Fatigue Rate Research Articles

Application of accelerated life testing in human reliability analysis

As manufacturers and technologies become more complicated, manufacturing errors such as machine failure and human error have also been considered more over the past. Since machines and humans are not error-proof, managing the machines and human errors is a significant challenge in manufacturing systems. There are numerous methods for investigating human errors, fatigue, and reliability that categorized under Human Reliability Analysis (HRA) methods. HRA methods use some qualitative factors named Performance Shaping Factors (PSFs) to estimate Human Error Probability (HEP). Since the PSFs can be considered as the acceleration factors in Accelerated Life Test (ALT). We developed a method for Accelerated Human Fatigue Test (AHFT) to calculate human fatigue, according to fatigue rate and other effective factors. The proposed method reduces the time and cost of human fatigue calculation. AHFT first extracts the important factors affecting human fatigue using Principal Component Analysis (PCA) and then uses the accelerated test to calculate the effect of PSFs on human fatigue. The proposed method has been applied to a real case, and the provided results show that human fatigue can be calculated more effectively using the proposed method.

Acute and Chronic Citrulline Malate Supplementation on Muscle Contractile Properties and Fatigue Rate of the Quadriceps.

This study compared the acute and chronic impact of citrulline malate (CM) supplementation on muscle contractile properties and fatigue rate of the quadriceps. Eighteen recreationally trained males consumed both a placebo (PL) and CM treatment for two separate dosing periods. The first experimental testing session for each dosing period was considered the baseline day, the second session the acute day, and the third session the chronic day, which followed seven consecutive days of supplementation. All testing sessions included exercising on a cycle ergometer at 50%-60% of their max power output for 30min followed by performing the Thorstensson test on an isokinetic dynamometer. A two-way (Supplement × Time) analysis of variance with repeated measures resulted in no significant interactions (p > .05) (PL: baseline day, acute day, chronic day vs. CM: baseline day, acute day, chronic day) for peak power (in watts) (469 ± 81, 490 ± 97, 502 ± 99 vs. 464 ± 85, 480 ± 103, 501 ± 81); peak torque (in newton meters) (150 ± 26, 157 ± 32, 161 ± 31 vs. 149 ± 27, 156 ± 33, 161 ± 26); fatigue rate (in percentage) (57 ± 9, 57 ± 10, 58 ± 9 vs. 57 ± 10, 56 ± 9, 58 ± 9); and heart rate (in beats per minute) (156 ± 17, 146 ± 13, 146 ± 9 vs. 155 ± 11, 146 ± 11, 146 ± 9). The results of this study suggest that neither acute nor chronic supplementation of CM had an effect on recovery or fatigue rate of the quadriceps.

Patient-Reported Outcomes Using Automated Chatbot for Breast Cancer Patients Receiving Radiation Therapy

We previously reported our experience using innovative and automated chatbots ("Health Chats") in head and neck cancer patients during radiation treatment (RT). We created a breast cancer (BC) Health Chat. The aims of this pilot study are to 1) assess the usability of the Health Chats, 2) engage patients by providing frequent individualized education, and 3) identify areas of unmet needs specific to BC patients via collection of patient-reported outcomes (PROs).Between January 2020 and December 2020, adults with BC aged ≥ 18 years who were English literate and were scheduled for RT at one of four academic hospitals were screened. Participants were sent chats 2 days before on-treatment visits during the duration of RT, then weekly for 4 weeks post-treatment, and monthly for an additional 3 months ("long-term follow-up"). Health Chats used PRO-CTCAE questions customized for BC patients. Clinicians were notified if any "red flag" symptoms were reported (PRO-CTCAE ≥ 3 or pain score ≥8). At the end of each chat, patients received customized educational material specific to symptoms reported.20 breast cancer patients were enrolled, and 16 patients completed at least one chat. These 16 patients completed a median of 9 chats, out of a maximum of 10-12 chats. 11 patients continued to chat during the immediate post-treatment phase, and 10 patients continued to chat during long-term follow-up. Patient engagement with Chats is high, with 6 patients providing written feedback about the details of their symptoms, and 3 patients using unscheduled chats to contact the care team. The average System Usability Scale score (n = 9) was 82.77. A total of 811 pain or PRO-CTCAE scores were collected. There were 2 counts of pain scores ≥ 8, and no reports of grade 3+ skin toxicity or breast swelling. 5 out of 11 patients reported that their pain continued to worsen after finishing their last RT treatment, and 10 out of 11 patients reported that their breast pain, swelling, or skin toxicities peaked 2 weeks after RT. Patients reported severe and prolonged fatigue or insomnia: there were 4 counts of grade 3 fatigue and 3 counts of grade 4 fatigue, and 2 counts of grade 3 insomnia and 1 count of grade 4 insomnia. 4 out of 10 patients reported continued fatigue or insomnia during long-term follow-up. Of the 5 patients who screened positive for depression or anxiety using PHQ2 or GAD2 questionnaire, 3 patients continued to report persistent symptoms during long-term follow-up.To our knowledge, this is the first study using chatbots to collect PROs for BC patients receiving RT. Our results show that BC patients are highly engaged and satisfied with Health Chats. As expected, patients report that pain and skin toxicities peak 2 weeks after RT. We also identify unexpectedly high rates of severe fatigue, insomnia, and persistent anxiety and depression. These toxicities are difficult to observe by clinicians and may represent unmet patient needs that should be addressed by future interventions.

