Physical Fatigue Research Articles

The effect of singing or playing melodica on disease symptoms, self-efficacy level and exercise capacity in chronic obstructive pulmonary patients: a randomized controlled study.

The aim of this randomized controlled experimental study is to determine the effect of singing or playing melodica activity applied to COPD patients on their symptoms, self-efficacy levels, and exercise capacities. The study was carried out in the chest diseases polyclinics of a hospital in Turkey between September 2020 and August 2021 with 30 patients: 15 in the control group and 15 in the song/melodica group. The data were collected with a patient information form and the scales examining disease symptoms, self-efficacy, and exercise capacity. The physical symptom, anxiety, Borg dyspnea, and fatigue scores of the disease in the post-test were significantly lower in the patients in the song/melodica group than those in the control group. In the post-test, the self-efficacy level, walking distance values were found to be significantly higher in the song/melodica group than in the control group. It is concluded that singing or playing melodica was an effective method in reducing the symptoms of the disease and enhancing the level of self-efficacy and exercise capacity in COPD patients.

Investigating the Comparative Effectiveness of Yoga and Relaxation Therapy on Restlessness, Fatigue and Difficulty Concentrating in Multiple Sclerosis Patients

Background: Multiple sclerosis (MS) is a long-term autoimmune disorder affecting the central nervous system, leading to reduced quality of life and impaired physical and psychological functions. Objectives: This study aims to examine the relative efficacy of yoga and relaxation therapy in improving sleep disturbances, fatigue, and cognitive impairment among individuals diagnosed with MS. Methods: This study employed a semi-experimental research design, including a pre-test, post-test, and follow-up over three months. The target population comprised all MS patients referred to the Iranian MS Association in Tehran between July and November 2023. Sixty participants were selected using purposive sampling and randomly assigned to research groups: Two yoga therapy groups with 17 participants each, a relaxation therapy group with 16 participants, and a control group with 18 participants. The yoga therapy group participated in twelve 90-minute sessions twice a week, while the control group received no intervention and was placed on a waiting list. Various tools, including the Multidimensional Fatigue Inventory (MFI), Cohen-Mansfield Agitation Inventory (CMAI-O), and a concentration skills questionnaire, were used to collect data. The data were analyzed using ANOVA, Bonferroni post hoc test, MANCOVA, and Kruskal-Wallis H tests with a significance level of 0.05, utilizing SPSS 27 software. Results: The study found a significant difference (P < 0.001) in the restlessness factor in both the post-test and follow-up phases. Additionally, there was a significant difference (P < 0.001) in the levels of physical fatigue, mental fatigue, decreased activity, and decreased motivation in both the post-test and follow-up phases, indicating significant changes in the fatigue factor among the research groups. However, there was no significant difference in the general fatigue component between the research groups. A significant difference (P < 0.001) was also found in the concentration factor, particularly in the components of voluntary and involuntary concentration, during both the post-test and follow-up stages. Conclusions: The results of this study indicate that both yoga and relaxation therapy techniques significantly reduce restlessness, physical tiredness, mental fatigue, decreased activity, and decreased motivation. Furthermore, the findings validate that both yoga and relaxation therapy techniques effectively enhance voluntary and involuntary concentration.

The development of physical state and exhaustion factors monitoring system with capability of collecting, estimating and analysing data for military personnel

The purpose of the research analysis of known invasive and non-invasive examination methods, determination of the necessary criteria for assessing the degree of fatigue of submariners, a survey of Navy personnel involved in service on submarine ships was conducted, on the basis of which a justification of research directions was carried out for the subsequent development of a system for collecting, evaluating and analyzing the physiological state and factors affecting the fatigue of military personnel.Methods: the use of an experimental non-invasive research method to determine the degree of fatigue and physiological condition of submariners based on three criteria during the month, the analysis of the results obtained, the establishment of a comparative analysis method during the development, a structural analysis of the system based on previously known devices and sensors.Results. The dependence of the studied indicators on the time of watch keeping and their connection with the increase in fatigue were found. It has been established that in order to develop a system for monitoring the fatigue of submariners, a systematic analysis and objective assessment should be carried out, including: determination of methods for monitoring the condition of military personnel; application of knowledge from medicine, physiology, biophysics, biomechanics, bioengineering, electronics, circuitry and programming, to develop effective methods for monitoring physical condition and fatigue. Based on the analysis of domestic and foreign techniques and devices, a proprietary method for implementing a system for collecting assessments, analyzing the physiological state and factors affecting the fatigue of military personnel is proposed.Conclusion. It is concluded that it is necessary to conduct non-invasive studies of the degree of fatigue, before proposing the development and proposal of its own device and methodology for assessing the degree of fatigue, capable of implementing individual features of the system for operational monitoring in order to improve combat readiness, situational awareness, health, safety, mobility of submariners.The development of such monitoring systems and devices is necessary in the modern world to prevent or prevent disasters without reducing the efficiency of submariners.

