Interventions for fatigue in Parkinson's disease: A systematic review and meta‐analysis

The authors sought to review the efficacy of interventions for fatigue in Parkinson's disease. A search was conducted of PubMed, Cinahl, Psychinfo, EMBASE, and Web of Knowledge up to November 2013. Methodological quality was assessed using the PEDro scale. For meta‐analyses, studies were weighted on variance. Effect sizes were calculated with 95% confidence interval (CI); overall effect was presented by means of a Z‐score; heterogeneity was investigated using the I². Fourteen articles (n = 1,890) investigating drugs and behavioral therapy were eligible. Ten studies demonstrated excellent, three good, and one fair methodological quality. Three articles (investigating amphetamines) were appropriate for meta‐analysis, which was performed according to scales used: Multidimensional Fatigue Inventory: mean difference, –6.13 (95%CI: –14.63‐2.37, Z = 1.41, P = 0.16; I² = 0); Fatigue Severity Scale: mean difference, –4.00 (95%CI: –8.72‐0.72, Z = 1.66, P = 0.10; I² = 0). Currently insufficient evidence exists to support the treatment of fatigue in PD with any drug or nondrug treatment. Further study is required. © 2014 International Parkinson and Movement Disorder Society     

What influences pre‐hospital cannulation intentions in paramedics? An application of the theory of reasoned action

Background Intravenous cannulation is a common and important intervention undertaken by paramedics for administration of fluids and drugs in the pre‐hospital setting. This study was a partial application of the theory of reasoned action to the prediction of pre‐hospital cannulation intentions as part of an evaluation of an educational intervention to change cannulation behaviour in paramedics in line with national guidance. Methods In 2008 a self‐completion questionnaire was sent to paramedics from Nottinghamshire and Lincolnshire divisions of East Midlands Ambulance Service NHS Trust, UK. This included measures of prior behaviour related to cannulation, attitude towards cannulation, normative influence related to cannulation and intention to cannulate as well as demographic information. Results Of the 323 paramedics sent questionnaires 137 (42.2%) responded. Attitude towards cannulation (but not normative or peer influence) was a necessary factor for prediction of intention to cannulate in respondents. Past cannulation behaviour was indirectly related to intention to cannulate through the mediation of attitude towards cannulation. Conclusion The theory of reasoned action provides a parsimonious way to predict intentions to cannulate. This study suggests that design and evaluation of interventions to reduce inappropriate cannulation should be targeted towards changing attitudes of paramedics, rather than towards addressing behavioural norms. Future research could utilize social‐psychological theories to better understand clinical behaviour prior to implementation of complex educational or organizational interventions.