Title Participants Abstract "The Value of Fatigue Severity to Rule Out Depression in Older Adult Patients With Cancer" "Laura Deckx, Marjan van den Akker, Denise Vergeer, Doris van Abbema, Franchette van den Berkmortel, Loes LINSEN, Eric DE JONGE, Bert HOUBEN, Mieke van Driel, Frank Buntinx" "Purpose/Objectives: To evaluate whether fatigue severity can serve as a cue to investigate the presence of depression in older adult patients with cancer. Design: Cross-sectional observational cohort study. Setting: Seven hospitals and general practices in Belgium and the Netherlands. Sample: 205 older adult patients with cancer and 436 older adults without cancer (aged 70 years or older). Methods: The diagnostic accuracy of fatigue as a proxy for depression was evaluated using sensitivity, specificity, and predictive values. Main Research Variables: Fatigue was measured with a visual analog scale, and depression was measured with the 15-item Geriatric Depression Scale. Findings: Fifty-six percent of the population experienced fatigue, and 13% were depressed. For fatigue as a cue for depression, sensitivity was 82%, specificity was 47%, positive predictive value was 18%, and negative predictive value was 95%. Conclusions: The data confirm that fatigue is a valuable cue to investigate the presence of depression because 82% of depressed participants were correctly identified by fatigue. The assessment of fatigue severity is intuitive, quick, straightforward, and usually already implemented. Implications for Nursing: Identification of depression is difficult in older adult patients with cancer. Instead of experiencing affective symptoms of depression, older adult patients are more likely to disclose somatic symptoms, such as fatigue, which often overlap with cancer-related symptoms. Nurses should be aware of this problem and should be alert for the possibility of depression in older adult patients presenting with fatigue." "The i-DREAMS intervention strategies to reduce driver fatigue and sleepiness for different transport modes" "Fran Pilkington-Cheney, Amir Pooyan Afghari, Ashleigh Filtness, Eleonora Papadimitriou, Andre Lourenco, Tom BRIJS" "Driver sleepiness and fatigue are important contributors to many transport incidents and significantly increase crash risk. Recently, detection systems have been developed which aim to monitor the state of the driver and detect increasing levels of fatigue. However, there has been less focus on appropriate intervention strategies for drivers once fatigue and sleepiness have been detected. This paper describes the i-DREAMS fatigue intervention strategies, which aim to keep drivers within a safe driving zone. Interventions will be provided both in real-time and post-trip and can be customized to be used with a variety of transport modes. Real-time interventions will measure fatigue through trip duration, and driver sleepiness through heart-rate variability (HRV) information, obtained by means of sensors in the steering wheel or a wearable device, and attributed to Karolinska Sleepiness Score (KSS) bands. Thresholds for warnings will map onto phases of a 'Safety Tolerance Zone' and will be dynamic changing as the driver state and driving situation develops. Post-trip interventions will aggregate data throughout the duration of the drive and aim to provide customized feedback and coping tips related to driver levels of fatigue and sleepiness, to improve driving behavior. Goals and challenges will add a gamified aspect to the post-trip interventions. The next stage of the development of the i-DREAMS fatigue intervention strategy is to test the concept in a series of simulator and field trials. Future research should explore acceptance and compliance of interventions and frequency of alerts." "Fatigue failure monitoring of 316L stainless steel coupons using optical fibre based distributed strain sensing" "Ben Dieter De Pauw, Michaël Hinderdael, Marc Moonens, Dieter Jens De Baere, Thomas Geernaert, Francis Berghmans, Patrick Guillaume" "We demonstrate the application of optical frequency domain reflectometry to detect, locate and track the propagation of fatigue cracks in simple beam-shaped stainless-steel specimens. To do so we recorded the strain distribution along the entire length of hot rolled and additively manufactured 316L steel specimens with a spatial resolution of 1 mm using an embedded optical fibre, and we evaluated fatigue induced damage under four-point bending load cycles. Our findings are threefold. First, we show that the onset of fatigue damage can be detected using our methodology based on a damage index adapted to optical frequency domain reflectometry measurements, which allows alerting for potential failure. We also show that our optical fibre mounting and embedding technique enables the fibre to survive critical failure of the steel specimen. In addition, we obtain strain profile measurements with a spatial resolution that allows linking the strain distribution with imperfections in the four-point bending set-up." "How to Tackle Mental Fatigue" "Matthias Proost, Jelle Habay, Jonas De Wachter, Kevin De Pauw, Ben Rattray, Romain Meeusen, Bart Roelands" "INTRODUCTION: Mental fatigue (MF) is a psychobiological