthesis, which comprised six levels of evidence (Table 1). Results Eighteen studies (10 cross-sectional designs, 8 longitudinal designs) were included. A majority of the studies included were of good quality, whilst two had fair quality and one poor quality. Lower physical function, more pain, higher depressive symptoms, lower physical activity, older age, increased anxiety, greater pain catastrophizing, worse radiographic evidence, higher body mass index, greater comorbidity/illness burden, lower six minutes walk and increased joint stiffness were included in the best evidence synthesis. From the best evidence grading, most of these factors had limited or conflicting evidence on its association with fatigue within the hip/knee OA populations. However, lower physical function and higher depressive symptoms were graded as having strong evidence on their associations with fatigue while higher pain levels had moderate evidence. Conclusion Lower physical function levels, higher depressive symptoms and higher pain are related to fatigue in the hip/knee OA population. More longitudinal studies are warranted to investigate the potential association of other identified factors and fatigue. Disclosures H.O. Fawole None. O.A. Idowu None. U.O. Abaraogu None. J.L. Riskowski None. A. Dell'Isola None. M.P. Steultjens None. S.F.M. Chastin None.

Individual, business-related, and work environment factors associated with driving tired among taxi drivers in two metropolitan U.S. cities

Introduction: Violence-related events and roadway incidents are the leading causes of injury among taxi drivers. Fatigue is under-recognized and prevalent in this workforce and is associated with both injury outcomes. We describe the association of individual, business-related, and work environment factors with driving tired among taxi drivers in two very different cities. Method: We developed a comprehensive survey for licensed taxi drivers. We trained surveyors to administer the 30-min survey using systematic sampling among taxi drivers waiting for fares in two large U.S. cities: the Southwest (City 1) and the West (City 2). A driving tired scale of the Occupational Driver Behavior Questionnaire was the outcome. Multivariate logistic models described driving tired behavior in city-specific models using adjusted Odds Ratios (ORadj). Results: City 1 and City 2 had 496 and 500 participants, respectively. Each driving tired behavior was significantly more prevalent in City 2 than City 1 (p < .05). There were more variables and a greater diversity of variables in the models describing drowsy driving in City 1 than City 2. In City 1, variables describing negative safety climate (ORadj = 1.15), socio-demographic groups (identifying as Asian, educational attainment), passenger-related violence (ORadj = 1.79), and company tenure (ORadj =1.15) were associated with driving tired. In City 2, high perceived safety training usefulness (ORadj = 0.48) was associated with driving tired. A risk factor for driving tired that was common to both cities was job demands (ORadj = 1.21 in City 1; 1.43 in City 2). Conclusions: These findings represent two diverse taxi populations driving in two geographically distinct regions that differ in safety regulation. It is important that safety measures that include fatigue awareness training are reaching all drivers. Fatigue management training should be integrated into driver safety programs regardless of location. Practical applications: Fatigue management strategies that recognize individual factors, business-related characteristics, and work environment are an important component of road safety and are particularly relevant for occupational drivers.

Does work-induced fatigue accumulate across three compressed 12 hour shifts in hospital nurses and aides?

Fatigue-related impairments in the nursing workforce contribute to a multitude of health, safety, and economic consequences at the individual, organizational and societal levels. Long and compressed work schedules are commonly worked in the healthcare industry, but more research is needed to understand the cumulative effects of multiple work shifts on physiology-based performance outcomes in nurses. The purpose of this study was to compare the effects of a single nursing work shift versus three compressed (one every 24 hours) 12 hour shifts on performance-based fatigue in nurses and aides. Twenty-six fulltime hospital working nurses and aides (age = 36.1 ± 13.3 years) reported to the lab for testing before, immediately after working a single 12 hour shift, and after working three 12 hour shifts in a 72 hour period. Outcome measures included vigilance-based reaction time, lapses of attention, and muscle function assessments (lower and upper body muscle strength, explosive strength and vertical jump performance). All variables except hand grip strength showed a significant decline following the three work shifts. The psychomotor vigilance reaction time and lapses of attention variables also generally showed a significant decline from the end of shift one to the end of shift three, indicting an accumulation of fatigue in these metrics with increasing number of shifts worked. Muscle function variables responded early in the duty cycle, showing a significant decline after a single work shift, but did no further decline by the end of the third shift. These findings use objective measures to substantiate that fatigue impairments occur from working a single 12 hour shift, and in several instances, increase further with more successive work shifts. Caution should be employed by personnel and administrators with work schedules involving multiple compressed 12 hour shifts. Fatigue management strategies may be used to improve risks and consequences from fatigue-related mishaps, and this study reports several variables that appear sensitive to identifying and tracking fatigue in this population.

Fatigue, symptom burden, and health-related quality of life in patients with myelodysplastic syndrome, aplastic anemia, and paroxysmal nocturnal hemoglobinuria.