The effect of personal protective equipment on cardiac compression quality.

IntroductionCardiac compression is a cumbersome procedure. The American Heart Association suggests switching of cardiopulmonary resuscitation (CPR) provider every 2 min to prevent any decrease in resuscitation quality. High quality CPR is associated with improved outcomes. Previous studies have highlighted the difficulties in providing high quality CPR particularly while wearing personal protective equipment (PPE). This study aimed to evaluate the impact of personal protective equipment (PPE) use on CPR quality in prehospital cardiac arrest situations.MethodsIn this prospective simulation study, we compared the cardiac compression qualities and fatigue rates among prehospital health care professionals (HCPs) who were or were not using PPE.ResultsA total of 76 prehospital HCPs comprising 38 compression teams participated in this study. The mean compression rate was 117.71 ± 8.27/min without PPE and 115.58 ± 9.02/min with PPE (p = 0.191). Overall compression score was 86.95 ± 4.39 without PPE and 61.89 ± 14.43 with PPE (p < 0.001). Post-cardiac compression fatigue score was 4.42 ± 0.5 among HCPs who used their standard uniform and 7.74 ± 0.92 among those who used PPE (p < 0.001). The overall compression score difference between the two conditions was 25.05 ± 11.74 and the fatigue score difference was 3.31 ± 0.98.DiscussionPPE use is associated with decreased cardiac compression quality and significantly higher fatigue rates than those associated with the use of standard uniforms. Routine use of mechanical compression devices should be considered when PPE is required for out-of-cardiac arrests.

Rehabilitation program combining physical exercise and heart rate variability biofeedback in hematologic patients: a feasibility study

PurposeHematologic patients have a poorer health-related quality of life due to the disease and its treatments. Non-pharmacological interventions represent an opportunity in tertiary cancer prevention to manage persistent symptoms and support patients in their return to active daily living. This interventional study aimed to evaluate the feasibility of a program combining physical exercise (PE) and heart rate variability biofeedback (HRVB) in hematologic patients.MethodHematologic patients in remission within 6 months participated in a 12-week rehabilitation program including 24 supervised sessions of PE associated with 10 supervised sessions of HRVB and daily home-based practice of paced breathing. We assessed patient adherence, fatigue, physical function, and heart rate variability.ResultsTwenty patients were included, 17 completed the protocol and 3 dropped out due to disease progression or time constraints; no adverse events or incidents were reported. Participation rates were 85% for PE and 98% for HRVB-supervised sessions. Significant improvements of physical capacity (6-min walk test, p < 0.001; 50-foot walk test, p < 0.001), muscle strength (grip force test, p < 0.01), and flexibility (toe-touch test, p < 0.001; back scratch test, p < 0.05) were measured. Coherence ratio (p < 0.001) and low-frequency spectral density of HRV signal (p < 0.003) increased significantly, suggesting improved autonomic function. Fatigue, static balance, and other time and frequency indicators of HRV were not improved (all p > 0.05).ConclusionA rehabilitation program combining PE and HRVB is feasible in hematologic patients and effective on physical function. Further research with a larger sample size is needed to investigate effectiveness on patients’ autonomic functions and their impacts on symptomatology.

Disparities among GU cancer patients referred to palliative care.

