Related Fatigue Research Articles

P260 The efficacy of biologic treatment in improving fatigue in ankylosing spondylitis: a literature review and implications for clinical practice

Abstract Background Ankylosing spondylitis (AS) is a chronic, inflammatory condition that predominantly manifests as arthritis in the axial skeleton. AS related fatigue remains under-researched despite evidence that it is an important contributor to the quality of life in these patients. The impact of biologic therapy on fatigue in patients with AS is not fully understood. Furthermore, it is not clear whether any of the licensed biologic drugs are more effective in treating fatigue in AS than others. The aim of this review is to critically appraise the evidence regarding the effectiveness of biologic agents in treating AS associated fatigue to help guide clinical practice. Methods Pre-defined search terms were entered into PubMed and Embase to identify papers studying the effectiveness of etanercept, adalimumab, infliximab, golimumab, certolizumab pegol and secukinumab in AS associated fatigue. Results were restricted to those published in English from 1990 onwards. 64 papers were initially identified and screened using predefined exclusion criteria; of these, 13 were selected for final inclusion. Results No head-to-head studies analysing fatigue were identified and all studies included analysed fatigue as a secondary outcome measure. Most studies utilised a single question fatigue measurement such as the BASDAI fatigue score. Variation in methodology precluded a meta-analysis. There is evidence that all six biologics improve fatigue in AS to varying degrees. For etanercept, three out of four studies found significant improvement compared to placebo at week 12 and week 54. However, one study that utilised a more robust form of fatigue assessment found no significant differences between etanercept and placebo at week 12. For Adalimumab, two studies were identified, both of which were robust and suggested strong efficacy in treating AS associated fatigue at week 12. For infliximab, two out of three studies were open label trials which showed significant improvement in fatigue at week 6. The third study was a post-hoc analysis of a randomised placebo-controlled trial and showed improvement in fatigue scores at week 24. Two studies were identified for Golimumab, both of which showed significant improvement in fatigue scores at week 24 and week 104 respectively. One placebo-controlled trial of certolizumab pegol showed significant improvement in fatigue at week 24. For secukinumab, one study was identified: a post-hoc analysis of a randomised, placebo-controlled trial. This showed a significant improvement in fatigue at week 16; however, this improvement was not sustained at week 104. Conclusion Although none of the studies analysed fatigue as a primary outcome measure, it appears that biologic treatment overall is successful to varying degrees in the treatment of AS associated fatigue. Future studies would benefit from utilising robust fatigue assessments, comparing biologics, and evaluating long-term effectiveness. In addition, vigilance in recognising fatigue and subsequent considered holistic management is paramount. Disclosures R. Amarnani None. A. Soni Grants/research support; Oxford-UCB Prize Fellowship.

Is Multidimensional Fatigue Inventory (MFI-20) adequate to measure brain injury related fatigue?

BackgroundFatigue is a common symptom in patients with acquired brain injury (ABI) related disability while its multidimensionality has never been investigated, and specifically its relationship with patients’ cognitive functioning. ObjectiveThis study aimed to evaluate the validity of the Multidimensional Fatigue Inventory (MFI-20) in patients living with ABI-related disability. MethodsFour hundred twenty-six participants divided in three different groups (ABI-related disability, physical-related disability without an ABI, and healthy volunteers with no disability) were administered the French version of the Multidimensional Fatigue Inventory. We investigated the link between these fatigue measures and neuropsychological assessment in patients with ABI. Performance on this tool was compared according to the group and we calculated normative data for the Multidimensional Fatigue Inventory based on healthy volunteers’ performance. ResultsIn patients with ABI, fatigue measures significantly correlated with neuropsychological measures of attention, memory and executive functions. We found higher scores on Mental Fatigue and Reduced Activities dimensions in patients with ABI in comparison with the patients with physical disability (p < 0.05) and healthy controls (p < 0.01). ConclusionsThe Multidimensional Fatigue Inventory appeared to be a sensitive tool to detect ABI-related fatigue, fatigue levels being higher than in patients with physical disability and in healthy volunteers. As fatigue appeared to be related to memory, executive and attentional functioning of patients with ABI-related disability who often face unemployment, its impact on vocational outcome following ABI should be further investigated.

