Differences in morning and evening fatigue in oncology patients and their family caregivers

Purpose of the researchTo identify distinct latent classes of individuals based on ratings of morning and evening fatigue; evaluate for differences in phenotypic characteristics, as well as symptom and quality of life scores, among these latent classes; and evaluate for an overlap in morning and evening fatigue class membership.Patients and methodsIn a sample of 167 oncology outpatients and 85 of their FCs, growth mixture modeling was used to identify distinct latent classes based on ratings of morning and evening fatigue obtained before, during, and after radiation therapy. Analyses of variance and Chi Square analyses were used to evaluate for differences among the morning and evening fatigue latent classes.ResultsThree distinct latent classes for morning fatigue were identified. Participants in the High Morning Fatigue class (47%) were younger and had lower functional status. Three distinct latent classes for evening fatigue were identified. Participants in the High Evening Fatigue class (61%) were younger, more likely to be female, more likely to have children at home, and more likely to be a FC. Only 10.3% of participants were classified in both the Very Low Morning and Low Evening Fatigue classes and 41.3% were classified in both the High Morning and High Evening Fatigue classes.ConclusionsDifferent characteristics were associated with morning and evening fatigue, which suggests that morning and evening fatigue may be distinct but related symptoms. Additional research is needed to elucidate the mechanisms that may underlie diurnal variability in fatigue.     

Subgroups of chemotherapy patients with distinct morning and evening fatigue trajectories

Purpose

Purposes of this study were to identify subgroups of patients with distinct trajectories for morning and evening fatigue, evaluate for differences in demographic and clinical characteristics among these subgroups, and compare and contrast the predictors of subgroup membership for morning and evening fatigue.

Methods

Outpatients with breast, gastrointestinal, gynecological, or lung cancer (n?=?582) completed questionnaires, a total of six times over two cycles of chemotherapy (CTX). Morning and evening fatigue severity were evaluated using the Lee Fatigue Scale. Latent profile analysis (LPA) was used to identify distinct subgroups.

Results

Three latent classes were identified for morning fatigue (i.e., low (31.8 %), high (51.4 %), and very high (16.8 %)) and for evening fatigue (i.e., moderate (20.0 %), high (21.8 %), and very high (58.2 %)). Most of the disease and treatment characteristics did not distinguish among the morning and evening fatigue classes. Compared to the low class, patients in the high and very high morning fatigue classes were younger, had a lower functional status, and higher level of comorbidity. Compared to the moderate class, patients in the very high evening fatigue class were younger, more likely to be female, had child care responsibilities, had a lower functional status, and a higher level of comorbidity.

Conclusion

LPA allows for the identification of risk factors for more severe fatigue. Since an overlap was not observed across the morning and evening fatigue classes and unique predictors for morning and evening fatigue were identified, these findings suggest that morning and evening fatigue may have distinct underlying mechanisms.

     

对腹部手术患者晨晚间护理依从性的调查

目的提高患者对晨晚间护理的依从性,促进患者早日康复。方法对普通外科100例腹部手术患者发放问卷,调查患者对晨晚间护理的依从性。结果晨晚间护理依从性好的患者占55％,依从性一般占37％,依从性差占8％。患者拒绝晨晚间护理主要原因有身体虚弱、伤口疼、不想动;患者接受晨晚间护理主要原因有使自己清洁卫生、舒适;患者最易接受的护理为雾化吸人;拒绝程度最高的护理为刷牙。结论掌握患者对晨晚间护理的态度,主动进行护理干预,有助于患者术后康复。     

重症监护病房实施护士长早晚查房的体会

根据重症监护病房护理工作的特点 ,我院护理质控增加了护士长早晚查房的新举措。通过 1a的实践 ,体会颇深 ,现介绍如下。1　护士长早晚查房的重要性1.1　护士长早晚查房是重症监护病房护理工作的需要　重症监护病房病人病情重 ,变化快 ,及时发现病情变化及时处理尤其重要 ;带管     

24-hour blood pressure control with ramipril: comparison of once-daily morning and evening administration

The antihypertensive efficacy of ramipril administered once daily, either in the morning or in the evening, was compared in an open, randomized, crossover trial in 33 patients with mild-to-moderate essential hypertension. A 24-hour ambulatory blood pressure monitoring device was used. A significant (P < 0.05) decrease from baseline blood pressure values was observed with both dosing regimens. A slight, but discernible difference in the effectiveness of the two regimens was observed in the mean daytime (10 am to 8 pm) blood pressure for both diastolic and systolic values. The mean daytime blood pressure decreased from 145.8/95.4 mm Hg to 139.7/89.7 mm Hg following morning administration and to 142.3/91.8 mm Hg following evening administration. The mean nighttime (midnight to 6 am) blood pressure was slightly lower in patients receiving ramipril in the evening than in those receiving the drug in the morning. The mean blood pressure during the critical time (4 am to 8 am) was similar for the two dosing regimens. Ramipril proved to be an efficacious antihypertensive treatment with once-daily dosing and provided as good, or slightly better, blood pressure control when administered in the morning than in the evening.     

Relationship of endogenous circadian melatonin and temperature rhythms to self-reported preference for morning or evening activity in young and older people.