114 Background: The role of palliative care in genitourinary (GU) malignancies has been understudied. Despite representing nearly 25% of new cancer diagnoses, with over 350,000 new cases diagnosed each year, few GU patients have been included in palliative care trials under the theory that symptoms are less severe for GU patients than other solid tumors. Early involvement of palliative care services improves the patient care experience, decreases healthcare utilization, is associated with survival benefit, and results in improved quality of life and mood. To further elucidate the role of palliative care in oncology, we must study its utility in subsets of malignancy like GU cancers, as needs for patients may differ by malignancy type. Methods: A retrospective cross-sectional analysis of initial outpatient palliative care visits was performed using data from the Quality Data Collection Tool for Palliative Care (QDACT-PC) database from 2014-2020. QDACT-PC is a web-based, point-of-care registry used by physicians across the United States to track quality metrics associated with patient consultations. Data was collected and analyzed from patients' initial visits including pain scale, dyspnea scale, feeling of well-being (Quality of Life scale), fatigue scale, constipation scale, palliative performance status (PPS), and preference for resuscitation status. Scales for these variables were 0-10, with the exception of a scale of 0-100% for PPS. Patients less than 18 and greater than 90 years old were excluded. Chi-squared and Student’s t-tests were used to compare categorical and continuous variables, respectively. Results: 824 GU oncology patients (358 prostate cancer patients, 251 bladder cancer patients, 215 renal cancer patients) were compared against all patients with non-GU cancers (7807 patients). Notably, non-GU patients reported higher rates of fatigue (4.50 vs. 4.13, p = 0.0013) and dyspnea (1.63 vs. 1.11, p &lt; 0.0001) than GU patients. GU malignancies had non-significant higher reported pain (3.73 vs. 3.60, p = 0.3109) and constipation (1.96 vs. 1.83, p = 0.2319) and lower PPS (4.95 vs. 4.96, p = 0.8555) and QOL (4.55 vs. 4.73, p = 0.0962). Preference for resuscitation at the time of referral was similar between the two groups (p = 0.6339). Only 16.5% of prostate cancer patients referred to palliative care in this database were black, while black patients are often estimated to represent 30% of new prostate cancer diagnoses each year. Conclusions: GU patients represent 9.54% of cancer patients seen by palliative care while the incidence is nearly 25%. Traditionally, GU patients were underrepresented in palliative care trials under the notion of less severe symptoms; however, this study demonstrates that GU patients have as severe symptoms as non-GU patients, highlighting a disparity in referral to palliative care. Furthermore, the lack of representation of black patients suggests potential inequity and warrants further investigation.

32.5 The Combination of CYP2C19 Metabolized Antidepressants and Cannabinoids Presents Elevated Risk of Antidepressant-Related Side Effects

Given increasing cannabinoid use in adolescents, we sought to identify differential rates of side effects typically associated with the cytochrome P450 enzyme 2C19 (CYP2C19) metabolized antidepressants with concurrent use of cannabinoids as reported to the US FDA Adverse Event Reporting System (FAERS). We analyzed approximately 15 million patient reports from the FDA for the use of CYPC219 metabolized medications (sertraline, escitalopram, and citalopram; n = 427,932), cannabinoids (tetrahydrocannabinol, cannabidiol [CBD], cannabinoids; n = 7008), and their combination (n = 421). The 3 mutually exclusive cohorts were analyzed for their frequencies of side effects. Side effect frequencies in the CYP2C19 medication cohort were used as baseline for comparison with the cannabinoid and combination cohorts. Twenty-three side effects with over 5% frequency on the sertraline or escitalopram label were used for benchmarking our comparative analysis. Comparative analysis of these 23 side effects in the FAERS data revealed that patients on a combination of CYP2C19 metabolized medications and cannabinoids showed a disproportionately higher risk for certain side effects. Compared to patients taking sertraline or escitalopram alone, patients in the combination group presented a 4.97-fold increase in cough, 3.33-fold higher rate of diarrhea, 3.29-fold higher rate of fatigue, 2.87-fold increase in dizziness, and 2.54-fold increase in influenza. There is an increase in certain side effects reported to FAERS in patients taking a CYP2C19 metabolized antidepressant in combination with cannabinoids. Studies are needed to examine the concurrent use of SSRIs and cannabinoids, either CBD or recreational marijuana, with outcomes in adolescents focused on tolerability and efficacy.

유연 리튬 폴리머 이차전지의 기계적 변형에 따른 성능 및 안전성 평가

Purpose: Flexible lithium-ion batteries have been used as energy sources for wearable and flexible devices. However, their reliability in mechanical stress environments must be guaranteed for them to be stably used in these applications. In this study, the effect of mechanical fatigue on the performance and safety of a lithium polymer battery, which is a flexible lithium-ion battery, was investigated.<BR>Methods: Mechanical fatigue tests were conducted under bending, torsion, and wrinkling (i.e., a combination of bending and torsion) modes at various fatigue rates and strains. The capacity degradation of these fatigued flexible lithium-ion batteries was evaluated using the charge–discharge test. Their safety was assessed using various environmental and electrical misuse tests in accordance with existing standards.<BR>Results: The capacity degradation of all fatigued batteries was greater than that of the undeformed battery. In particular, the torsion and wrinkling stress had a greater effect on capacity degradation. The environmental and electrical misuse tests revealed that leakage, explosion, and ignition phenomena were not caused by mechanical fatigue.<BR>Conclusion: Mechanical fatigue stress can be concluded to be the main factor affecting the performance degradation of flexible lithium-ion batteries. Furthermore, further studies are required to determine the root causes of this significant performance degradation.