Identifying the relevant determinants of MS related fatigue: The role of the clinical indicators of disease and personality

Background and objectiveResearch on the factors contributing to multiple sclerosis (MS) related fatigue are far from conclusive. Some studies put forward that clinical aspects of the disease give rise to this symptom whilst others emphasize the effects of psychological factors on its etiology. This study investigated the relationship between clinical aspects of MS and personality with MS fatigue. MethodA total of 201 participants with MS of which 48 (23.9%) males and 153 (76.1%) females took part in this online study. Questionnaires were populated measuring clinical features of the disease (disease duration, type of MS, Expanded Disability Status Scale - EDSS), personality traits, and MS-related fatigue. Data was analyzed by hierarchical regression analyses. ResultsPersonality traits accounted for a greater variance in MS fatigue (R² = .482, p < .01) than clinical aspects of the disease, these results were conclusive after controlling for the sociodemographic variables and depression. Temperament explained in total 10.5% variance of fatigue and character an additional 4.0 %. High Harm avoidance (HA) (β = .229, p < .01) and low Self-directedness (SD) (β = −.217, p < .01) directly predicted fatigue. Also, temperament was shown to indirectly affect fatigue, through character. High HA and high Novelty-seeking (NS) through low SD predicted fatigue. The association between clinical features and fatigue was not observed unless paired with personality traits. EDSS in conjunction with HA and Secondary – progressive MS (SPMS) coupled with SD negatively affected fatigue levels. ConclusionPersonality traits directly and indirectly predicted MS-related fatigue. Furthermore, the impact of clinical indicators of disease on fatigue would not be observed unless these features occurred together with particular personality traits.

Special Issue on Fatigue and Fracture of Non-Metallic Materials and Structures

This Special Issue covers the broad topic of structural integrity of non-metallic materials, and it is concerned with the modelling, assessment and reliability of structural elements of any scale. In particular, the articles being contained in this issue concentrate on the mechanics of fracture and fatigue in relation to applications to a variety of non-metallic materials, including concrete and cementitious composites, rocks, glass, ceramics, bituminous mixtures, composites, polymers, rubber and soft matters, bones and biological materials, advanced and multifunctional materials.

Perioperative fatigue in patients with diffuse glioma

PurposeFew studies have assessed fatigue in relation to glioma surgery. The purpose of this study was to explore the prevalence of pre- and postoperative high fatigue, perioperative changes, and factors associated with pre- and postoperative high fatigue in patients undergoing primary surgery for diffuse glioma.MethodsA total of 112 adult patients were prospectively included. Patient-reported fatigue was assessed before and one month after surgery using the cancer-specific European Organization for Research and Treatment of Cancer questionnaire fatigue subscale. The scores were dichotomized as high fatigue (≥ 39) or low fatigue (< 39). A change in score of ≥ 10 was considered as a clinically significant change. Factors associated with pre- and postoperative high fatigue were explored in multivariable regression analyses.ResultsHigh fatigue was reported by 45% of the patients preoperatively and by 42% of the patients postoperatively. Female gender and low Karnofsky Performance Status (KPS) were associated with preoperative high fatigue, while postoperative complications, low KPS and low-grade histopathology were associated with postoperative high fatigue. In total 35/92 (38%) patients reported a clinically significant improvement of fatigue scores after surgery, 36/92 (39%) patients reported a clinically significant worsening of fatigue scores after surgery, and 21/92 (23%) patients reported no clinically significant change in fatigue scores after surgery. Patients with low-grade gliomas more often reported low fatigue before surgery and high fatigue after surgery, while patients with high-grade gliomas more often reported high fatigue before surgery and low fatigue after surgery.ConclusionsOur findings indicate that fatigue is a common symptom in patients with diffuse glioma, both pre- and postoperatively. Perioperative changes were frequently seen. This is important knowledge when informing patients before and after surgery.