Patient-Reported Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and can progress to serious complications, including metabolic dysfunction-associated steatohepatitis (MASH), cirrhosis, end-stage liver disease, and hepatocellular carcinoma. Predisposing risk factors for MASH include obesity, type 2 diabetes, dyslipidemia, and metabolic syndrome. Patients with MASH often experience significant impairments in their health-related quality of life and other patient-reported outcomes (PROs), particularly in physical functioning domains, fatigue, and vitality. Incorporating PROs offers valuable insights into patients' perspectives on their symptoms, treatment efficacy, and overall well-being, thereby guiding more holistic and patient-centered care strategies. This review aims to investigate the utilization of patient-reported outcome measures (PROMs) in the context of MASLD and MASH care, identify which PROMs are employed, and summarize the outcomes reported.

Switching treatment to cipaglucosidase alfa plus miglustat positively affects patient-reported outcome measures in patients with late-onset Pompe disease.

Late-onset Pompe disease (LOPD), a rare autosomal recessive multisystemic disorder, substantially impacts patients' day-to-day activities, outcomes, and health-related quality of life (HRQoL). The PROPEL trial compared cipaglucosidase alfa plus miglustat (cipa+mig) with alglucosidase alfa plus placebo (alg+pbo) in adult patients with LOPD over 52weeks and showed improved motor and respiratory function in patients switching treatment from standard-of-care enzyme replacement therapy (ERT) to cipa+mig at baseline. This study evaluated the impact of cipa+mig on patient-reported outcomes (PROs), including HRQoL in ERT-experienced patients, using data from PROPEL. PROs evaluated included the Subject's Global Impression of Change (SGIC), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 20a, PROMIS Fatigue Short Form 8a, Rasch-built Pompe-specific Activity (R-PAct), and European Quality of Life-5 Dimensions 5 Response Levels (EQ-5D-5L). The proportions of responders in the cipa+mig arm and the alg+pbo arm were compared via chi-squared or Fisher's exact test (patient-level responder analysis), and least squares (LS) mean differences were calculated for change from baseline at Week 52 of the PRO measures (group-level analysis). At Week 52, patient-level SGIC responder and group-level SGIC analyses favored cipa+mig compared with alg+pbo across all SGIC domains (e.g. 90 vs. 59% responders in the cipa+mig vs. the alg+pbo group for SGIC ability to move around; P = 0.0005; and LS mean difference 0.385; P = 0.02). Similarly, PROMIS Physical Function and Fatigue domains numerically favored cipa+mig in both analyses (e.g. 50 vs. 40% responders in the cipa+mig vs. alg+pbo arm for PROMIS Physical Function; P = 0.37; and LS mean difference 3.1; P = 0.11). R-PAct for both treatment groups was similar in the patient-level responder analysis, but numerically favored alg+pbo in the group-level analysis (35% responders in both arms; P = 0.95; and LS mean difference -0.8; P = 0.48). Self-care, usual activities, and depression/anxiety domains of EQ-5D-5L numerically favored cipa+mig in both analyses (e.g. 20 vs. 12% responders in the cipa+mig vs. alg+pbo arm for EQ-5D-5L self-care; P = 0.54; and LS mean difference -0.108; P = 0.52). Overall, switching treatment from alglucosidase alfa to cipa+mig positively impacted PRO measurements during the double-blind period of PROPEL. NCT03729362; Registration date: November 1, 2018; https://clinicaltrials.gov/study/NCT03729362.