Iron deficiency anemia induces postural control disorders in young women

BackgroundDue to menstruation and restrictive dietary practices, women are at a particular risk of iron deficiency anemia (IDA). This hematologic manifestation could impair postural control as it induces fatigue, muscle weakness, cognitive and neurological functions alteration. AimThis study aimed to investigate IDA effects on postural control in young women in comparison to healthy counterparts. Material and methodsTwenty-four young women with IDA and twenty-four controls participated in this study. Center of pressure (CoP) excursions, in the bipedal and semi-tandem postures on the firm and foam surfaces in the eyes opened (EO) and closed (EC), were recorded, and Romberg index was calculated to evaluate postural control. Besides physical performance, attentional capacity, fatigue, and heart and respiratory rates were assessed. ResultsYoung women with IDA had significantly higher CoP velocity (CoPv) values in the bipedal posture in both vision and surface conditions (EO [firm: P < 0.001 and foam: P < 0.01]; EC: P < 0.001), as well as in the semi-tandem posture (EO [firm: P < 0.01 and foam: P < 0.001]; EC: P < 0.001) compared to controls indicating that they had worse postural control than their peers. In addition, values of the respiratory rate (P < 0.001), attentional capacity (P < 0.001), physical performance (P < 0.001), fatigue (P < 0.001), and Romberg index on the foam surface in both postures (P < 0.05) were significantly higher in young women with IDA compared to controls. ConclusionsPhysical performance, fatigue, tachypnea and attentional capacity resulting from IDA may explain postural control disorder in young women.

Negative Effects of Endoscopists' Fatigue on Colonoscopy Quality on 34,022 Screening Colonoscopies.

There is still considerable controversy surrounding the relationship between fatigue of endoscopists and the quality of colonoscopy. The aim of this study is to comprehensively explore the association between fatigue and adenoma detection rate (ADR) and cecal intubation rate (CIR). The mixed effects logistic regression model was used to explore the relationship between fatigue- related factors including procedure order, session of procedures and the day of week and ADR as well as CIR. When controlling for confounders, the day of week (Monday as reference, Friday, p=0.022; weekends, p=0.015) and session of procedures (P<0.001) were significantly associated with ADR while procedure order (<5 as reference, 6-10, p<0.001; >10, p=0.001) and session of procedures (p=0.004) were independent predictors for CIR. Additionally, there was a significant downward trend on ADR and CIR with the approaching of weekends (p=0.005) and increasing procedure orders (p<0.001), respectively. In the subgroup analysis stratified by gender, age and workload intensity, significant lower ADR was found in the afternoon in all subgroups (male, p<0.001; female, p=0.005; <40 years, p<0.001; ≥40 years, p=0.020; intensity<50 per month, p=0.017; intensity≥50 per month, p<0.001) but the downward trend on ADR as the week progressed was only found in endoscopists with male gender (p=0.011), age<40 (p=0.027) and high workload intensity (p=0.003). Moreover, a significant downward trend on CIR as the procedure order increased was found in all subgroups except endoscopists with age≥40 (male, p=0.005; female, p<0.001; <40 years, p<0.001; intensity<50 per month, p=0.001; intensity≥50 per month, p<0.001). Colonoscopies in the afternoon will affect ADR negatively while increasing procedure order will cause a lower CIR. Importantly, the significant negative influence of Friday and weekends on ADR was first discovered in this study. Moreover, endoscopists with female gender and advanced age (≥40) but not high workload intensity showed superiority in resistance of fatigue caused by the end of the week and increasing daily procedures.

Effect of Blow Bottle Device and Flutter on Functional Capacity, Dyspnea, Fatigue, and Peak Expiratory Flow Rate in Mild-to-Moderate COPD Patients: A Comparative Study

Background: Chronic obstructive pulmonary disease (COPD) is expected to rank third among the sixth largest leading causes of death by 2020 and sixth most debilitating condition. Positive expiratory pressure techniques such as flutter and blow bottle devices are usually used to improve respiratory function. Objective: The objective of this study is to compare the effect of blow bottle device and flutter device on functional capacity, dyspnea, fatigue, and peak expiratory flow rate (PEFR) in participants with mild-to-moderate COPD. Patients and Methods: Forty-five participants, between 40 and 70 years were screened for the study. Of these, 32 participants were included and 27 completed the study. They were classified into two groups. Group A was given blow bottle device and Group B flutter device. A 1-week intervention protocol was given to the participants. Results: There was a significant postintervention improvement in mean walking distance in both Group A and Group B, (128.07 ± 15.48 m to 141.53 ± 16.75 m, 163.92 ± 48.2 m to 177.64 ± 55.3 m), respectively, and in PEFR ([Group A 180 ± 83.46 L/min to 195.76 ± 92.91 L/min and in Group B 138.57 ± 39.39 L/min to 158.57 ± 33.30 L/min]). Dyspnea and fatigue decreased significantly postintervention in both groups. Conclusion: Both blow bottle and flutter devices are effective as adjunct therapy in the improvement of functional capacity, dyspnea, fatigue, and PEFR in participants with mild-to-moderate COPD. Flutter device is more effective in improving functional capacity, dyspnea, and fatigue, whereas the blow bottle device is more effective in increasing PEFR.