A novel classification of fatigue in multiple sclerosis based on longitudinal assessments

Background: Magnetic resonance imaging (MRI) studies of multiple sclerosis–related fatigue had limited reproducibility. Temporal fatigue fluctuations have not been considered. Objective: To investigate whether a novel group allocation that reflects temporal dynamics of fatigue improves our ability to detect fatigue-associated structural brain abnormalities. Methods: Patient stratification based on biennial fatigue assessments: sustained fatigue (SF, n = 29, fatigued at the latest ⩾2 assessments), one time-point fatigue (1F, n = 15, fatigued at the latest, but non-fatigued at the penultimate assessment), reversible fatigue (RF, n = 31, non-fatigued at the latest assessment, but reported fatigue previously), and never fatigued (NF, n = 54). Brain parenchymal fraction (BPF) and T2 lesion volume (T2LV) were compared between these groups and were derived using a conventional, single time-point fatigued versus non-fatigued stratification. Results: The SF versus NF stratification yielded improved power. SF (p = 0.005) and RF (p = 0.043) showed significantly higher T2LV than NF. T2LV showed no significant differences in SF versus 1F, SF versus RF, or 1F versus RF. Fatigued versus non-fatigued patients showed significantly higher T2LV (p = 0.030). We found no significant differences in BPF between the groups. Conclusion: Taking into account temporal fatigue dynamics increases the statistical power with respect to T2LV and may improve characterization of brain pathological correlates of MS-related fatigue.

Metabolic analysis of amino acids and vitamin B6 pathways in lymphoma survivors with cancer related chronic fatigue.

Chronic cancer-related fatigue (CF) is a common and distressing condition in a subset of cancer survivors and common also after successful treatment of malignant lymphoma. The etiology and pathogenesis of CF is unknown, and lack of biomarkers hampers development of diagnostic tests and successful therapy. Recent studies on the changes of amino acid levels and other metabolites in patients with chronic fatigue syndrome/myalgic encephalopathy (CFS/ME) have pointed to possible central defects in energy metabolism. Here we report a comprehensive analysis of serum concentrations of amino acids, including metabolites of tryptophan, the kynurenine pathway and vitamin B6 in a well characterized national Norwegian cohort of lymphoma survivors after high-dose therapy and autologous stem cell transplantation. Among the 20 standard amino acids in humans, only tryptophan levels were significantly lower in both males and females with CF compared to non-fatigued survivors, a strikingly different pattern than seen in CFS/ME. Markers of tryptophan degradation by the kynurenine pathway (kynurenine/tryptophan ratio) and activation of vitamin B6 catabolism (pyridoxic acid/(pyridoxal + pyridoxal 5'-phosphate), PAr index) differed in survivors with or without CF and correlated with known markers of immune activation and inflammation, such as neopterin, C-reactive protein and Interleukin-6. Among personal traits and clinical findings assessed simultaneously in participating survivors, higher neuroticism score, obesity and higher PAr index were significantly associated with increased risk of CF. Collectively, these data point to low grade immune activation and inflammation as a basis for CF in lymphoma survivors.

Study on Fatigue Characteristics of Carbonation Erosion Prestressed Hollow Slabs in Whole Life Cycle

In this paper, the whole life cycle (failure‐reinforcement‐failure) durability and related fatigue properties of prestressed hollow beam under carbonation erosion environment were studied. According to a 20 m hollow slab beam, the model of prestressed hollow beam was designed and made, and the durability and fatigue tests for the whole life cycle of prestressed hollow beam were carried out. The results showed that the compressive strength and elastic modulus of the specimens increased by about 20% under the action of carbonization erosion. With the increase of fatigue loading cycles, the crack occurrence and development speed of carbonized erosion components were greater than those of healthy components, and the fatigue life decreased sharply from 3 million cycles to 50,000 cycles. Pasting carbon fiber and steel plate had better reinforcement effect on the damaged prestressed plate beam and could help improving the fatigue life of the reinforced component. Comparing the reinforcement of different strengthening methods, it is found that the steel‐plate‐reinforced components have better mechanical properties and antifatigue attenuation characteristics than the carbon‐fiber‐reinforced ones. The research results have important theoretical value for improving the durability of structure and prolonging its service life.