state that impairs cognitive as well as physical performance in different settings. Recently, numerous studies have sought ways to counteract these negative effects of MF. An overview of the explored countermeasures for MF is, however, lacking.OBJECTIVES: The objective of this review is to provide an overview of the different MF countermeasures currently explored in literature. Countermeasures were classified by the timing of application (before, during or after the moment of MF) and type of intervention (behavioural, physiological and psychological).METHODS: The databases of PubMed (MEDLINE), Web of Science and PsycINFO were searched until March 7, 2022. Studies were eligible when MF was induced using a task with a duration of at least 30 min, when they assessed MF markers in at least two out of the three areas wherein MF markers have been defined (i.e., behavioural, subjective and/or [neuro]physiological) and used a placebo or control group for the countermeasure.RESULTS: A total of 33 studies investigated one or more countermeasures against MF. Of these, eight studies assessed a behavioural countermeasure, 22 a physiological one, one a psychological countermeasure and two a combination of a behavioural and psychological countermeasure. The general finding was that a vast majority of the countermeasures induced a positive effect on behavioural (e.g., task or sport performance) and/or subjective MF markers (e.g., visual analogue scale for MF or alertness). No definitive conclusion could be drawn regarding the effect of the employed countermeasures on (neuro)physiological markers of MF as only 19 of the included studies investigated these measures, and within these a large heterogeneity in the evaluated (neuro)physiological markers was present.DISCUSSION: Within the physiological countermeasures it seems that the use of odours during a MF task or caffeine before the MF task are the most promising interventions in combating MF. Promising behavioural (e.g., listening to music) and psychological (e.g., extrinsic motivation) countermeasures of MF have also been reported. The most assumed mechanism through which these countermeasures operate is the dopaminergic system. However, this mechanism remains speculative as (neuro)physiological markers of MF have been scarcely evaluated to date.CONCLUSION: The present systematic review reveals that a wide range of countermeasures have been found to successfully counteract MF on a subjective, (neuro)physiological and/or behavioural level. Of these, caffeine, odours, music and extrinsic motivation are the most evidenced for countering MF. To provide in-detail practical guidelines for the real-life application of MF countermeasures, more research must be performed into the underlying mechanisms and into the optimal dosage and time of application/intake." "Evaluation of an optimized context-aware clinical decision support system for drug-drug interaction screening" "Katoo Muylle, Kristof Gentens, Alain Dupont, Pieter Cornu" "OBJECTIVE: Evaluation of the effect of six optimization strategies in a clinical decision support system (CDSS) for drug-drug interaction (DDI) screening on alert burden and alert acceptance and description of clinical pharmacist intervention acceptance.METHODS: Optimizations in the new CDSS were the customization of the knowledge base (with addition of 67 extra DDIs and changes in severity classification), a new alert design, required override reasons for the most serious alerts, the creation of DDI-specific screening intervals, patient-specific alerting, and a real-time follow-up system of all alerts by clinical pharmacists with interventions by telephone was introduced. The alert acceptance was evaluated both at the prescription level (i.e. prescription acceptance, was the DDI prescribed?) and at the administration level (i.e. administration acceptance, did the DDI actually take place?). Finally, the new follow-up system was evaluated by assessing the acceptance of clinical pharmacist's interventions.RESULTS: In the pre-intervention period, 1087 alerts (92.0 % level 1 alerts) were triggered, accounting for 19 different DDIs. In the post-intervention period, 2630 alerts (38.4 % level 1 alerts) were triggered, representing 86 different DDIs. The relative risk forprescription acceptance in the post-intervention period compared to the pre-intervention period was 4.02 (95 % confidence interval (CI) 3.17-5.10; 25.5 % versus 6.3 %). The relative risk for administration acceptance was 1.16 (95 % CI 1.08-1.25; 54.4 % versus 46.7 %). Finally, 86.9 % of the clinical pharmacist interventions were accepted.CONCLUSION: Six concurrently implemented CDSS optimization strategies resulted in a high alert acceptance and clinical pharmacist intervention acceptance. Administration acceptance was remarkably higher than prescription acceptance." "Evaluation of Context-Specific Alerts for Potassium-Increasing Drug-Drug Interactions: A Pre-Post Study" "Katoo Muylle, Kristof Gentens, Alain Dupont, Pieter Cornu" "Objective: To investigate whether context-specific alerts for potassium-increasing drug-drug interactions (DDIs) in a clinical decision support system reduced the alert burden, increased alert acceptance, and