BackgroundFatigue is distressing and affects quality of life (QoL) among patients with myelodysplastic syndrome (MDS), aplastic anemia (AA), and paroxysmal nocturnal hemoglobinuria (PNH). Limited data exist on the impact of fatigue, QoL, and related symptoms in these patients.ObjectiveProspectively assess fatigue (functional assessment of cancer therapy‐anemia [FACT‐An]); QoL (FACT‐An subscales); pain (brief pain inventory); and depression, anxiety, and stress (depression anxiety stress scale‐21) and strategies used to manage these symptoms in patients with MDS, AA, and PNH.MethodsSurveys were administered via the AA and MDS International Foundation website and database from October 2014 through April 2015 in a cross‐sectional study. Results were summarized using descriptive statistics.ResultsOf 303 patients, 145 (48%) had MDS, 84 (28%) had AA, and 74 (24%) had PNH; 31 (10%) had >1 diagnosis. The mean age was 57 years, 200 (66%) were female, and 195 (92%) were white. The mean fatigue scores were 25 (range 1‐52) for the whole cohort, 28 for AA, 25 for MDS, and 24 for PNH (P = 0.117); these are all considered severe level. The mean QoL score was 68 (range 10‐104) for the whole cohort, 67 for AA, 69 for MDS, and 67 for PNH (P = 0.821). The ranges for stress were normal; pain and depression, mild; and anxiety, moderate. The most common management strategies perceived as helpful for fatigue in the past month were preserving energy, physical activity, and naps.ConclusionsMany patients with MDS, AA, and PNH report severe fatigue. The helpfulness of fatigue management strategies may impact patients’ continued use; whether these strategies are beneficial and decrease fatigue levels needs more study.

Investigation of the relationship among fatigue, self-efficacy and quality of life during chemotherapy in patients with breast, lung or gastrointestinal cancer.

To explore the relationship between fatigue and self-efficacy, and quality of life (QoL) during chemotherapy of patients with breast, lung or gastrointestinal cancers. This study is a descriptive-correlational research. The study population comprised of patients with breast, lung and gastrointestinal cancer treated at the outpatient chemotherapy unit. Patients' self-efficacy and QoL were assessed using Functional Assessment of Chronic Illness Therapy-Fatigue scale and Strategies Used by Patients to Promote Health scale. The sample included 236 patients receiving chemotherapy for lung cancer (30.9%), gastrointestinal (25.8%) or breast cancers (25.4%). The patients had little confidence in performing self-care self-efficacy during chemotherapy for the management of illness and chemotherapy-related side effects. The study found that the patients with cancer were moderately fatigued and all the domains of QoL of patientswith cancer undergoing chemotherapy were considerablyimpaired. Positive correlations were found between self-efficacy scores and fatigue scores (p<0.001), and QoL scores (p<0.001). Better self-efficacy beliefs were associated with better QoL and lower fatigue. Improving the cancer patients' self-confidence in performing self-care behaviours may have a positive impact on performing cognitive and behavioural fatigue management strategies and can influence positively the patients' QoL during chemotherapy.

2B-Alert App: A mobile application for real-time individualized prediction of alertness.

Knowing how an individual responds to sleep deprivation is a requirement for developing personalized fatigue management strategies. Here we describe and validate the 2B‐Alert App, the first mobile application that progressively learns an individual’s trait‐like response to sleep deprivation in real time, to generate increasingly more accurate individualized predictions of alertness. We incorporated a Bayesian learning algorithm within the validated Unified Model of Performance to automatically and gradually adapt the model parameters to an individual after each psychomotor vigilance test. We implemented the resulting model and the psychomotor vigilance test as a smartphone application (2B‐Alert App), and prospectively validated its performance in a 62‐hr total sleep deprivation study in which 21 participants used the app to perform psychomotor vigilance tests every 3 hr and obtain real‐time individualized predictions after each test. The temporal profiles of reaction times on the app‐conducted psychomotor vigilance tests were well correlated with and as sensitive as those obtained with a previously characterized psychomotor vigilance test device. The app progressively learned each individual’s trait‐like response to sleep deprivation throughout the study, yielding increasingly more accurate predictions of alertness for the last 24 hr of total sleep deprivation as the number of psychomotor vigilance tests increased. After only 12 psychomotor vigilance tests, the accuracy of the model predictions was comparable to the peak accuracy obtained using all psychomotor vigilance tests. With the ability to make real‐time individualized predictions of the effects of sleep deprivation on future alertness, the 2B‐Alert App can be used to tailor personalized fatigue management strategies, facilitating self‐management of alertness and safety in operational and non‐operational settings.

Descriptive Report of the Impact of Fatigue and Current Management Strategies in Cerebral Palsy.

