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Acupuncture ineffective for IVF birth rates
Researchers from Western Sydney University have found that women undergoing acupuncture treatment during their IVF (in vitro fertilisation) cycle experienced no significant difference in live birth rates. Published in JAMA, the study examined the effects of acupuncture administered before and after an embryo transfer. Undertaken across 16 IVF centres in Australia and New Zealand, the randomised clinical trial involved 848 women aged 18–42 years, who were undergoing an IVF cycle using fresh embryos between June 2011 and October 2015, whereby participants were given either acupuncture or a sham acupuncture control (a non-insertive needle placed away from the true acupuncture points). The results showed the rate of live birth was 18.3% among participants who received acupuncture versus 17.8% in those who received the sham acupuncture control, a non-significant difference. While a short course of acupuncture may statistically be no better than sham at improving live birth and pregnancy outcomes, a psychosocial benefit from acupuncture was reported by women undergoing IVF.
UTI: ibuprofen no substitute for antibiotics
Researchers from the University of Oslo in Norway have found that ibuprofen is not a safe alternative to antibiotic treatment for urinary tract infection (UTI). The study, published in PLoS Medicine, randomly allocated 383 women with uncomplicated UTIs to receive either standard treatment of antibiotics for 3 days or ibuprofen as a symptomatic treatment without an antimicrobial effect. Women’s symptoms, bacterial growth from urinary samples, and the occurrence of adverse events, including systemic infection or hospitalisation, were monitored during the study. The results showed that women assigned to receive ibuprofen without antibiotics took 3 days longer to get well on average. Seventy out of 181 (39%) patients receiving ibuprofen compared with 131 out of 178 (74%) receiving antibiotics recovered from symptoms by Day 4 (35% adjusted risk difference, 95% CI). Also, among women in the ibuprofen group, 12 (6.6%) developed a febrile UTI, with a smaller proportion (3.9%) developing a serious kidney infection, which did not occur in the antibiotics group. Although more than half of the patients initially treated with ibuprofen got well without taking antibiotics, suggesting that this approach could potentially reduce overall antimicrobial usage, the study concluded, in confirmation of other recently reported trials that it is not safe to recommend ibuprofen instead of antibiotics in uncomplicated cystitis, due to the increased risk of developing a serious upper UTI.
Disruptions to body clock linked to mood disorders
In the largest observational study of its kind, researchers from the University of Glasgow have found that disrupted body clock rhythms are associated with increased susceptibility to depression, bipolar disorder and adverse wellbeing. The study, involving 91 105 people, was published in The Lancet Psychiatry. These disturbances to the body’s internal clock, characterised by increased activity during rest periods and/or inactivity during the day, are also associated with mood instability, more subjective loneliness, lower happiness and health satisfaction and worse cognitive function. The results held true even after adjusting for a wide range of influential factors, including age, sex, lifestyle, education, body mass index and childhood trauma. The researchers analysed activity data in the participants (aged 37–73 years) from the UK Biobank general population cohort to obtain an objective measure of patterns of rest and activity rhythms, known as relative amplitude. All participants wore accelerometers for 7 days between 2013 and 2015 to record their activity. This information was linked to mental health questionnaires to assess symptoms of mental disorders and subjective wellbeing and cognitive function. Mathematical modelling was used to investigate associations between low relative amplitude (reflecting greater activity during rest periods and/or daytime inactivity) and lifetime risk of mood disorder as well as wellbeing and cognitive function. The researchers found that lower relative amplitude was associated with greater odds of reporting lifetime history of major depression or bipolar disorder (adjusted odds ratio, 1.06 and 1.11; table 2). Lower relative amplitude was also found to be reliably associated with greater mood instability, higher neuroticism scores, more subjective loneliness, lower happiness and health satisfaction and slower reaction time (an indirect measure of cognitive function).
Exercise doesn’t slow dementia
Moderate to high intensity exercise does not slow cognitive impairment in older people with dementia, according to a study by researchers from the University of Oxford, published by the BMJ. The trial involved 494 people with mild to moderate dementia (average age 77 years) living in the community across 15 regions of England. General health and fitness was assessed at the start of the study, and participants were randomly assigned to either a supervised exercise and support program (329 patients) or to usual care (165 patients). The program consisted of 60–90-minute group sessions in a gym twice a week for 4 months, plus home exercises for one additional hour each week with ongoing support. The main (primary) outcome was an Alzheimer’s disease assessment score (ADAS-cog) at 12 months. Other (secondary) outcomes included activities of daily living, number of falls, and quality of life. Compliance with exercise was good and participants were assessed again at 6 and 12 months. After taking account of potentially influential factors, the researchers found that cognitive impairment declined over the 12-month follow-up in both groups. The exercise group showed improved physical fitness in the short term, but higher ADAS-cog scores at 12 months (25.2 v 23.8) compared with the usual care group, indicating worse cognitive impairment. However, the average difference was small and clinical relevance was uncertain. No differences were found in secondary outcomes, including number of falls and quality of life, or after further analyses to test the strength of the results.
Online first at the MJA
21 May Perspective: Virtual medicine: how virtual reality is easing pain, calming nerves and improving health
Spiegel; doi: 10.5694/mja17.00540
Virtual reality has been used to help treat anxiety, control pain, support physical rehabilitation and distract patients during wound care … OPEN ACCESS for 1 week.
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It goes without saying that the old addage that he or she who “controls the treasury bench controls the business” is true. Thus by logic and commonsense, those who occupy that role will automatically direct its operation along their their philosophical guidelines. By allowing accountants and bureaucrats (as currently occurs) to own and run health care, (which indeed should not be considered a business entity only) you get nothing but an absolute business model that completely subjugates patient’s requirements to the concept of the QALY and other economic theories “du jour”. It appears to me that the old triumpherate system of a Medical Director, a Director of Nursing and Ancillary Services and a Senior Hospital Administrator could be modified to allow for an annual rotating ”head of hospital post” as the best available compromise so as to redress the total imbalance of power that currently applies. Hopefully this structure would ensure that patient’s needs and the reality of budgetary restrictions are equally met. In summary it is long overdue for the “Harvard School of Medicine” to actively fight back against the aggressive economic rationalist policies of the “Harvard School of Business”. A final metaphor to help summarise what I’m saying.