Evaluation of the Value of Nursing Intervention Guidance in Controlling the Fatigue Level of Patients with Breast Cancer

To investigate the effect of the continuous nursing intervention model on postoperative fatigue levels and quality of life in breast cancer patients. A total of 112 patients with breast cancer who received radiotherapy and chemotherapy in the oncology department of our hospital from January 2018 to January 2020 were collected and randomly divided into the observation group (n=56) and the control group (n=56). The general clinical data of the two groups were comparable. Patients in the control group were instructed with conventional nursing interventions, while those in the observation group were given continuous nursing management in addition to conventional nursing care, and their mastery of nursing management health, quality of life and changes in cancer-related fatigue status were assessed by the selfadministered questionnaires, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, and the revised piper fatigue scale, respectively. The results showed that only 35 (62.50 %) patients in the control group were completely compliance, 4 (7.14 %) were partially compliance, and 17 (30.36 %) were non-compliance, while 48 (85.71 %) were completely compliance, 6 (10.71%) were partially compliance, and 2 (3.58 %) were non-compliance in the observation group, the difference between the two groups was statistically significant (p<0.05). After nursing, the quality of life scores of patients in the control group and the observation group were significantly improved, and the revised piper fatigue scale scores decreased significantly, the quality of life of the patients and the cancer related fatigue in the observation group was more significantly improved than that in the control group, and the difference was statistically significant (p<0.05). In the nursing intervention of breast cancer patients, the continuous intervention model can improve the life and mental state of breast cancer patients significantly, to improve their quality of life, alleviate the symptoms of cancer-related fatigue, and promote the rehabilitation of breast cancer patients.

The Effects of Acupuncture on Cancer-Related Fatigue: Updated Systematic Review and Meta-Analysis.

BackgroundSeveral studies have identified fatigue as one of the major symptoms experienced during and after cancer treatment. However, there are limited options to manage cancer related fatigue (CRF) with pharmacological interventions. Several acupuncture studies suggested that acupuncture has a positive impact on CRF. This review aims to assess the evidence of acupuncture for the treatment of CRF.MethodElectronic database searches were conducted on 4 English databases (Medline, PubMed, Embase, and ScienceDirect). Search keywords were; “acupuncture” and “cancer,” or “cancer related fatigue.” Studies published as full text randomized controlled trials (RCTs) in English were included. Estimates of change in fatigue cores were pooled using a random effects meta-analysis where randomized comparisons were available for true acupuncture versus sham acupuncture and true acupuncture versus usual care. The quality of original papers were assessed using the Cochrane Collaboration’s tool for assessing risk of bias (ROB).ResultsNine RCTs were selected for review with a total of 809 participants and a range of 13 to 302 participants within the studies. Six RCTs reported significant improvement of CRF for the acupuncture intervention compared to the control groups. Pooled estimates suggest Brief Fatigue Inventory scores are 0.93 points lower 95% CI (−1.65, −0.20) in true acupuncture versus sham acupuncture and 2.12 points lower 95% C (−3.21, −1.04) in true acupuncture versus usual care. Six studies had low risk of bias (ROB) and 3 studies had a moderate ROB predominantly in blinding of participants, blinding of assessors and incomplete data outcomes. Among the 9 RCTs, 2 studies have reported the occurrence of minor adverse effects (spot bleeding and bruising) related to acupuncture treatment. No serious adverse reactions related to acupuncture were reported.ConclusionThe current literature review suggests that acupuncture has therapeutic potential in management of CRF for cancer survivors. Promotion of acupuncture in cancer care to manage CRF may improve the quality of life of cancer survivors.