Impact of enzalutamide on patient-reported fatigue in patients with prostate cancer: data from the pivotal clinical trials

BackgroundFatigue is a multifactorial symptom commonly reported by patients with prostate cancer as a result of disease and treatment. This study assesses the impact enzalutamide has on patient-reported fatigue (“fatigue”) by using patient-reported outcomes from four pivotal, placebo-controlled trials of enzalutamide (ARCHES (NCT02677896), PROSPER (NCT02003924), PREVAIL (NCT01212991), and AFFIRM (NCT00974311)).MethodsFatigue was assessed in the individual studies using the Functional Assessment of Cancer Therapy–Prostate item GP1 at baseline, weeks 13 or 17, and every 12 weeks until disease progression. Longitudinal changes were assessed using mean scores and mixed-model repeated measures.ResultsThe fatigue rates at baseline were higher in patients with later-stage disease (metastatic and/or castration-resistant prostate cancer (CRPC)) and among patients who had already received prior treatment lines; rates ranged between 58% in PROSPER (nonmetastatic CRPC) and 86% in AFFIRM (post-docetaxel metastatic CRPC). Irrespective of disease state, initiation of enzalutamide or placebo resulted in an early increase of fatigue (by weeks 13 or 17), with fatigue levels stabilizing thereafter. At last assessment, ≥55% of patients reported fatigue improvement or stabilization in all trials compared to baseline. More patients reported fatigue worsening by ≥1 or ≥2 units with enzalutamide plus androgen deprivation therapy (ADT) than with placebo plus ADT in ARCHES, PROSPER, and PREVAIL, but the between-group difference was <10% in all trials.ConclusionsThe levels of fatigue were greater in mCRPC and lower in earlier states of disease. In all trials, patients reported a small increase in fatigue for the first 13–17 weeks after starting enzalutamide or placebo, with slightly greater fatigue with enzalutamide in all studies except AFFIRM, but fatigue stabilized or improved thereafter. This suggests a role for clinical management of fatigue to help patients cope early in treatment.

MP41-19 ADVERSE EVENTS OF THE SECOND-LINE TREATMENT STRATEGIES FOR PATIENTS WITH LOCALLY ADVANCED OR METASTATIC UROTHELIAL CARCINOMA OF THE BLADDER: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

You have accessJournal of UrologyBladder Cancer: Invasive II (MP41)1 Sep 2021MP41-19 ADVERSE EVENTS OF THE SECOND-LINE TREATMENT STRATEGIES FOR PATIENTS WITH LOCALLY ADVANCED OR METASTATIC UROTHELIAL CARCINOMA OF THE BLADDER: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS Ekaterina Laukhtina, Keiichiro Mori, Hadi Mostafaei, Axel S. Merseburger, Peter Nyirady, Marco Moschini, Fahad Quhal, Benjamin Pradere, Reza Sari Motlagh, Victor M. Schuettfort, Dmitry Enikeev, and Shahrokh F. Shariat Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Keiichiro MoriKeiichiro Mori More articles by this author , Hadi MostafaeiHadi Mostafaei More articles by this author , Axel S. MerseburgerAxel S. Merseburger More articles by this author , Peter NyiradyPeter Nyirady More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Fahad QuhalFahad Quhal More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , Reza Sari MotlaghReza Sari Motlagh More articles by this author , Victor M. SchuettfortVictor M. Schuettfort More articles by this author , Dmitry EnikeevDmitry Enikeev More articles by this author , and Shahrokh F. ShariatShahrokh F. Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002062.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The present systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to compare the mortality rates related to adverse events (AEs) and discontinuation of treatment due to toxicity as well as all AEs of currently used regimens of second-line treatment strategies for locally advanced or metastatic urothelial carcinoma of the bladder (UCB). METHODS: The MEDLINE and EMBASE databases were searched for articles published from January 2000 until June 2020 according to the Preferred Reporting Items for Systematic Review and Meta-analysis extension statement for NMA. Eligible studies included RCTs comparing different second-line treatment strategies for the treatment of locally advanced or metastatic UCB. An NMA was performed to assess the mortality rates related to AEs and discontinuation of treatment due to toxicity as well as all AEs. For the assessment of AEs, arm-based analyses were performed to estimate the odds ratio (OR) of the AEs and 95% credible interval (CI) from the available raw data presented in the included manuscripts. The relative ranking of the different treatments for each outcome were estimated using the p-score, which can be considered a frequentist analog to the surface under the cumulative ranking curves. RESULTS: Five trials comprising 2,205 patients met our eligibility criteria. Formal NMA was conducted for these outcomes. Therapy regimens were categorized into groups as follows: immunotherapy as single regimen, immunotherapy in combination, and best supportive care (BSC). According to our results, BSC had the best likelihood of resulting in low mortality rates related to AEs (odds ratio (OR): 0.58, 95% credible interval (CI): 0.08–4.03), and toxicity leading to discontinuation of treatment (OR: 0.06, 95% CI: 0.01–0.49). It is highly likely that immunotherapy, as single regimen, has the lowest rates of motor and sensory neuropathies (OR: 0.05, 95% CI: 0.02–0.13 and OR: 0.07, 95% CI: 0.01–0.65, respectively), constipation (OR: 0.12, 95% CI: 0.04–0.40), abdominal pain (OR: 0.25, 95% CI: 0.03–1.92), alopecia (OR: 0.00, 95% CI: 0.00–0.02), decreased appetite (OR: 0.60, 95% CI: 0.45–0.82), vomiting (OR: 0.23, 95% CI: 0.13–0.41), and febrile neutropenia (OR: 0.04, 95% CI: 0.01–0.28). It is highly likely that immunotherapy, in combination regimen, has the lowest rates of anemia (OR: 0.14, 95% CI: 0.02–0.81) and fatigue (OR: 0.37, 95% CI: 0.20–0.68). Chemotherapy had the lowest rate of diarrhea (p score: 0.8162) and pneumonitis (p score: 0.9051). CONCLUSIONS: Immunotherapy, especially as a single regimen, was the best tolerated treatment with the lowest AEs. With respect to AEs, chemotherapy should be avoided if possible, in patients with hematological and central nervous system disorders as well as those with inclination to severe constipations. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e768-e769 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ekaterina Laukhtina More articles by this author Keiichiro Mori More articles by this author Hadi Mostafaei More articles by this author Axel S. Merseburger More articles by this author Peter Nyirady More articles by this author Marco Moschini More articles by this author Fahad Quhal More articles by this author Benjamin Pradere More articles by this author Reza Sari Motlagh More articles by this author Victor M. Schuettfort More articles by this author Dmitry Enikeev More articles by this author Shahrokh F. Shariat More articles by this author Expand All Advertisement Loading ...