had an effect on the occurrence of hyperkalemia. Materials and Methods: In the pre-intervention period all alerts for potassium-increasing DDIs were level 1 alerts advising absolute contraindication, while in the post-intervention period the same drug combinations could trigger a level 1 (absolute contraindication), a level 2 (monitor potassium values), or a level 3 alert (informative, not shown to physicians) based on the patient's recent laboratory value of potassium. Alert acceptance was defined as non-prescription or non-administration of the interacting drug combination for level 1 alerts and as monitoring of the potassium levels for level 2 alerts. Results: The alert burden decreased by 92.8%. The relative risk (RR) for alert acceptance based on prescription rates for level 1 alerts and monitoring rates for level 2 alerts was 15.048 (86.5% vs 5.7%; 95% CI 12.037–18.811; P < 0.001). With alert acceptance for level 1 alerts based on actual administration and for level 2 alerts on monitoring rates, the RR was 3.597 (87.6% vs 24.4%; 95% CI 3.192–4.053; P < 0.001). In the generalized linear mixed model the effect of the intervention on the occurrence of hyperkalemia was not significant (OR 1.091, 95% CI 0.172–6.919). Conclusion: The proposed strategy seems effective to get a grip on the delicate balance between over- and under alerting." "Clinical Decision Support Systems for Drug Allergy Checking: Systematic Review" "Laura Légat, Sven Van Laere, Marc Nyssen, Stephane Steurbaut, Alain Dupont, Pieter Cornu" "Background: Worldwide, the burden of allergies—in particular, drug allergies—is growing. In the process of prescribing, dispensing, or administering a drug, a medication error may occur and can have adverse consequences; for example, a drug may be given to a patient with a documented allergy to that particular drug. Computerized physician order entry (CPOE) systems with built-in clinical decision support systems (CDSS) have the potential to prevent such medication errors and adverse events. Objective: The aim of this review is to provide a comprehensive overview regarding all aspects of CDSS for drug allergy, including documenting, coding, rule bases, alerts and alert fatigue, and outcome evaluation. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as much as possible and searches were conducted in 5 databases using CPOE, CDSS, alerts, and allergic or allergy as keywords. Bias could not be evaluated according to PRISMA guidelines due to the heterogeneity of study types included in the review. Results: Of the 3160 articles considered, 60 met the inclusion criteria. A further 9 articles were added based on expert opinion, resulting in a total of 69 articles. An interrater agreement of 90.9% with a reliability Κ=.787 (95% CI 0.686-0.888) was reached. Large heterogeneity across study objectives, study designs, study populations, and reported results was found. Several key findings were identified. Evidence of the usefulness of clinical decision support for drug allergies has been documented. Nevertheless, there are some important problems associated with their use. Accurate and structured documenting of information on drug allergies in electronic health records (EHRs) is difficult, as it is often not clear to healthcare providers how and where to document drug allergies. Besides the underreporting of drug allergies, outdated or inaccurate drug allergy information in EHRs poses an important problem. Research on the use of coding terminologies for documenting drug allergies is sparse. There is no generally accepted standard terminology for structured documentation of allergy information. The final key finding is the consistently reported low specificity of drug allergy alerts. Current systems have high alert override rates of up to 90%, leading to alert fatigue. Important challenges remain for increasing the specificity of drug allergy alerts. We found only one study specifically reporting outcomes related to CDSS for drug allergies. It showed that adverse drug events resulting from overridden drug allergy alerts do not occur frequently. Conclusions: Accurate and comprehensive recording of drug allergies is required for good use of CDSS for drug allergy screening. We found considerable variation in the way drug allergy are recorded in EHRs. It remains difficult to reduce drug allergy alert overload while maintaining patient safety as the highest priority. Future research should focus on improving alert specificity, thereby reducing override rates and alert fatigue. Also, the effect on patient outcomes and cost-effectiveness should be evaluated." "Binge Viewing, Sleep, and the Role of Pre-Sleep Arousal" "Liese Exelmans, Jan Van den Bulck" "STUDY OBJECTIVES: To investigate the prevalence of binge viewing, its association with sleep and examine arousal as an underlying mechanism of this association. METHODS: Four hundred twenty-three adults (aged 18-25 years old, 61.9% female) completed an online survey assessing regular television viewing, binge viewing, sleep quality (Pittsburgh Sleep Quality Index), fatigue (Fatigue Assessment Scale), insomnia (Bergen Insomnia Scale), and pre-sleep arousal (Pre-Sleep Arousal Scale). Regression analyses were