Study on the Impact of Hormone Therapy for Prostate Cancer on the Quality of Life and the Psycho-Relational Sphere of Patients: ProQoL.

Prostate cancer and its treatment, particularly androgen deprivation therapy (ADT), can profoundly impact patients' quality of life. The aim of the prospective observational study reported here was to evaluate the effects of ADT on various aspects of quality of life in men with prostate cancer at a community-based hospital in Southern Italy. Eligible men initiating hormonal therapy were recruited between December 2021 and December 2023. Data were collected at baseline (T0) and after 3months (T1) and 6months (T2) of ADT using standardized questionnaires (European Organization for Research and Treatment of Cancer [EORTC] QLQ-C30, EORTC QLQ-PR25) and semi-structured interviews. Of the 52 participants, 43 completed all three assessments. The EORTC QLQ-C30 showed a statistically significant worsening in physical functioning (mean score decrease from 83.8 at T0 to 76.7 at T2; p < 0.001), increased fatigue (from 23.7 to 35.2; p < 0.001), and insomnia (from 23.7 to 31.8; p = 0.048) following ADT initiation. The QLQ-PR25 revealed a significant decline in sexual functioning (from 59 to 26.9; p < 0.001) and sexual activity (from 27.3 to 12; p = 0.001). Interviews revealed a significant rise in the number of patients reporting depressed mood. Interviews also highlighted a worsening in body image perception and sexuality, increased feelings of dependence, and challenges in the social and relational spheres. ADT significantly impacts various aspects of quality of life in men with prostate cancer, particularly physical functioning, fatigue, sexual function, body image, and emotional well-being. These results underscore the critical importance of a comprehensive, patient-centered approach that addresses both the physical and psychosocial aspects of care.

Trends in the practice environment of Chinese healthcare professionals from 2008 to 2023: an age period cohort analysis.

Healthcare practice environment plays a vital role in evaluation and the development of health sector in China. However, there are few comprehensive reviews and studies focusing on its state and changing trends. This study aimed to examine the dynamic trends in Chinese healthcare professionals' perceptions of their practice environment from 2008 to 2023 using age period cohort (APC) analysis. Four national cross-sectional surveys of healthcare professionals were conducted in 2008, 2013, 2018, and 2023. APC analysis was performed to distinguish effects of age, period and cohort. Covariates like gender, department, job satisfaction, and doctor-patient relationships were also analyzed. Between 2008 and 2023, healthcare professionals' perceptions of their practice environment first declined and then improved. Those aged 28-38 during 2013-2018 and born between 1978 and 1988 had the most negative perceptions. After 2018, perceptions improved, peaking in 2023. Those under 23 and over 43 exhibited larger age effects. Birth cohorts after 1993 also had more positive effects. Controlling for covariates attenuated APC effects. Females, those in obstetrics and emergency medicine, nurses, technicians, and administrators perceived better environments. Higher job satisfaction and doctor-patient relationship harmony are also associated with more positive perceptions. Income matching efforts and perceptions of promotion fairness had positive impacts, while increasing severity of physical fatigue and psychological anxiety negatively influenced perceptions of the practice environment. The APC analysis provided nuanced insights into evolving practitioner perceptions amid healthcare reforms in China. Tailored policies focused on career stage and generation are needed to address disruptions and sustain improvements. Monitoring feedback on reforms and changes is essential for optimizing the practice environment over time.

Nursing as an earthquake survivor: A qualitative study on nurses traumatized by the Kahramanmaraş earthquake in Turkey.

