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Tired all the time: can new research on fatigue help clinicians? (Harvey&Wessely, 09)

Discussion in 'Latest ME/CFS Research' started by Dolphin, Mar 10, 2010.

  1. Dolphin

    Dolphin Senior Member

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    (Not a recommendation)

    Br J Gen Pract. 2009 Apr;59(561):237-9.

    Tired all the time: can new research on fatigue help clinicians?
    Harvey SB, Wessely S.

    Comment on:

    Br J Gen Pract. 2009 Apr;59(561):e93-100.

    I thought some people might be interested to see what Simon Wessely was advising GPs. The article has just become publicly available I think.

    html:
    http://rcgp.publisher.ingentaconnec...00000059/00000561/art00008&mimetype=text/html

    pdf: http://rcgp.publisher.ingentaconnec...59/00000561/art00008&mimetype=application/pdf
  2. fds66

    fds66 Senior Member

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    Couldn't get those links to work, says they have timed out.
  3. Dolphin

    Dolphin Senior Member

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  4. Marco

    Marco Old blackguard

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    Near Cognac, France
    Hilarious!

    Thanks Tom.
  5. Mithriel

    Mithriel Senior Member

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    So Wessely has taken us from ME a serious neurological disease caused by a virus through Chronic Fatigue Syndrome to chronic fatigue to tired all the time.....

    That in itself explains why his methods don't help us.

    Mithriel
  6. Koan

    Koan Be the change.

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    What I find fascinating about this article is that it is all about addressing the "anxiety" of the treating physician.

    It's all about MD, MD, MD.
  7. oerganix

    oerganix Senior Member

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    Yeah, capture the physicians by making THEM less anxious and you might be able to get away with blaming patients for everything: their own illness, the physician's response to them and lack of a good outcome for anyone.

    Koan said:
    "What I find fascinating about this article is that it is all about addressing the "anxiety" of the treating physician.



    'Over 10% of patients attending primary care clinics describe at least one month of substantial fatigue.1 Despite its prevalence, many clinicians feel uncertain or dissatisfied with the level of care they are able to provide patients with persistent fatigue.2 These anxieties are not without basis; up to two-thirds of patients with chronic fatigue report being dissatisfied with the quality of care they receive.3 GPs will tend to stereotype patients with chronic fatigue as having certain undesirable traits and will feel a sense of hopelessness regarding treatment options.4 However, there is now an emerging body of research evidence which should provide GPs with a greater sense of certainty regarding their management decisions. Incorporating this evidence base into clinical practice should allow clinicians to feel less helpless, and will hopefully result in improved outcomes for patients suffering from the debilitating effects of fatigue.

    One of the main anxieties when managing a complaint of fatigue is how to begin and when to end... '



    "It's all about MD, MD, MD. "
  8. Koan

    Koan Be the change.

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    What you said.
  9. oerganix

    oerganix Senior Member

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    Hugs to you, Koan, and welcome back!
  10. Koan

    Koan Be the change.

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    :hug:

    from the single luckiest person in the whole wide world:

    me
  11. Dolphin

    Dolphin Senior Member

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    One related online comment

    Good observations so far.

    As I pointed out in another thread, one patient posted a comment on a related paper:

    Others could also post comments on the Harvey & Wessely paper at http://www.rcgp.org.uk/publications/bjgp/discussion_forum.aspx although given the paper is a little old, it might reduce the chances they'll put it up a little although one year probably isn't that old and the issue is relevant all the time.

    Best to use at least one reference (the original paper is one) to make it look more formal. Putting websites as references is another trick.
  12. Koan

    Koan Be the change.

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    Yes, but Tom, the doctors mustn't be anxious that someone could go undiagnosed for 5 years and end up with osteoporosis and a bowel resection that might have been avoided, now should they.

    argh
  13. ukxmrv

    ukxmrv Senior Member

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  14. Dolphin

    Dolphin Senior Member

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    :Retro smile:

    The whole argument about delaying testing (i.e. don't test the patient when they first come - you can wait 4 weeks and see how things goes) is very dodgy:
    The study appears to clearly show that not doing testing the first time is not a good idea.

    Yes.
    http://www.eftdevon.co.uk/
  15. Esther12

    Esther12 Senior Member

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    No fair - they want to charge me $30 for this now.

    I'm having trouble searching for it on the forum too as all the words are too short/common.

    If anyone d/l a copy when it was free, could they put it up in the library?

    I'm interested to know what reference 4 is too.

    Ta.
  16. Esther12

    Esther12 Senior Member

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  17. oceanblue

    oceanblue Senior Member

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    The authors say:

    while quoting a couple of CBT references from the '90s.

    Yet the most comprehensive study of CBT to date, a Cochrane Review that includes unpublished trials (to help overcome publication bias), concludes that CBT is only modestly helpful (40% improvement at the end of treatment vs 26% for controls; probably even less effective at follow-up 1 year later). Some of the studies within the Cochrane Review are themselves dodgy, but even taking the review results at face value shows that CBT isn't very helpful. So, by Wessely and Harvey's logic, if CBT doesn't help much, behavioural patterns are probably not very important in maintaining fatigue patterns. Yes, the opposite of what the authors claim. Maybe someone should let the GPs know?
  18. anciendaze

    anciendaze Senior Member

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    Could mean Electronic Funds Transfer.
  19. Sean

    Sean Senior Member

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    Gee, I can't imagine why they would do that, Prof Wessely.
  20. Esther12

    Esther12 Senior Member

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    lol

    Maybe it's because we all lack personal insight?

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