conducted. Mediation analysis was performed using PROCESS Macro. RESULTS: There were 80.6% who identified themselves as a binge viewer. Among those who binge viewed (n = 341), 20.2% had binge viewed at least a few times a week during the past month. Among poor sleepers (Pittsburgh Sleep Quality Index > 5), 32.6% had a poor sleep quality associated with being a binge viewer. Higher binge viewing frequency was associated with a poorer sleep quality, increased fatigue and more symptoms of insomnia, whereas regular television viewing was not. Cognitive pre-sleep arousal fully mediated these relationships. CONCLUSIONS: New viewing styles such as binge viewing are increasingly prevalent and may pose a threat to sleep. Increased cognitive arousal functions as the mechanism explaining these effects. Measures of media exposure should take into account the user's level of engagement with media. Interventions aimed at (1) alerting viewers about excessive viewing duration and (2) reducing arousal before sleep may be useful ways to tackle sleep problems in binge viewers." "Examining attentional functioning in depression using a personalized network approach : a proof-of-principle study" "Brage Kraft, Ragnhild Bø, Kristof Hoorelbeke, Ernst Koster, Rune Jonassen, Catherine J. Harmer, Nils Inge Landrø" "Reduced attentional functioning has been identified as an important factor in depression etiology and maintenance. However, current research does not fully take into account the large heterogeneity of depression, for example identifying for whom and how reduced attentional functioning plays a role. In this proof-of-principle study, we demonstrate how a personalized network approach can provide more nuanced insight into the role of attentional functioning in depression. To this end, we estimated person-specific symptom networks in a depression sample, and explored associations between reduced attentional functioning (alerting, orienting, executive control) and symptom centrality (expected influence). Participants with ongoing and remitted depression were enrolled to 14 days of intensive assessment of depression symptoms in their daily life using a smartphone app. Based on these data, person-specific network models were estimated using vector autoregression modelling. Orienting, alerting and executive control were assessed using the Attentional Network Test in the laboratory. Person-specific networks showed large variability in symptom dynamics. Higher centrality of fatigue was associated with reduced orienting efficiency, and higher centrality of passivity was associated with reduced executive control. This study highlights the potential of assessing individual symptom dynamics when considering cognitive functioning in depression." "Overall performance of a drug-drug interaction clinical decision support system: quantitative evaluation and end-user survey" "Greet Van De Sijpe, Charlotte Quintens, Greet De Vlieger, Rik Schrijvers, Paul De Munter, Veerle Foulon, Minne Casteels, Lorenz Van der Linden, Isabel Spriet" "BACKGROUND: Clinical decision support systems are implemented in many hospitals to prevent medication errors and associated harm. They are however associated with a high burden of false positive alerts and alert fatigue. The aim of this study was to evaluate a drug-drug interaction (DDI) clinical decision support system in terms of its performance, uptake and user satisfaction and to identify barriers and opportunities for improvement. METHODS: A quantitative evaluation and end-user survey were performed in a large teaching hospital. First, very severe DDI alerts generated between 2019 and 2021 were evaluated retrospectively. Data collection comprised alert burden, override rates, the number of alert overrides reviewed by pharmacists and the resulting pharmacist recommendations as well as their acceptance rate. Second, an e-survey was carried out among prescribers to assess satisfaction, usefulness and relevance of DDI alerts as well as reasons for overriding. RESULTS: A total of 38,409 very severe DDI alerts were generated, of which 88.2% were overridden by the prescriber. In 3.2% of reviewed overrides, a recommendation by the pharmacist was provided, of which 79.2% was accepted. False positive alerts were caused by a too broad screening interval and lack of incorporation of patient-specific characteristics, such as QTc values. Co-prescribing of a non-vitamin K oral anticoagulant and a low molecular weight heparin accounted for 49.8% of alerts, of which 92.2% were overridden. In 88 (1.1%) of these overridden alerts, concurrent therapy was still present. Despite the high override rate, the e-survey revealed that the DDI clinical decision support system was found useful by prescribers. CONCLUSIONS: Identified barriers were the lack of DDI-specific screening intervals and inclusion of patient-specific characteristics, both leading to a high number of false positive alerts and risk for alert fatigue. Despite these barriers, the added value of the DDI clinical decision support system was recognized by prescribers. Hence, integration of DDI-specific screening intervals and patient-specific characteristics is warranted to improve the performance of the DDI software."