Nurses' critical input and firsthand disaster management experience are vital to healthcare quality. This study aims to comprehend nurses' experiences during and after the earthquakes, their coping mechanisms for posttraumatic stress disorder (PTSD), and the consequent effects on their profession, given the nurses' crucial role in disaster response. A descriptive qualitative study using semistructured interviews was conducted between April and May 2024. Fifteen nurses were selected using criterion and snowball sampling methods from those working as earthquake survivor nurses in the affected areas. The COREQ guidelines for reporting qualitative research were followed. Five main themes were: emotional reactions/physical difficulties, career and motivation, PTSD and well-being, suggestions, and work performance. The results highlighted the significant psychological and professional challenges that nurses encounter, including the effects of severe PTSD symptoms, coping strategies, and the influence on their capacity to deliver care. Nurses dealing with earthquakes face unique challenges that test their resilience on all levels. Learning from their experiences and coping mechanisms can help healthcare systems support these frontline workers better. Investing in disaster preparedness and mental health resources for nurses is crucial for their well-being and the overall strength of the healthcare system during crises. Effectively managing workloads and rest periods can reduce physical fatigue and prevent burnout. Shift rotations and adequate staffing levels are necessary. Access to psychological mental health support is vital for nurses to recover from the psychological effects of disasters. Regular disaster preparedness training is imperative for physical safety and psychological resilience. Robust support systems, including safe accommodation and peer support groups, are crucial for nurses in disaster response.

Abstract 4137636: Cardiac radiation dose and changes in physical activity and quality of life in patients with locally advanced lung cancer

Background: Physical activity is associated with prognosis in cancer. However, in non-small cell lung cancer (NSCLC), a high cardiovascular (CV) population, the relationships between RT dose, physical activity, and CV patient-reported outcomes remain unclear. We determined the associations between cardiac radiation dose-volume metrics and changes in physical activity and quality-of-life (QoL) in patients treated with definitive chemoradiation. Methods: NSCLC participants treated with chemoradiation were enrolled in a multi-center longitudinal cohort study. Self-reported physical activity via Godin–Shephard Leisure-Time Physical Activity Questionnaire (Godin) and QoL via Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue and Dyspnea Scales were collected at baseline, end of RT, 6, and 12 months post-RT. Changes in Godin and FACIT scores over time were examined using linear mixed-effects models. Multivariable linear regression via generalized estimating equations assessed the associations between: 1) mean heart dose (MHD) and longitudinal changes in physical activity and QoL, and 2) concurrent changes in physical activity and FACIT scores. Results: Across 101 participants, the mean age was 66 years, with 57% male, 66% White, and 25% Black. The median (Q1, Q3) MHD was 10.8 Gy (6.1,16.3). Very low physical activity [9 (0, 25)], high dyspnea [4 (1, 9)], and low fatigue [39 (31,46)] were reported at baseline. With chemoRT, there was a significant worsening of physical activity ( P = 0.03), fatigue ( P &lt; 0.001), and dyspnea ( P &lt; 0.001). Each 1-Gy increase in MHD was associated with a modest decline in physical activity (-0.28; 95% CI -0.53, -0.02, P = 0.03), and higher physical activity was associated with a concurrent decrease in fatigue ( P &lt; 0.001) and dyspnea ( P = 0.007) (Table). Conclusions: In locally advanced NSCLC, physical activity levels prior to RT were very low, and higher cardiac radiation dose was associated with a further decline in physical activity. Increased physical activity was associated with concurrent decreases in fatigue and dyspnea. Strategies to promote physical activity may result in improved QoL in this high CV group.

Analysis of Occupational Safety and Health at Oil Plus Filling Station Installations: Literature Review

Background: Public Fuel Filling Station Installation which is an installation for distributing fuel oil into motor vehicle fuel tanks, with a significant risk of danger. The number of work accidents that occur at fuel filling stations continues to increase from 2018-2020. Program Safety and health need to be pursued to protect workers from the possibility of accidents and work-related diseases. Objective: This research aims to determine potential dangers and prevent accidents and occupational diseases among fuel station workers. Method: This research uses the "PRISMA" literature review method (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidances and The data source for this research comes from literature search results on the internet from databases from Science Direct and ResearchGate. Using keywords “Occupational health and safety for fuel filling installation workers” “Occupational health and safety for Hydrogen and Gas Refuelling Station” “Occupational health and safety for Electrical Vehicle” published in the last five years, from 2019 to 2024, which are indexed Q1, Q2 and Q3. Results: As many 5,657 journals were found, but 10 journals were selected that met the inclusion and exclusion criteria. Potential dangers that threaten fuel station workers include: physical factors namely physical fatigue and noise and hearing problems. Chemical factors namely toxic gasses, dangerous liquids and BTEX gas (benzene, toluene, ethylbenzene, p-xylene, o-xylene, dan m-xylene). Physiological factors, psychological fatigue and quality of work life. Safety climate as an effort to prevent accidents and work-related illnesses by implementing management safety priority and ability, management safety empowerment and management safety justice. Conclusion: Potential dangers that threaten fuel station workers are: physical factor, chemical factor and psychological factor. Safety climate by implementing safety management priorities and capabilities, management safety empowerment, and management safety justice, as well as compliance with occupational safety and health regulations such as the use of personal protective equipment to reduce the risk of danger and thus reduce the occurrence of work accidents.