BACKGROUND: Morningness-eveningness refers to interindividual differences in preferred timing of behavior (i.e., bed and wake times). Older people have earlier wake times and rate themselves as more morning-like than young adults. It has been reported that the phase of circadian rhythms is earlier in morning-types than in evening types, and that older people have earlier phases than young adults. These changes in phase have been considered to be the chronobiological basis of differences in preferred bed and wake times and age-related changes therein. Whether such differences in phase are associated with changes in the phase relationship between endogenous circadian rhythms and the sleep-wake cycle has not been investigated previously. METHODS: We investigated the association between circadian phase, the phase relationship between the sleep-wake cycle and circadian rhythms, and morningness-eveningness, and their interaction with aging. In this circadian rhythm study, 68 young and 40 older subjects participated. RESULTS: Among the young subjects, the phase of the melatonin and core temperature rhythms occurred earlier in morning than in evening types and the interval between circadian phase and usual wake time was longer in morning types. Thus, while evening types woke at a later clock hour than morning types, morning types actually woke at a later circadian phase. Comparing young and older morning types we found that older morning types had an earlier circadian phase and a shorter phase-wake time interval. The shorter phase-waketime interval in older "morning types" is opposite to the change associated with morningness in young people, and is more similar to young evening types. CONCLUSIONS: These findings demonstrate an association between circadian phase, the relationship between the sleep-wake cycle and circadian phase, and morningness-eveningness in young adults. Furthermore, they demonstrate that age-related changes in phase angle cannot be attributed fully to an age-related shift toward morningness. These findings have important implications for understanding individual preferences in sleep-wake timing and age-related changes in the timing of sleep.     

Blood glucose pre-prandial baseline decreases from morning to evening in type 2 diabetes: role of fasting blood glucose and influence on post-prandial excursions

BACKGROUND: To know the relationships between pre- and postprandial blood glucose (BG), i.e. BG profile shape, is a requisite for an appropriate therapy for type 2 diabetic patients. In non diabetic subjects, pre-breakfast, pre-lunch and pre-dinner BG are similar, so that BG postprandial excursions are superimposed on a stable BG preprandial baseline. We aimed to clarify: (a) whether BG preprandial baseline is stable also in type 2 diabetes and (b) whether fasting BG (FBG) influences the slope of BG preprandial baseline and the relationships between pre- and postprandial BG. DESIGN: We evaluated self-measured BG profiles of 237 type 2 diabetic patients on diet alone (M/F, 152/85; age 58.6 +/- 0.7 years; years from diagnosis 4.8 +/- 0.6; BMI 28.0 +/- 0.3 kg m-2): 536 profiles containing preprandial BG (corresponding HbA1c 6.8 +/- 0.06%) and 208 profiles containing both pre- and postprandial BG (corresponding HbA1c 6.8 +/- 0.09%). The profiles, measured by nurses, of 866 type 2 diabetic patients on diet alone were also considered (corresponding HbA1c 6.7 +/- 0.04%). RESULTS: In self-measured profiles containing only preprandial BG: (i) FBG (6.77 +/- 0.07 mmol L(-1)) is higher than pre-lunch BG (6.09 +/- 0.07 mmol L(-1)), P = 0.0001) and pre-dinner BG (5.84 +/- 0.06 mmol L(-1)), P =0.0001); (ii) the delta value between FBG and pre-dinner BG is correlated with FBG (r = 0.57, P = 0.0001), the highest FBG, the steepest the fall of BG preprandial baseline throughout the day. This trend is confirmed in profiles measured by nurses. In profiles containing both pre- and postprandial BG: (i) there is a trend to preprandial BG fall (P = 0.0001) and to postprandial BG increase (P = 0.0001) from morning to evening; (ii) postprandial excursions are influenced and sometimes masked by the slope of BG preprandial baseline, thus, in profiles with FBG < or = 6.7 mmol L(-1), all postprandial values are higher than FBG (P = 0.0001), whereas in profiles with FBG > 7.8 mmol L(-1), postprandial values are not significantly higher than FBG. CONCLUSION: In type 2 diabetes, the shape of BG profiles changes in relation to FBG, because it deeply influences the slope of BG preprandial baseline on which postprandial excursions are superimposed. Thus, before planning treatment policies, not only the extent of fasting and postprandial hyperglycaemia, but also the shape of profiles should be considered, to safely correct hyperglycaemia without inducing hypoglycaemia.     

“早太极、晚八段”对社区2型糖尿病失眠患者睡眠质量的影响

目的：观察“早太极、晚八段”的中医运动养生法对社区2型糖尿病失眠患者睡眠质量的干预效果。方法：将62例社区2型糖尿病伴失眠患者以社区为单位随机分为试验组32例和对照组30冽,在常规治疗基础上,试验组采用“早太极、晚八段”的中医运动养生法进行干预,对照组每天进行步行锻炼。结果：试验组患者失眠疗效高于对照组（P〈0．05）,匹兹堡睡眠质量指数低于对照组（P〈0．05）。结沦：“早太极、晚八段”的中医运动养生法对2型糖尿病失眠患者睡眠质量有一定的改善作用。     

夜间门诊的护理管理

全科夜间门诊在大型综合医院的开展，对护理管理工作提出更高的要求。夜间门诊中健全的管理体制、科学的管理方法、有效的质量监督是搞好夜间门诊的关键。问卷调查的结果提示我们要不断改进工作．深化优质服务，使夜间门诊这项方便患者的工作做的更好更完善。     

夜间门诊的护理管理

全科夜间门诊在大型综合医院的开展,对护理管理工作提出更高的要求.夜间门诊中健全的管理体制、科学的管理方法、有效的质量监督是搞好夜间门诊的关键.问卷调查的结果提示我们要不断改进工作,深化优质服务,使夜间门诊这项方便患者的工作做的更好更完善.