Health Status of Grinders in Different Foundries in West Bengal

The most significant operation to produce products in manufacturing sector in West Bengal is grinding. There is always a need of high human involvement to successfully plan and execute it. The body postures of the grinders are not correct and scientific in different grinding units. Prolonged working hours exceed the capacity of the grinder’s causes’ uneasiness, elevated risk of chronic pain, increase heart rate and developed body stresses. Prolonged working hours exceed the physical capacity of the workers that causes’ body discomfort, physical fatigue, joints pain, sprain of ligaments in different soft tissues. Work related musculoskeletal disorders (WRMSD), body fatigue and strain injuries are very common health problems of grinders in different micro, small &amp; medium scale grinding units in West Bengal. The productivity and cost benefits of this unit are highly related with the physical capabilities and physical comfort of the grinders. The data of musculoskeletal disorder of workers was collected, evaluated and validated by using RULA and Discomfort Questionnaire. It was observed that lack of Ergonomic planning and unergonomic body postures increase the muscular stresses &amp; muscular disorders which affect the health status of grinders. The significant reduction of body stresses and correct body postures were required to improve the quality of work and health status of the grinders.

Work related fatigue and sleepiness at work among intern house officers of four hospitals in Sri Lanka

Introduction: Intern house officers (IHOs) are expected to work long duration shifts with frequent on-calls. Lack of adequate sleep due to prolonged duty hours leads to increase in medical errors. United States and European countries have imposed guidelines to restrict duty hours of IHOs, however no such restrictions are implemented in Sri Lanka. Objectives: The aim of this study was to evaluate fatigability and sleepiness at work among IHOs of four main hospitals in Sri Lanka. Method: IHOs of Colombo South Teaching Hospital, National Hospital Sri Lanka, Lady Ridgway Children’s Hospital and De Soysa Maternity Hospital were recruited. Duty rosters were analysed for the length of duty shifts and night on-calls. Questionnaires were used to record fatiguability, sleepiness at work, medical errors, risk at work and daytime sleepiness. Results: Out of 94 IHOs, 73% worked more than 100 hours and 32% worked more than 125 hours a week. Notably, 38% did three night on-calls per week and 31% did more than three. Subjective fatigue level at work was reported as “most of the time” and “always” by more than 80% of IHOs, 32% had severe day time sleepiness. Fatigue risk assessment score indicated that 97% IHOs were in the high-risk group. Female IHOs were found to be more fatigued. One third of doctors reported medical errors due to fatigue and sleepiness which was significantly high in medicine rotation. Conclusions: IHOs were found to be over working. Majority were fatigued and sleepy at work. Self reported medical errors during internship were found to be high.

Work related fatigue and sleepiness at work among intern house officers of four hospitals in sri lanka

Work related fatigue and sleepiness at work among intern house officers of four hospitals in sri lanka

Onkologische Rehabilitation integriert in die Behandlungspfade der modernen Onkologie

Cancer Rehabilitation: integrated in the care pathways of modern oncology Abstract. People suffering from cancer are affected both by the cancer disease and from side-effects of multimodal anticancer interventions such as surgical, radiooncological and drug therapies. These effects can lead to physical, emotional, social, intellectual or existential functional deficits, which presence and impact are often underrecgonized by oncology professionals. Oncological rehabilitation targets such deficits by multimodal, transprofessionally delivered, goal steered and human centered coordinated interventions. Indications for oncological rehabilitation exist in situations before, during, between and after cancer therapies in both curative and non-curative intention. This includes for example prehabilitation, rehabilitation of myeloma patients between transplantions, of patients suffering from cancer-treatment related fatigue or from advanced cancer undergoing anticancer treatment: basically, every patient in modern oncology who suffers from substantial functional deficits. Oncological rehabilitation defines concrete goals in order to achieve the functions in comparison to before the deficits occurred, the overlaying aims to achieve an optimal self-determination and independence. A profound understanding of the oncological situation by both the patient and professionals is necessary to define realistic goals. Based on - and steered by - these goals, oncological rehabilitation employs specific rehabilitation interventions, supported by a transprofessionally coordinated team of exercise specialists, physiotherapy, ergotherapy, speech, art and music therapists, nutritional, socialwork and psycho-oncological counsellors, as well as activating and therapy-accompanying nurses and physicians. Competence in both cancer disease and anticancer treatment side effects as well as rehabilitation procedures is relevant in goal setting and rehabilitative treatment guidance as well as administration of systemic cancer therapies during oncological rehabilitation. It is a reality in modern oncology that many cancer patients require both oncological rehabilitation and ongoing anticancer treatments. The integration of oncological rehabilitation in the treatment pathways of modern oncology demands new models - including new forms of reimbursement - making allowance for the realities and needs of modern oncology.