Circadian Rhythm and Physical Fatigue Separately Influence Cognitive and Physical Performance in Amateur Athletes

Background/Objectives: Circadian rhythm (CR) influences various physiological functions, including physical and cognitive performance, which fluctuate throughout the day. The present study aimed to investigate the combined and separate effects of CR and physical fatigue on cognitive and physical performance. Methods: A sample of 18 amateur athletes was subjected to a series of tests at three different times of the day: morning, afternoon, and evening. Fatigue was induced following an isokinetic concentric exercise combined with a 20 min treadmill run, followed by assessments of selected physical and cognitive tasks. Results: A repeated measure ANOVA did not reveal an interaction between CR and fatigue in cognitive performance (p &gt; 0.05). However, a significant main effect of fatigue was observed in visual reaction time (VisRT) across all three timepoints. Moreover, peak torque (PT) and the peak torque fatigue index (PTFI) showed significant differences between the three times of the day, peaking in the evening. Conclusions: Although we found no interaction between CR and the physical fatigue state on selected cognitive parameters at the three times of the day, a separate effect of fatigue on cognitive performance was identified. Additionally, physical parameters exhibited peak values occurring in the evening hours. Future research should further explore underlying mechanisms that potentially influence cognitive performance at different times of the day.

Employment status of multiple sclerosis patients in Japan

Aims We conducted a questionnaire survey on Japanese MS patients to determine the relationship of fatigue, depression, and physical activity limitations with the employment status. Materials and Methods The study was conducted to assess the Patient Reported Outcome of MS patients treated with disease modifying drug ≥6 months by recruiting MS patients from a web-based patient panel. Multiple regression analysis was performed by using items described in the Work Productivity and Activity Impairment Questionnaire-General Health Version 2.0 (WPAI-GH) and Fatigue Severity Scale (FSS), Quick Inventory of Depressive Symptomatology (Self-Report) (QIDS-SR), and Patient Determined Disease Step (PDDS). Results Employment rates decreased after MS development and were more pronounced in the group with advanced physical disability with PDDS score ≥ 3. Health-related activity limitations were higher with advanced disability. In the analysis of the 5 subdomains of WPAI-GH by FSS score, the domains “due to health reasons”, “disability rates during work”, “overall work disability among the employed”, and” health-related limitations” all increased with higher FSS scores.” In WPAI-GH by QIDS-SR, the work disability rate was higher in the depressed group than in the normal group, and health-related activity limitations increased with the greater depression. Limitations This is a cross-sectional survey and data are based on PRO, hence are subjective and are collected based on patients' overall responses. Some bias could be attributed to memory and literacy rates as this is an online survey. Conclusions The results suggested that the onset of MS prevented patients from working and forced them to resign from their jobs or give up full-time work. The rate of employment tended to be lower in the group with advanced limitations; suggesting that controlling the progression of limitations may lead to lower turnover, and the rate of health-related activity limitations was correlated with the degree of physical activity limitations, depression, and fatigue, respectively.

Research on the Application of Multi-ball Training Method in Table Tennis Training in Colleges and Universities

This paper aims to explore the practical application effect and strategy of multi-ball training method in table tennis training in colleges and universities. As an efficient and systematic training method, multi-ball training method has significantly improved the technical proficiency, physical fitness level and competition adaptability of athletes through continuous and repeated hitting practice. The study also pointed out that when applying multi-ball training method, we should pay attention to following the principle of moderation to avoid overtraining leading to physical fatigue and injury of athletes; At the same time, we should fully consider the individual differences of athletes and make personalized training plans; In addition, the importance of technical details should be emphasized to ensure that athletes form correct technical action stereotypes in training. Therefore, it is suggested that table tennis coaches in colleges and universities actively adopt this method in teaching and training to improve the quality and effect of training.

