Tired all the time - South Tees Hospitals NHS Foundation...
Transcript of Tired all the time - South Tees Hospitals NHS Foundation...
RCN CFS/ME Special Interest Group
CFS/ME recognition
WHO neurological illness
Chief Medical Officer
Medical Research Council research strategy
RCN Special Interest Group
All Party Parliamentary Group Inquiry
Media interest with Gilderdale case
RCN CFS/ME Special Interest Group
What is CFS/ME?
Unexplained, persistent fatigue >4 months
Post exercise malaise > 24 hrs
Sleep & temperature disturbances
Sore, swollen throat
Muscle & joint pain and stiffness
Forgetfulness
Poor concentration / headaches
Accident prone
NB this list is not exhaustive
RCN CFS/ME Special Interest Group
Alternative terminology
Chronic Fatigue Syndrome
Myalgic encephalomyelitis (ME)
Post viral fatigue
= CFS/ME NB Don’t get caught up in semantics
Use our NHS resources wisely
Let’s put our energy into earlier diagnosis and improving treatment outcomes
RCN CFS/ME Special Interest Group
How common is it?
NICE guidance (2007)
Estimates 0.3-0.4% of population
E.g. in GP practice with a register
of 10,000 patients
Estimated that 30-40 patients are
likely to have CFS/ME
….But not all will be diagnosed
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Tip of the iceberg
Diagnosed and referred
to Specialist Service
Diagnosed and managed
in Primary Care
Undiagnosed
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Vulnerable groups
Nurses Royal Free
Hospital
Teachers
Even not working Retired/ill health
On benefits
Caring & conscientious + demanding job
RCN CFS/ME Special Interest Group
What are the symptoms?
Physical
Cognitive
Emotional
Tip!
Sleep deprivation may present as
‘depression’
RCN CFS/ME Special Interest Group
What else could it be? Alternative diagnoses
Thyroid problems
Anaemia
Diabetes
Coeliac disease
Obesity
Anxiety and/or depression
HIV or Hepatitis
Routine screening in primary care Early diagnosis < 4-6 months
Prompt treatment
Rehabilitation and recovery
Improved health outcome if patient’s 1st contact with health service is positive
RCN CFS/ME Special Interest Group
Listen to your patient….
I’m tired all the time
I’m not coping at work
I don’t seem to
have the
energy that I
used to
I don’t know
what’s wrong
with me, I
feel so ill
most of the
time
My legs feel like lead
I can’t
think
straight
My head
feels like
cotton wool
RCN CFS/ME Special Interest Group
How is it diagnosed?
History of present illness
Clinical assessment
Physical examination
Routine blood screening
Exclude other causes of fatigue
RCN CFS/ME Special Interest Group
What is the treatment?
Gradual rehabilitation
Pacing/activity management
Gentle exercise therapy
Positive thinking and support
Realistic goals
Patience & time to convalesce
RCN CFS/ME Special Interest Group
Where is the nearest service?
National Centre
Regional Networks
Local Specialist Service
Ask your GP to refer
Find service on Choose & Book
RCN CFS/ME Special Interest Group
Teesside CFS/ME Specialist Service
The James Cook University Hospital, Middlesbrough TS4 3BW
RCN CFS/ME Special Interest Group
What if I suspect CFS/ME?
Assess your patient:
Physical symptoms
Activity levels
Cognitive impairment
Emotional status
Remember to PACE…
RCN CFS/ME Special Interest Group
Important physical marker!
Over activity (however small)
increases symptoms
Swollen, sore throat
Legs ‘like lead’
Head feels heavy/achy
Recovery takes days
= post exercise malaise
RCN CFS/ME Special Interest Group
Important cognitive marker!
Normal brain function can be impaired
Poor short term memory
Can’t concentrate
Struggles to understand new information
Struggles to maintain conversation
Jumbled word order
= signs of cognitive impairment
RCN CFS/ME Special Interest Group
Key assessment questions
If you do too much on a good
day, how do you feel
afterwards?
Look for post exercise malaise
How do you manage on the
telephone?
Look for cognitive impairments
RCN CFS/ME Special Interest Group
Time as marker!
If patient is still fatigued after 4-6
months
No other illness present
Diagnosis of CFS/ME should be
considered
RCN CFS/ME Special Interest Group
Principles of care
Holistic assessment Physical, cognitive, emotional
Prompt action to remove/reduce stress
Improve prognosis
Evidence-based rehabilitation Early diagnosis
Start advice and rehabilitation
Co-ordination of care
Planning longer term patient goals
Empathy and support
Act as advocate where necessary
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Patient information
Part of our duty of care
Patients need simple, good quality information Understand illness
Manage symptoms
Maintain/improve health
Increase wellbeing
Understanding information is key to informed consent Cognitive impairment = vulnerable adult
RCN CFS/ME Special Interest Group
Patients’ rights
Patients are likely to be classed as
disabled under the law
Disability Discrimination Act (1995)
Reasonable adjustments
In employment
In health care
Do you provide written advice /
management plans for your patient
with known memory problems?
RCN CFS/ME Special Interest Group
Further information
Understanding the illness NHS Direct website (A-Z Health topics)
BBC Health website (A-Z Health topics)
NICE Guidance (No 53)
Help with employment NHS Plus Occupational Health CFS/ME advice
Direct Gov www.direct.gov.uk
Access to work
Charity support Action for ME www.afme.org
Benefits advice Welfare Rights Advisors in Job Centres
Action for ME
Disability Alliance