Approach to Fatigue Best Practice, 2020, Dukes et al

Andy

Andy

Retired committee member
Put this in the psychosocial sub-forum as the authors seem pretty clueless.
Owing to the broad differential diagnoses that can present as fatigue, a rational approach to diagnosis is paramount. Performance of a battery of diagnostic tests is unlikely to assist with diagnosis, highlighting the importance of a thorough history and physical examination. Fatigue can be a sequela of an underlying medical disease or exists as a primary condition. Management of secondary fatigue largely depends on treatment of the underlying condition. There are no FDA-approved medications for primary fatigue, now known as system exertion intolerance disease. Treatment is focused on individualized exercise therapy and cognitive behavioral therapy.
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Pubmed, (that gives the abstract above), http://www.ncbi.nlm.nih.gov/pubmed/33246515
Paywall, (that gives less of the abstract above), https://www.sciencedirect.com/science/article/abs/pii/S002571252030119X
 
The authors are all from this department:

Internal Medicine Department, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 565, Norfolk, VA 23507, USA. Electronic address: dukesjc@evms.edu.

There are no FDA-approved medications for primary fatigue, now known as system exertion intolerance disease. Treatment is focused on individualized exercise therapy and cognitive behavioral therapy.
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Perhaps someone could point them in the direction of the CDC recommendations for CFS which don't include exercise, and tell them what SEID stands for, and it's criteria, which is not just about fatigue.
 
Trish said:
Perhaps someone could point them in the direction of the CDC recommendations for CFS which don't include exercise, and tell them what SEID stands for, and it's criteria, which is not just about fatigue.
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I suspect they know all about the loss of approval of GET - which is why they say 'individualised exercise therapy'. It improbably a red flag relevant to the NICE draft. Individualisation is a weasel word.
 
Ooof. That's just sad. Imagine the confusion of using SEID (somehow suggesting it HAS replaced the terms ME and CFS) and actually advising for GET, even though the IOM report is the only piece of literature describing SEID and it obviously does not advise exercise as it literally invalidated the evidence base that promotes this model. Reading comprehension is hard.

Papers like this are oddly good for my mental health. My life is temporarily pointless, I literally do nothing all day every day, just trying to make it to the next day. And yet I still accomplish more than these people, because although I do nothing, at least I do not make the world worse from it. This is just a race to the bottom, down to the pits of intellectual emptiness so total it puts intergalactic voids to shame.
 
alktipping said:
all higher education is run for profit . the education business is staggering with multi billion pound profits yearly as for quality control of the products sold i doubt it is policed in any significant manner.
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My understanding of the US system is that all Universities, including the private ones, have to maintain the legal status of being a not-for-profit organisation, but of course there are still advantages to drawing in as much money as possible. They use the profits to expand, or they plough it back into the institution in ways that are benefical to the faculty.

I might be wrong about all of them. But this is certainly the way hospitals work in the US.

Obviously, in the UK, western Europe, Canada and Australasia, most Universities are public and receive government funding, but this doesn't mean they can't turn a profit, although again that profit must be invested back into the organisation. The downside is that they can also incur a loss. They are still responsible for balancing their own accounts at the end of the day.

All the Universities where I have friends - and that includes Europe, the UK and the antipodes - will making a net loss this year. There's a massive crisis in the sector, which has been hit hard by Covid. We are one of the least hard hit, but there will still be job losses at my institution.
 
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