A Randomized Controlled Trial of Gamification to Increase Physical Activity Among Black and Hispanic Breast and Prostate Cancer Survivors: Rationale and Design of the ALLSTAR Clinical Trial

Survivors of breast and prostate cancer, especially those that are Black and/or Hispanic, are at high risk for cardiovascular events. Physical activity can reduce the risk of cardiovascular events in cancer survivors, but Black and Hispanic people are less likely to engage in routine physical activity. Concepts from behavioral economics have been used to design scalable, low-touch, gamification interventions that increase physical activity in individuals at high risk for cardiovascular events, but the effectiveness of these strategies in Black and Hispanic survivors of breast and prostate cancer is uncertain. ALLSTAR (NCT05176756) is a pragmatic, virtual, randomized controlled trial designed to evaluate the effectiveness of a gamification intervention informed by behavioral economic concepts to increase daily physical activity in Black and Hispanic breast and prostate cancer survivors who received cardiotoxic therapies and have additional risk factors for cardiovascular disease. Patients were either referred by their cancer care team or identified by electronic health record searches; contacted by letter, email, text message and/or phone; and complete enrollment and informed consent on the Penn Way to Health online platform. Patients are then provided with a wearable fitness tracker, establish a baseline daily step count, set a goal to increase daily step count by 1500-3000 steps from baseline, and are randomized 1:1 to control or gamification. Interventions continue for 6 months, with follow-up for an additional 3 months to evaluate the durability of behavior change. The trial has met its enrollment goal of 150 participants, with a primary endpoint of change from baseline in daily steps over the 6-month intervention period. Key secondary endpoints include change from baseline in daily steps over the 3-month post-intervention follow-up period, change in moderate to vigorous physical activity over the intervention and follow-up periods, and change in patient-reported measures of physical function, fatigue, and overall quality of life. ALLSTAR is a virtual, pragmatic randomized clinical trial powered to demonstrate whether gamification is superior to control in increasing physical activity in Black and Hispanic breast and prostate cancer survivors. Its results will have important implications for strategies to promote physical activity in survivors of breast and prostate cancer, specifically among minority populations. clinicaltrials.gov; https://clinicaltrials.gov/study/NCT05176756.

Cognitive and physical fatigue: the experience and consequences of brain fog after spontaneous coronary artery dissection, a qualitative study

Abstract Background Mild cognitive impairment (often subjectively referred to as "brain fog") and cognitive fatigue are common sequelae after acute coronary syndrome. However, little is known about the nature and impact of these experiences in spontaneous coronary artery dissection (SCAD) survivors. Purpose To understand if and how brain fog and cognitive fatigue are experienced following SCAD. Methods Participants were recruited from a larger SCAD genetics study database and were considered eligible if they had experienced SCAD within 12 months. Seven semi-structured online focus groups, with the primary aim of exploring psychosocial impacts of SCAD, were conducted between December 2021 and January 2022. Each focus group lasted for 1 hour 30 minutes and were led by investigators extensively experienced in qualitative research and cardiac rehabilitation. Interviews were digitally recorded, transcribed verbatim, and thematically analysed using Braun and Clark’s reflexive approach. Results Participants (n=30) had a mean age of 52.2±9.5 years and mostly female (n=27, 90%), partnered (n=27, 90%) and employed (n=27, 90%). Four main themes were identified: experiences of brain fog, perceived causes of brain fog, impacts of brain fog and coping with brain fog. Experiences of brain fog included memory lapses, difficulty concentrating and impaired judgement. Perceived causes of brain fog included medication, sleep deprivation and tiredness, and menopause and hormonal changes. The impacts of brain fog included rumination, changes in self-perception, disruption to hobbies and pastimes, and limitations at work. Coping mechanisms used for these challenges included reminders, setting expectations, being one's own advocate, making lifestyle adjustments, and support from peers. Conclusion Brain fog is commonly experienced by SCAD survivors and present challenges to normal life after SCAD. The impacts on daily life are varied, including those relating to self-perception and capacity to work. SCAD survivors reported difficulty understanding causes and found their own path to coping. Clinicians should be aware of these experiences as they are ideally placed to assist patients with these challenges.