Associations between Depression, Anxiety, Fatigue, and Learning Motivating Factors in e-Learning-Based Computer Programming Education.

Quarantines imposed due to COVID-19 have forced the rapid implementation of e-learning, but also increased the rates of anxiety, depression, and fatigue, which relate to dramatically diminished e-learning motivation. Thus, it was deemed significant to identify e-learning motivating factors related to mental health. Furthermore, because computer programming skills are among the core competencies that professionals are expected to possess in the era of rapid technology development, it was also considered important to identify the factors relating to computer programming learning. Thus, this study applied the Learning Motivating Factors Questionnaire, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder Scale-7 (GAD-7), and the Multidimensional Fatigue Inventory-20 (MFI-20) instruments. The sample consisted of 444 e-learners, including 189 computer programming e-learners. The results revealed that higher scores of individual attitude and expectation, challenging goals, clear direction, social pressure, and competition significantly varied across depression categories. The scores of challenging goals, and social pressure and competition, significantly varied across anxiety categories. The scores of individual attitude and expectation, challenging goals, and social pressure and competition significantly varied across general fatigue categories. In the group of computer programming e-learners: challenging goals predicted decreased anxiety; clear direction and challenging goals predicted decreased depression; individual attitude and expectation predicted diminished general fatigue; and challenging goals and punishment predicted diminished mental fatigue. Challenging goals statistically significantly predicted lower mental fatigue, and mental fatigue statistically significantly predicted depression and anxiety in both sample groups.

Deconstructing Apathy in Parkinson's Disease: Challenges in Isolating Core Components of Apathy From Depression, Anxiety, and Fatigue.

Apathy, fatigue and depression are amongst the most debilitating non-motor syndromes of Parkinson's disease (PD). The aim of this study was to examine the prevalence of apathy, depression, anxiety and fatigue and whether these syndromes are separable in PD. A total of 337 patients were examined using the Unified Parkinson's Disease Rating Scale (UPDRS part III), the Apathy Evaluation Scale, the Hospital Anxiety and Depression Scale and the Fatigue Severity Scale. Using standard cutoff criteria, the prevalence rates of significant apathy, mild-to-severe depression, mild-to-severe anxiety and severe fatigue were 23.7, 13.4, 15.4, and 17.8%, respectively. Next, confirmatory factor analysis was employed of items from these three clinical scales. A priori hypothesis testing including four different factors (reduced motivation/interest, physical fatigue, reduced pleasure, anxiety) was performed. The factor analysis revealed strong fit statistics for the model with χ2 (57, N = 377) = 58.9, p = 0.41, CMIN/DF = 1,034, NFI = 0.977, CFI = 0.999, IFI = 0.999, RFI = 0.968, and TLI = 0.999. The RMSEA was 0.01, and the standardized RMR was 0.027. These results support the hypothesis that apathy, fatigue, depression and anxiety represent prevalent syndromes that can be separated in Parkinson's disease and that apathy is not just a subcomponent of depression or fatigue. The results of this study may contribute to a clearer diagnostic process for apathy, fatigue and depression and may aid in patient care.

Short-term outcome of pregnant women vaccinated with BNT162b2 mRNA COVID-19 vaccine.