To describe the effect of fatigue and self-management practices for adolescents and young adults with cerebral palsy. A survey of 124 people with cerebral palsy with the Fatigue Impact and Severity Self-Assessment. Participants in Gross Motor Function Classification System (GMFCS) level I experienced little effect of fatigue, with high proportions of this group disagreeing to statements about fatigue impacting their general activities, mobility, and social activities. Participants in GMFCS levels II to V reported effect of fatigue on activities. Differences between groups were evident in questions related to fatigue interference with length of time for physical activity and with motivations to participate in social activities. All other items related to management of fatigue were not significantly different between groups. Fatigue effect is greater for participants with more functional limitations. The lack of significant differences between groups, on the Management and Activity Modification subscale, indicates more research is needed regarding strategies for fatigue management.

Commentary on "Descriptive Report of the Impact of Fatigue and Current Management Strategies in Cerebral Palsy".

Commentary on "Descriptive Report of the Impact of Fatigue and Current Management Strategies in Cerebral Palsy".

Understanding and living with multiple sclerosis fatigue

Introduction Fatigue substantially affects the lives of many people with multiple sclerosis. This study aimed to further our understanding of the experience of living with multiple sclerosis fatigue by exploring how people became aware of and understood their multiple sclerosis fatigue and how they accommodate it in their daily lives. Method The study used an existential approach to thematic analysis. Thirteen in-depth, semi-structured interviews with people who experienced multiple sclerosis fatigue were conducted and analysed. Results Participants developed an understanding of multiple sclerosis fatigue through gaining awareness of its effect on their lives, seeking information themselves and being informed by health professionals. Participants described how they began to understand the effect of fatigue in their lives and make decisions about how to accommodate it. They discussed the challenges associated with helping others to understand their multiple sclerosis fatigue. Conclusion Lay and expert explanations, the phenomenological notions of lived experience, self-identity and embodiment and stigma associated with invisible disability were useful concepts for understanding the results. Clinicians should consider these concepts when supporting people with multiple sclerosis fatigue to understand the effect of fatigue in their daily lives and use fatigue management strategies to make effective lifestyle changes to accommodate it.

The importance of self-care for fatigue amongst patients undergoing chemotherapy for primary cancer

To measure Cancer Related Fatigue (CRF), and explore fatigue self-care strategies used to ameliorate CRF amongst patients undergoing chemotherapy for primary cancer. A consecutive sample of patients (n=362) undergoing chemotherapy with a primary diagnosis of breast, colorectal, Hodgkin's and non-Hodgkin's lymphoma cancers were recruited. A mixed methods design was utilised. The study questionnaires included: the Piper Fatigue Scale-Revised and a researcher developed fatigue Self-Care Survey. The mean total fatigue score was 4.9 (SD=2.2); the highest mean subscale score occurred in the affective meaning dimension (M=5.4, SD=2.9). The mean number of strategies used at least "occasionally" was 14.8, (SD=3.42, range=5-24). The most frequently used self-care strategies were: "Receiving support from family and friends" (66.6%); "having a healthy diet" (57.1%); "taking part in hobbies or distraction activities" (42.9%); "spending time chatting with friends"(37.3%); "adjusting mood and being more positive" (36.3%) and "resting and taking it easy" (33.8%). The self-care strategies of socializing (OR=0.66, 95% CI=0.47-0.930, p=0.016) and exercise (OR=0.73, 95% CI=0.57-0.93, p=0.012) were associated with decreased odds of developing CRF. Four categories emerged following analysis of qualitative data, these included: rest and relaxation, physical activity, psychological well-being, and supportive care. CRF is a debilitating, complex phenomenon, therefore multiple CRF strategies should be used for the optimum management of CRF including exercise and socializing. Health care professionals have an important role in promoting the use of evidence based fatigue management strategies.

Principles of fatigue in residency education: a qualitative study.

Proposals to implement fatigue-management strategies in residency education assume that medicine shares the view of other risk-adverse industries that fatigue is hazardous. This view is an essential underpinning of fatigue-management strategies that other industries have embedded as part of their workplace occupational health and safety programs. We sought to explore how residents understand fatigue in the context of their training environment. We interviewed 21 residents in 7 surgical and nonsurgical programs at Western University in 2014. All participants met the inclusion criteria of routinely working 24-hour call shifts while enrolled in their training program. Data collection and analysis occurred iteratively in keeping with constructivist grounded theory methodology and informed theoretical sampling to sufficiency. Four predominant principles of fatigue captured how the social learning environment shaped residents' perceptions of fatigue. These included the conceptualization of fatigue as (a) inescapable and therefore accepted, (b) manageable through experience, (c) necessary for future practice and (d) surmountable when required. This study elaborates our understanding of how principles of fatigue are constructed and reinforced by the training environment. Whereas fatigue is seen as a collective hazard in other industries, our data showed that, in residency training, fatigue may be seen as a personal challenge. Consequently, fatigue-management strategies that conceptualize fatigue as an occupational threat may have a limited impact on resident behaviour and patient safety.