Prognostic value of patient-reported outcomes in advanced or metastatic melanoma patients treated with immunotherapy: Findings from the CheckMate-067 study

ObjectivePatient-reported outcomes (PROs) that predict survival in cancer patients have yet to be realized as practical tools for clinicians to make better treatment decisions. To identify such PROs in adults with advanced melanoma treated with immunotherapy, this study used 7.5-year follow-up data from CheckMate-067, a phase 3, randomized, double-blind study of nivolumab or nivolumab plus ipilimumab versus ipilimumab. MethodsPRO data assessed using the European Organization of Research for the Treatment of Cancer Core-30 and EQ-5D-3L at baseline and during subsequent visits after treatment initiation were pooled across treatment arms. Associations between baseline PRO or change from baseline (CFB) scores with survival outcomes (progression-free survival [PFS], overall survival [OS], and melanoma-specific survival [MSS]) were examined using Cox proportional hazards models for PFS or OS and cause-specific hazard models for MSS. ResultsBaseline and CFB scores for most PRO domains, especially for physical functioning, global health status/quality of life (GHS/QoL), fatigue, and EQ-5D visual analog scale (VAS), were prognostic of all survival outcomes. Achieving meaningful improvement/maintenance of baseline PRO scores at 12 weeks following treatment initiation predicted better survival outcomes than with meaningful worsening from baseline. ConclusionsPROs at baseline and during treatment, particularly for physical functioning, GHS/QoL, fatigue, and EQ-VAS, were prognostic of survival outcomes. This knowledge may accelerate development of prognostic tools to manage treatment in patients with previously untreated unresectable or metastatic melanoma who undergo immunotherapy.

Associations Between Physical, Cognitive, and Mental Health Domains of Post-Intensive Care Syndrome and Quality of Life: A Longitudinal Multicenter Cohort Study.

To explore associations between the physical, cognitive, and mental post-intensive care syndrome (PICS) health domains with changes in health-related quality of life (HRQoL) following ICU admission. A longitudinal prospective multicenter cohort study. Patients (n = 4092) from seven Dutch ICUs. None. At ICU admission, 3 and 12 months post-ICU, patients completed validated questionnaires regarding physical health problems, cognitive health problems, mental health problems, and HRQoL. Composite scores were created for the physical health domain (physical problems and fatigue) and mental health domain (anxiety, depression, and post-traumatic stress disorder). Adjusted multivariable linear regression analyses were performed, including covariables (e.g., patient characteristics, disease severity, pre-ICU HRQoL, etc.) to explore associations between the physical, cognitive, and mental health domains of PICS and changes in HRQoL at 3 and 12 months post-ICU. At 3 months (n = 3368), physical health problems (β = -0.04 [95% CI, -0.06 to 0.02]; p < 0.001), cognitive health problems (β = -0.05 [95% CI, -0.09 to -0.02]; p < 0.001), and mental health problems (β = -0.08 [95% CI, -0.10 to -0.05]; p < 0.001) were negatively associated with changes in HRQoL. Also, at 12 months (n = 2950), physical health problems (β = -0.06 [95% CI, -0.08 to -0.03]; p < 0.001), cognitive health problems (β = -0.04 [95% CI, -0.08 to -0.01]; p < 0.015), and mental health problems (β = -0.06 [95% CI, -0.08 to -0.03]; p < 0.001) were negatively associated with changes in HRQoL. PICS symptoms in the physical, cognitive, and mental domains are all negatively associated with changes in HRQoL at 3 and 12 months post-ICU. At 3 months, PICS symptoms in the mental domain seem to have the largest negative associations. At 12 months, the associations of PICS in the mental and physical domains are the same. This implies that daily ICU care and follow-up care should focus on preventing and mitigating health problems across all three PICS domains to prevent a decrease in HRQoL.

Examining the Independent and Interactive Carryover Effects of Cognitive and Physical Exertions on Physical Performance.