Effectiveness of applying fatigue Nursing Guidelines on Oncology Patient Health Outcome

Background: Cancer related fatigue recognizes as one of the most regularly stated and distressing side effects reported by most of cancer patients and significant has long-term effect on the quality of life. Indeed, Fatigue can affect on the patient’s life including physical, psychological, social and spiritual aspects. Aim: evaluate the effect of applying fatigue nursing guidelines on oncology patient health outcome. Research design: Quasi experimental design was used in this study. Sample: A convenient sample of 94 cancer patients with a fatigue reported 4 or more on a 0 to 10 numeric screening scale. Setting: the study was conducted in oncology unit at Mansoura University and Port Said General Hospitals. Methods: The study implement the National Comprehensive Cancer Network guidelines for cancer related fatigue, Functional Assessment of Chronic Illness Therapy Fatigue Scale and Fatigue management barriers were measured at baseline, one month, and three months after intervention. Results: Participants experienced significant improvements in fatigue degrees at one-month assessment, and these improvements were continued at three-month assessment. Conclusion: The nursing fatigue guideline based on the National Comprehensive Cancer Network fatigue guideline was effective in reducing fatigue severity.

Sleep Quality and Fatigue among Breast Cancer Patients Undergoing Chemotherapy

Background: Breast cancer survivors make up a growing population facing treatment that poses long - standing adverse effects including chemotherapy- related sleep disorders and fatigue. There is limited knowledge of patients' lived experiences of chemotherapy- induced sleep disorders and fatigue. The aim of this study was to explore sleep quality and fatigue among breast cancer patients undergoing chemotherapy. Materials and Methods: One hundred fifteen patients were included in this census-based cross-sectional study. Data were collected through the Pittsburgh Sleep Quality Index and Brief Fatigue Inventory four days after the chemotherapy session. Statistical analysis was carried out using SPSS software version 13 and P<0.05 was considered statistically significant in all tests. Results: The mean hours of sleep were 5.6±1.83 in the range of 2 to 10 hours. The mean score of fatigue of participants was 5.59±1.67. Based on the cutting point, 57.4%, 20.9%, and 21.7% of participants had a moderate (4-6.9), mild (0.1-3.9), and severe (7-9.9) level of fatigue, respectively. The mean score of sleep quality among the participants was equal to 14.06±3.06, with a maximum and minimum of 7 and 21. The results of Spearman correlation coefficient showed that there is a significant relationship between fatigue and quality of sleep )0.210). Conclusion: Although the study findings revealed that patients with breast cancer undergoing chemotherapy experience different degrees of sleep disorders and fatigue, there is a need for more detailed studies to improve the quality of sleep and reduce fatigue in these patients due to the little attention paid to this issue in the medical field.

Moderate-to-vigorous intensity physical activity is associated with modified fatigue during and after cancer treatment.

The primary objective was to investigate the association between the amount of time spent in moderate-to-vigorous intensity physical activity (MVPA) and cancer-related fatigue (CRF) before, during, and 2 years after start of treatment. The results of the present study are based on data from the study "Early rehabilitation of cancer patients." Two hundred and forty patients (109 females) with one of the following cancer types were included: breast, colorectal, prostate and testicular cancer, and lymphoma. Chalder's fatigue questionnaire (FQ) was used to map CRF at baseline, 4, 8, 12, and 24 months post-inclusion. Baseline was at the time of diagnosis, before treatment start. Physical activity was recorded using SenseWear armband (SWA) at baseline, 4 and 24 months post-inclusion. One hour increased MVPA daily at baseline was associated with lower fatigue with - 0.8 at 4 months' follow-up (p < 0.001), - 0.7 at 8 months' follow-up (p = 0.001), - 0.6 at 12 months' follow-up (p = 0.008), and - 0.5 at 24 months' follow-up (p < 0.043). The participants maintained and improved PA level at the two follow-up points. The results imply that the amount of time spent in moderate to vigorous intensity physical activity at baseline can modify cancer related fatigue during and after cancer treatment. The participants managed to maintain and improve their activity level at the two follow-up points. Future research should map fatigue and measure activity, with objective measurement units, at several measurement points to map activity level over time and to substantiate these results.

