PubMed · 2900926
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1988-09-03. Fatigue.. https://pubmed.ncbi.nlm.nih.gov/2900926/
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Disability in patients with advanced cancer often results from bed rest, deconditioning, and neurologic and musculoskeletal complications of cancer or cancer treatment. Terminally ill patients have a high prevalence of weakness, pain, fatigue, and dyspnea in addition to other symptoms. Rehabilitation and palliative care have emerged as two important parts of comprehensive medical care for patients with advanced disease; this article discusses the relationship between the two and the possible role of rehabilitation interventions in the care of terminally ill patients. Palliative care and rehabilitation share common goals and therapeutic approaches. Both disciplines have a multidisciplinary model of care, which aims to improve patients' levels of function and comfort. There is scarce evidence that rehabilitation interventions can impact function and symptom management in terminally ill patients. However, clinical experience suggests that the application of the fundamental principles of rehabilitation medicine is likely to improve their care. Physical function and independence should be maintained as long as possible to improve patients' quality of life and reduce the burden of care for the caregivers. Future research on the rehabilitation of terminally ill patients should focus on better understanding the role of rehabilitation and defining appropriate interventions. The development of an evidence-based body of knowledge will ensure that these patients receive appropriate rehabilitation interventions.
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Fatigue has been identified as a major risk factor for shiftworkers. However, few organizations or governments currently manage work-related fatigue in any systematic or quantitative manner. This paper outlines an approach to managing fatigue that could improve shiftwork management. Using shift start and finish times as an input, the outlined model quantifies work-related fatigue on the basis of its known determinants; that is shift timing and duration, work history and the biological limits on sleep length at specific times of day. Evaluations suggest that work-related fatigue scores correlate very highly with sleep-onset latency, neurobehavioural impairment and subjective sleepiness. The model is useful in that it allows comparisons to be made between rosters independent of shift length and timing or the total number of work hours. Furthermore, unlike many models of sleepiness and fatigue, individual's sleep times are not required as hours of work are used as the input. It is believed the model provides the potential quantitatively to link the effects of shiftwork to specific organizational health and safety outcomes. This simple approach may be especially critical at a time when many organizations view longer and more flexible hours from their employees as an immediate productivity gain.