ABSTRACTObjectivesTo determine the immunogenicity and reactogenicity of the Pfizer/BioNTech BNT162b2 mRNA coronavirus disease 2019 (COVID‐19) vaccine among pregnant women compared with non‐pregnant women, and to evaluate obstetric outcome following vaccination.MethodsThis was an observational case–control study of pregnant women who were vaccinated with a two‐dose regimen of the BNT162b2 vaccine during gestation between January and February 2021 (study group) and age‐matched non‐pregnant women who received the vaccine during the same time period (control group). Participants received a digital questionnaire 1–4 weeks after the second dose and were asked to provide information regarding demographics, medication, medical history, history of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, timing of COVID‐19 vaccine doses and side effects after each vaccine dose. A second digital questionnaire, regarding current pregnancy and delivery outcomes, was sent to patients in the study group after the calculated due date. All recruited women were offered a serology blood test for SARS‐CoV‐2 immunoglobulin G (IgG) following the second vaccination dose and SARS‐CoV‐2 IgG levels were compared between the two groups.ResultsOf 539 pregnant women who were recruited after completion of the two‐dose regimen of the vaccine, 390 returned the digital questionnaire and were included in the study group and compared to 260 age‐matched non‐pregnant vaccinated women. The rates of rash, fever and severe fatigue following vaccination among pregnant women were comparable to those in non‐pregnant women. Myalgia, arthralgia and headache were significantly less common among pregnant women after each dose, local pain or swelling and axillary lymphadenopathy were significantly less common among pregnant women after the first and second doses, respectively, while paresthesia was significantly more common among the pregnant population after the second dose. Among pregnant women, there were no significant differences in the rates of side effects according to whether the vaccine was administered during the first, second or third trimester of pregnancy, except for local pain/swelling, which was significantly less common after the first dose when administered during the third trimester, and uterine contractions, which were significantly more common after the second dose when administered during the third trimester. The rates of obstetric complications, including uterine contractions (1.3% after the first dose and 6.4% after the second dose), vaginal bleeding (0.3% after the first dose and 1.5% after the second dose) and prelabor rupture of membranes (0% after the first dose and 0.8% after the second dose), were very low following vaccination. All serum samples in both groups were positive for SARS‐CoV‐2 IgG. However, pregnant women had significantly lower serum SARS‐CoV‐2 IgG levels compared to non‐pregnant women (signal‐to‐cut‐off ratio, 27.03 vs 34.35, respectively; P < 0.001). Among the 57 pregnant women who delivered during the study period and who completed the second questionnaire, median gestational age at delivery was 39.5 (interquartile range, 38.7–40.0) weeks, with no cases of preterm birth < 37 weeks, no cases of fetal or neonatal death and two (3.5%) cases of admission to the neonatal intensive care unit for respiratory support.ConclusionsThe adverse‐effect profile and short‐term obstetric and neonatal outcomes among pregnant women who were vaccinated with the BNT162b2 vaccine at any stage of pregnancy do not indicate any safety concerns. The vaccine is effective in generating a humoral immune response in pregnant women, although SARS‐CoV‐2 IgG levels were lower than those observed in non‐pregnant vaccinated women. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Modelling COVID-19 outbreaks in USA with distinct testing, lockdown speed and fatigue rates.

Each state in the USA exhibited a unique response to the COVID-19 outbreak, along with variable levels of testing, leading to different actual case burdens in the country. In this study, via per capita testing dependent ascertainment rates, along with case and death data, we fit a minimal epidemic model for each state. We estimate infection-level responsive lockdown/self-quarantine entry and exit rates (representing government and behavioural reaction), along with the true number of cases as of 31 May 2020. Ultimately, we provide error-corrected estimates for commonly used metrics such as infection fatality ratio and overall case ascertainment for all 55 states and territories considered, along with the USA in aggregate, in order to correlate outbreak severity with first wave intervention attributes and suggest potential management strategies for future outbreaks. We observe a theoretically predicted inverse proportionality relation between outbreak size and lockdown rate, with scale dependent on the underlying reproduction number and simulations suggesting a critical population quarantine ‘half-life’ of 30 days independent of other model parameters.

"Panic From Covid-19" - Autonomic Dysfunction In An Elite Tennis Player.