The role of non-pharmacological interventions in the management of rheumatoid-arthritis-related fatigue.

Non-pharmacological interventions may be beneficial in the management of rheumatoid arthritis related fatigue. A narrative review was undertaken, with a focus upon research published in the past 6 years. Seven studies were identified, four focusing upon physical activity, two on psychosocial interventions and one that investigated aromatherapy and reflexology. Findings supported previous evidence that physical activity and psychosocial interventions have potential to produce small to moderate reductions in fatigue related to rheumatoid arthritis. Reflexology and aromatherapy interventions also appeared promising. Limitations to the evidence included lack of consistency in fatigue measurement, and minimal data on long-term outcomes and cost effectiveness. The wide range of physical activity interventions prevent specific recommendations. For psychosocial interventions the strongest evidence is for group-based cognitive behavioural approaches. There was lack of consideration given to fatigue mechanisms and intervention design. Due to the complexity of fatigue, future research exploring personalized approaches is warranted.

Sleep and fatigue in newly graduated nurses-Experiences and strategies for handling shiftwork.

To explore newly graduated nurses' strategies for, and experiences of, sleep problems and fatigue when starting shiftwork. A more comprehensive insight into nurses' strategies, sleep problems, fatigue experiences and contributing factors is needed to understand what support should be provided. For graduate nurses, the first years of practice are often stressful, with many reporting high levels of burnout symptoms. Usually, starting working as a nurse also means an introduction to shiftwork, which is related to sleep problems. Sleep problems may impair stress management and, at the same time, stress may cause sleep problems. Previously, sleep problems and fatigue have been associated with burnout, poor health and increased accident risk. Semi-structured interviews were conducted with nurses (N=11) from four different Swedish hospitals, and qualitative inductive content analysis was used. The study was approved by the Regional Ethical Review Board in Stockholm. The COREQ checklist was followed. Many nurses lacked effective strategies for managing sleep and fatigue in relation to shiftwork. Various strategies were used, of which some might interfere with factors regulating and promoting sleep such as the homeostatic drive. Sleep problems were common during quick returns, often due to difficulties unwinding before sleep, and high workloads exacerbated the problems. The described consequences of fatigue in a clinical work context indicated impaired executive and nonexecutive cognitive function. The findings indicate that supporting strategies and behaviours for sleep and fatigue in an intervention for newly graduated nurses starting shiftwork may be of importance to improve well-being among nurses and increase patient safety. This study highlights the importance of addressing sleep and fatigue issues in nursing education and work introduction programmes to increase patient safety and improve well-being among nurses.

Preventing the risks of monotony related fatigue while driving through gamification

BackgroundDriving fatigue can have serious consequences. Too often fatal accidents are caused by fatigue. However, it is not uncommon for fatigue to occur while driving when the driver is under-challenged. Due to the increasing automation of vehicles, it is foreseeable that the number of accidents caused by monotony will increase. Interactions between driver and vehicle through gamification can remedy the situation and provide the driver with new stimuli during an otherwise monotonous journey.MethodsIn order to test the effectiveness of such interactions, we conducted a driving simulator study with 31 test persons to investigate driving performance and psycho-physiological parameters. Each subject ran through the experiment three times in randomized order to test the interaction system in comparison to a ride in which the driver was alone and a ride in which the driver had a co-driver.ResultsThe results provide clear indications of safer driving of the test subjects when driving with gamification and with a passenger. The tested interaction system prevents upcoming fatigue in a similar way to communication with a passenger. The experiments also provide insights into the effects of monotony in vehicle driving.