Search

OBJECTIVE Fatigue is a classical symptom of hyperglycemia, but the relationship between chronic fatigue and diabetes has not been systematically studied. We investigated prevalence, impact, and potential determinants of chronic [...]

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive–behavioural therapy should only be used to manage symptoms and reduce distress, not to aid recovery. This U-turn in recommendations from the previous 2007 guideline is controversial.We suggest that the controversy stems from anomalies in both processing and interpretation of the evidence by the NICE committee. The committee: (1) created a new definition of CFS/ME, which ‘downgraded’ the certainty of trial evidence; (2) omitted data from standard trial end points used to assess efficacy; (3) discounted trial data when assessing treatment harm in favour of lower quality surveys and qualitative studies; (4) minimised the importance of fatigue as an outcome; (5) did not use accepted practices to synthesise trial evidence adequately using GRADE (Grading of Recommendations, Assessment, Development and Evaluations trial evidence); (6) interpreted GET as mandating fixed increments of change when trials defined it as collaborative, negotiated and symptom dependent; (7) deviated from NICE recommendations of rehabilitation for related conditions, such as chronic primary pain and (8) recommended an energy management approach in the absence of supportive research evidence.We conclude that the dissonance between this and the previous guideline was the result of deviating from usual scientific standards of the NICE process. The consequences of this are that patients may be denied helpful treatments and therefore risk persistent ill health and disability.

The European OPTIMISTIC clinical trial has demonstrated a significant, yet heterogenous effect of Cognitive Behavioural Therapy (CBT) for Myotonic Dystrophy type 1 (DM1) patients. One of its remaining aims was the assessment of efficacy and adequacy of clinical outcome measures, including the relatively novel primary trial outcome, the DM1-Activ-c questionnaire. Assessment of the relationship between the Rasch-built DM1-Activ-c questionnaire and 26 commonly used clinical outcome measurements. Identification of variables associated with CBT response in DM1 patients. Retrospective analysis of the to date largest clinical trial in DM1 (OPTIMISTIC), comprising of 255 genetically confirmed DM1 patients randomized to either standard care or CBT with optionally graded exercise therapy. Correlations of 27 different outcome measures were calculated at baseline (cross-sectional) and of their respective intervention induced changes (longitudinal). Bootstrap enhanced Elastic-Net (BeEN) regression was validated and implemented to select variables associated with CBT response. In cross-sectional data, DM1-Activ-c correlated significantly with the majority of other outcome measures, including Six Minute Walk Test and Myotonic Dystrophy Health Index. Fewer and weaker significant longitudinal correlations were observed. Nine variables potentially associated with CBT response were identified, including measures of disease severity, executive cognitive functioning and perceived social support. The DM1-Activ-c questionnaire appears to be a well suited cross-sectional instrument to assess a variety of clinically relevant dimensions in DM1. Yet, apathy and experienced social support measures were less well captured. CBT response was heterogenous, requiring careful selection of outcome measures for different disease aspects.

Supplemental Digital Content is available in the text.

Chronic fatigue syndrome (CFS) is characterized by disabling fatigue, which is suggested to be maintained by dysfunctional beliefs. Fatigue and its maintenance are recently conceptualized as arising from abnormally precise expectations about bodily inputs and from beliefs of diminished control over bodily states, respectively. This study used functional neuroimaging to identify the neural correlates of fatigue and its maintenance by beliefs during a physical effort task.

To examine the cognitive profile of patients with myotonic dystrophy type 1 (DM1) on the basis of a systematic review and meta-analysis of the literature.

Fatigue in type 1 diabetes is prevalent and persistent, but so far, no evidence-based treatments are available. We aimed to investigate the efficacy of cognitive behavioural therapy (CBT) in reducing fatigue severity in patients with type 1 diabetes.