This study compared the effects of prior cognitive, physical, and concurrent exertion on physical performance. Fatiguing cognitive and physical exertions have been shown to negatively affect subsequent task performance. However, it is not clearly understood if concurrent physical and cognitive effort may exaggerate the negative carryover effects on physical task performance when compared to cognitive or physical exertion alone. Twenty-five participants completed four isometric handgrip endurance trials on different days. The endurance trials were preceded by four, 15-minute experimental manipulations (cognitive, physical, concurrent, control). Electromyography (EMG) and force tracing performance were monitored, with handgrip strength measured pre and post. Subjective ratings of mental and physical fatigue, as well as affect, motivation, and task self-efficacy, were also assessed. Handgrip strength decreased following both physical (-14.4% MVC) and concurrent (-12.3% MVC) exertion manipulations, with no changes being observed for the cognitive and control conditions. No differences were observed across conditions for endurance time, EMG, nor tracing performance. When compared to the control conditions, perceptions of mental and physical fatigue were higher following the experimental manipulation. Endurance trial self-efficacy was lower for the mental, physical and concurrent conditions compared to control. The concurrent condition resulted in similar decreases in strength as the physical fatigue condition, but otherwise resulted in similar carryover effects on endurance performance across all conditions. Further study is required at higher exposure levels, or for longer exposure durations, to further probe the influence of concurrent physical and cognitive effort on task performance. Concurrent cognitive and physical effort resulted in similar physical performance decrements to physical effort alone.

Incidentes críticos envolvendo graduandos de Enfermagem durante a Pandemia de COVID-19

Introduction: The academic environment is considered stressful for students. Knowing the changes in teaching-learning activities and their impacts has become essential to redirect new ways of interacting and facing such adverse situations. Thus, one of the ways to evaluate a situation experienced is by drawing parallels between the behaviors and feelings generated, through the critical incident technique (TIC). Objective: To identify critical incidents (situation, behaviors and feelings) related to academic activities during the COVID-19 pandemic. Method: Descriptive study based on the critical incident technique. The students were recruited via e-mail to inform the characterization items; they were asked to remember an academic situation and report it, listing the behaviors experienced and the feelings that originated. Results: Among the 24 situations, most portrayed the accumulation of tasks, difficulty in dealing with a new way of teaching, difficulties in adapting teachers and students to the strategies used regarding the overlapping of academic and domestic activities. Regarding the behaviors, lack of dialogue, difficulties in adapting activities and acts of understanding were mentioned. As for feelings, the positive ones were gratitude, understanding, feeling of support, learning, happiness; as for the negative ones, anxiety, sadness, anguish and physical fatigue stand out. Conclusion: This study identified critical incidents of nursing students during the pandemic. The data indicate that students experienced great stress during the period, but the impacts on professional training require further studies. Descriptors: Nursing; Teaching; Behavior; Pandemics; Adaptation, Psychological

The effect of recreational therapy application on fatigue in hemodialysis patients: a randomized clinical trial

BackgroundChronic Kidney Disease (CKD) is a progressive disorder that often leads to End-Stage Renal Disease (ESRD), necessitating hemodialysis (HD) treatment. Fatigue is a prevalent and debilitating symptom among HD patients, significantly affecting their quality of life. Recreational Therapy (RT) is a therapeutic recreational service designed to maintain and restore a person’s level of performance and independence in daily activities. This study aimed to evaluate the effect of a smartphone-based recreational therapy intervention on fatigue in hemodialysis patients.MethodsThis randomized controlled trial was conducted on HD patients at a hospital in Mashhad, Iran. The intervention group received a custom-designed recreational therapy mobile application, including music, comedy, exercise, and educational content. The control group received standard care. Fatigue was assessed using the Multidimensional Fatigue Inventory (MFI-20) before and after the 30-day intervention.ResultsA total of 72 patients (36 per group) participated in the study. The intervention group demonstrated a significant reduction in overall fatigue scores and improvements across various fatigue dimensions, including general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation, compared to the control group (p < 0.001).ConclusionThe smartphone-based recreational therapy intervention effectively reduced fatigue in hemodialysis patients. This approach could be a valuable complementary strategy for managing fatigue in this population. Further research is needed to explore the long-term sustainability of these benefits and the intervention’s impact on other patient-reported outcomes.Trial registrationThis study was registered in the Iranian Registry of Clinical Trials (no. IRCT20220803055608N1) on 29/08/2022.