Friday, August 26, 2011

Fatigue In HCV Infection: A Review (1989-2011)

Fatigue In HCV Infection: A Review (1989-2011)

From; AHCS = Australia Hepatitis C Support Group

Saturday, 11 June 2011 11:13
Written by Doug Mellors and Linda McInnes

To read the full review, please click the following link;
Fatigue in HCV Infection: A Review (1989-2011)

It is unusual to preface a review with an explanation of its genesis as this should be evident in its stated aims, nevertheless, a number of people who helped in creating this review have asked me to do so, and I thought, I should gratefully respond to their request.

The review began with a question “Why are the symptoms of hepatitis C such a mystery?” put to me by Kerry Paterson, (Executive Officer) of the South Australian Hepatitis C Council. We had been discussing symptoms and I had stated, with considerable consternation, that almost twenty years after the discovery of the hepatitis C virus there were still many health professionals who either denied the existence of subjective symptoms in HCV patients, or showed little interest in treating them.

My answer to Kerry’s question was that no one had done a comprehensive review of studies which, had examined the symptoms of hepatitis C; there wasn’t even a clear consensus on what these symptoms were until the first careful survey was published in 2006 – in a word, very few people would have known what research had been done. This answer was followed by a second question from Kerry “ Will you do it?” To which I answered, “Yes, if you can help me to get the journal articles I will need”. I hadn’t done any real research (my professional background was in psychology) for more than twelve years, my statistics, never brilliant, were very rusty, and my computer of archaic vintage – I realized I couldn’t possibly do this on my own, a brief visit to Adelaide University to do some preliminary searches to see what literature was out there, only confirmed my conclusion.

I first met Linda when she was visiting the Council towards the end of 2006, I was very impressed, that with only her son to help her, she had created the AHCS – Australian Hepatitis C Support website and forums. When I described the task ahead of me to Linda she showed a great deal of interest, – after a few further meetings with her, I asked her if she would help me with the review and was delighted when she accepted. A few months later Cecelia Lim, (Co-ordinator, Information and Resources) also from the Council, told us that her negotiations with the Department of Health, to allow us access to the journals we needed, had been successful.
When we had completed the first comprehensive searches (on five symptoms) we realized that there was much more material than we had expected, and too much for us to take on. We decided we would take one symptom at a time, we chose fatigue for three reasons: firstly, it is the symptom most commonly reported by people infected with the hepatitis C virus; secondly, fatigue has been studied more than any other symptom; and finally most studies that investigated fatigue also looked at other symptoms and this review also includes those results. It has taken three and a half years to produce the first half of the review.

By the end of the first year we had completed the first draft i.e. from 1989 – 2007, but during editing, it seemed too lacking in detail and depth of analysis. It had also begun to dawn on us that what we really wanted to create was an archive – if something is archived and is easily accessible it is no longer likely to be a ‘mystery’. We also wanted something that was not static so the commentaries could be changed or added to – providing a safeguard against any mistakes or misinterpretations that we may have made.

At the end of the second year the document was much improved but now it was too bulky and needed to be reduced – at the same time we were trying to catch up with more recent publications.

After about 9 months of revision we decided it was taking too long, we needed to get something out there, so we stopped and concentrated on getting the first half of the review finished – we hope we can finish off the remainder by the end of this year. Although mentioned in the “Introduction” it is probably worth stating here that the review is a very long document, more than 30,000 words (half the length of an average novel!). It takes 50 pages to describe and comment on 43 studies. It may be less taxing to first read the section “Results, Discussion, Summary and Conclusion” at the end of the document which only takes up a little more than 9 pages and is a brief summary of every study in the review. For those people who knew about this work, we apologise for its delay. We hope the reader will receive at least some small benefit from reading it.
Doug Mellors.

To read the full review, please click the following link;
Fatigue in HCV Infection: A Review (1989-2011)

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