[Clin Psychol Sci Prac 18: 325–330, 2011]

Abstract: Het chronisch vermoeidheidssyndroom (CVS) is een aandoening, waarbij ernstige vermoeidheid gepaard gaat met aanzienlijke beperkingen in het dagelijks functioneren, zonder dat een lichamelijke verklaring gevonden is. Het syndroom moet niet verward worden met de chronische vermoeidheid bij een chronische ziekte of kanker (zie kader 1 en 2). Bij CVS gaat het om een veelheid van klachten. Naast een overheersend gevoel van totale uitputting, zijn er vaak concentratie- en geheugenklachten, slaapklachten, spier- en gewrichtspijnen. Bijna altijd is er sprake van een vermindering van lichamelijke activiteiten. Gewone fysieke activiteiten, zoals het huishouden doen, geven problemen en vaak stopt de patiënt met sporten. De vermoeidheid heeft veelal gevolgen voor de sociale contacten, zoals op bezoek gaan of bezoek ontvangen. Veel CVS patiënten werken niet meer of slechts deeltijds. Omdat de betrokken patiënt er niet direct ‘ziek’ uitziet, is er vaak onbegrip vanuit de omgeving, soms ook vanuit artsen. Bij patiënten met CVS is er sprake van veelvuldig doktersbezoek en medicijngebruik.

Some inequalities associated with the Laplacian for trigonometric polynomials are given, which will be applied to investigate the behavior in approximation by trigonometric polynomials in higher dimensions and the best lower and upper estimates for some linear operators. In particular, we obtain a complete characterization for the approximation behavior of the classical Jackson operator. Thus the approximation error of a function by Jackson polynomials is equivalent to a K-functional defined by the Laplacian.

We will use the method introduced in the first part of our paper (see [5]) to give the best lower estimate of ?f - Bnf ? for the Bernstein polynomial operators by means of a modified modulus of smoothness. The key role in our approach is the estimate of the derivative of the iterated Bernstein polynomial operators.

Treatment of pituitary pathology mostly does not result in complete recovery of impairment in cognitive functioning. The primary aim of the current study was to assess cognitive impairment in patients with stable replacement therapy for hypopituitarism during the last 6 months prior to inclusion. It was expected that patients showed subjective and objective subnormal scores on neuropsychological functioning. Forty‐two patients (40% men, 49 ± 15 years) treated for hypopituitarism conducted a neuropsychological test battery, including the Cognitive Failures Questionnaire (CFQ), 15‐Word test (15‐WT), Cambridge Neuropsychological Test Automated Battery (CANTAB) Motor Screening Task (MOT), Spatial Working Memory (SWM) and Affective Go/No‐go (AGN). Results were compared to reference values of healthy norm groups. Male and female participants scored significantly worse on the CFQ (P< .01, d= 0.91‐4.09) and AGN mean correct latency (P< .01, d= 1.66 and 1.29, respectively). Female participants scored significantly worse on 15‐WT direct recall (P= .01, d= 0.66), 15‐WT delayed recall (P= .01, d= 0.79), SWM total errors (P= .05, d= 0.41), SWM strategy (P= .04, d= 0.43), AGN errors of commission (P= .02, d= 0.56) and omission (P= .04, d= 0.41). This study shows that subjective cognitive functioning is worse in patients treated for hypopituitarism compared to reference data. Also, female participants treated for hypopituitarism score worse on objective aspects of memory and executive functioning compared to reference data. Besides worse focus attention, this objective cognitive impairment was not found in male participants. It is recommended to conduct additional research, which focuses on the design and evaluation of a cognitive remediation therapy, aimed at compensation of impairments in different aspects of memory and executive functioning. Treatment of pituitary pathology mostly does not result in complete recovery of impairment in cognitive functioning. This study shows that subjective cognitive functioning is worse in patients treated for hypopituitarism compared to reference data. Also, female participants treated for hypopituitarism score worse on objective aspects of memory and executive functioning compared to reference data.

Fatigue is a presenting symptom of diabetes, but little is known of the course of fatigue. Clinical experience suggests that patients can suffer from chronic fatigue. In this study we investigated the prevalence of chronic fatigue, defined as severe and persistent fatigue lasting for at least six months in a large cohort of patients.