HISTORY: An 19 year old elite tennis player presented to the sports medicine clinic with complaints of persistent fatigue and underperformance following a SARS-COVID-19 (PCR+) infection. The athlete lives at a high performance academy and is home schooled at the academy. She tested positive at end of July (mostly systemic viral symptoms without dyspnoea) and followed the well accepted “return to sport programme” but now 3 months later still complains of inability to progress with her return to sport based on an extremely rapid rise in heart rate and episodes of fatigue. She also co persistent sore throat & anosmia. Previous medical history -non contributary except for previous sleep disorder and low ferritin at times. MEDICATIONS: Methylfenidate 10 mg daily, (increased to 36 mg daily) Oral iron supplement, melatonin, Vit C & D supplement. Physical examination revealed normal general, cardiovascular, neurological and respiratory systems. BP 130/70, Pulse rate 50 regular. Blood lab values for CBC, Ferritin, Vit D, U&E, D-dimer and CRP all WNR. SPECIAL INVESTIGATIONS: Resting ECG - Normal sinus rhythm 41 bpm - no conduction or other abn.Echo - Normal study - no TR or PR despite provocationStress Echo - appropriate increase in systolic function and increasing diastolic function during exercise. RV function response to exercise normal, Direct laryngoscopy-normal. Patient was discharged with reassurance that fatigue will abate over time and to continue to have mild exercise under the guidance of an athletic trainer. She is to monitor her fatigue-like symptoms. Three months later, she returned to the clinic complaining of “panic attacks” and requested referral to a psychologist. She describes the attacks as “impending death” rapid heart rate and sweatiness. On examination, all systems normal. BP 126/76 mmHg pulse rate 56 bpm. However on standing up suddenly after the examination, she appeared pale and claimed to be having a panic attack. Pulse rate on standing 133 bpm and BP 90/70 mmHg. She immediately recovered after 30 sec of placement in supine position with legs raised. DIAGNOSIS: Autonomic dysfunction possibly COVID induced. However, symptoms resolved over the next month and also coincided with withdrawal of methylfenidate. She is well at present 6 months later, and has returned to tennis training without symptoms.

Combination of Hua Shi Bai Du granule (Q-14) and standard care in the treatment of patients with coronavirus disease 2019 (COVID-19): A single-center, open-label, randomized controlled trial

ObjectiveTo evaluate the efficacy and safety of Hua Shi Bai Du Granule (Q-14) plus standard care compared with standard care alone in adults with coronavirus disease (COVID-19). Study DesignA single-center, open-label, randomized controlled trial. SettingWuhan Jinyintan Hospital, Wuhan, China, February 27 to March 27, 2020. ParticipantsA total of 204 patients with laboratory-confirmed COVID-19 were randomized into the treatment group and control group, consisting of 102 patients in each group. InterventionsIn the treatment group, Q-14 was administered at 10 g (granules) twice daily for 14 days, plus standard care. In the control group, patients were provided standard care alone for 14 days. Main Outcome MeasureThe primary outcome was the conversion time for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral assay. Adverse events were analyzed in the safety population. ResultsAmong the 204 patients, 195 were analyzed according to the intention-to-treat principle. A total of 149 patients (71 vs. 78 in the treatment and control groups, respectively) tested negative via the SARS-CoV-2 viral assay. There was no statistical significance in the conversion time between the treatment group and control group (Full analysis set: Median [interquartile range]: 10.00 [9.00-11.00] vs. 10.00 [9.00-11.00]; Mean rank: 67.92 vs. 81.44; P = 0.051). The recovery time for fever was shorter in the treatment group than in the control group. The disappearance rate of symptoms like cough, fatigue, and chest discomfort was significantly higher in the treatment group. In chest computed tomography (CT) examinations, the overall evaluation of chest CT examination after treatment compared with baseline showed that more patients improved in the treatment group. There were no significant differences in the other outcomes. ConclusionThe combination of Q-14 and standard care for COVID-19 was useful for the improvement of symptoms (such as fever, cough, fatigue, and chest discomfort), but did not result in a significantly higher probability of negative conversion in the SARS-CoV-2 viral assay. No serious adverse events were observed. Trial RegistrationChiCTR2000030288

Intradermal needling combined with heat-sensitive moxibustion for moderate to severe cancer pain

To observe the effect of intradermal needling combined with heat-sensitive moxibustion for moderate to severe cancer pain. A total of 60 patients with moderate to severe cancer pain were randomly divided into an observation group and a control group，30 cases in each one. In the control group，opioids were taken to relief pain according to the three-step analgesic method of World Health Organization. On the base of the treatment as the control group, intradermal needling combined with heat-sensitive moxibustion were applied at Neiguan (PC 6), Hegu (LI 4), Zusanli (ST 36), Taichong (LR 3), etc. in the observation group, 14 days of treatment were required. The equivalent morphine consumption at the first day and whole course, the scores of cancer quality of life questionnaire-C30 (QLQ-C30) and Hamilton anxiety scale before and after treatment, and the adverse reaction rate were compared in the two groups. The total analgesic effective rate was evaluated. The total analgesic effective rate was 93.3% (28/30) in the observation group, higher than 73.3% (22/30) in the control group (P<0.05). The total equivalent morphine consumption in the observation group was less than the control group (P<0.05). After treatment, the QLQ-C30 scores were increased (P<0.001) and the HAMA scores were decreased (P<0.001) in the both groups, and those in the observation group were superior to the control group (P<0.001). The adverse reaction rates of fatigue, dizziness, nausea and vomiting, constipation in the observation group were lower than the control group (P<0.05). Intradermal needling combined with heat-sensitive moxibustion can reduce the dose of opioids, improve the quality of life, relief the anxiety in patients with moderate to severe cancer pain, and reduce the incidence of common adverse reaction of opioids.