Acupuncture in pregnancy
BMJ 2008 doi:10.1136/bmj.39471.430451
Infertility and subsequent IVF are both emotionally challenging and financially draining. This systematic review and meta-analysis assessed whether acupuncture improved pregnancy and live-birth rates in those receiving IVF treatment.
Seven trials with 1,366 women were included in the study. Controls were either no adjuvant treatment or sham acupuncture.
Acupuncture was found to significantly increase the chances of conceiving, ongoing pregnancy and live births. The odds ratio for live births was an impressive 1.91, (confidence interval 1.39 to 2.64) and the NNT was 9, although the authors accept the odds ratio for live births may be flawed.
The data suggest that acupuncture has a role to play in those receiving IVF, and NICE may be required to evaluate the data and offer guidance.
Suicide rates decline in young men
BMJ 2008 doi:10.1136/bmj.39475.603935.25
While we endeavour to assess suicide risk among our patients, it is impossible to completely eliminate what is a devastating act for all concerned. Those particularly at risk include young men and the elderly, due to social isolation, chronic illness, alcoholism and depression.
Observational evidence that the suicide rate among young people may be falling motivated the authors of this UK-based study to investigate suicide in this group between 1968 and 2005. They looked at suicide in both men and women between the ages of 15 and 34 years.
The authors observed a decline in suicides since the 1990s and that by 2005 rates were at their lowest for almost 30 years.
The introduction of catalytic converters may also be related to the decline, although the authors acknowledge a reduction in suicide by all common methods, including hanging. The reasons behind this fall were attributed to a number of factors including changing unemployment rates.
While these data are comforting, we cannot afford to be complacent when managing our patients.
Cancer survivor follow-up
Lancet Oncology 2008; 9: 232-8
Three quarters of children will survive their cancer, and as a consequence oncologists tend to agree robust life-long follow up is required. Systems to ensure adequate follow up are currently inconsistent.
This relatively short study was based in the Netherlands and considered whether it was feasible to offer shared care follow up between secondary and primary care. The review by primary care doctors included assessments according to guidelines of the UK Children's Cancer Study Group Late Effects Group. Main endpoints were satisfaction rather than clinical endpoints. Eighty-eight per cent of patients and 82 per cent of family doctors were satisfied with the shared care model.
Training and safety data, backed up by adequate resources, will be required if such schemes are rolled out on a national level.
Omega-3 fatty acids for cardioprotection
Mayo Clin Proc 2008; 83: 324-32
As yet, patients tend not to be routinely prescribed omega-3 fatty acids post-MI. This Mayo Clinic study reviewed three trials totalling 32,000 patients randomised to omega-3 supplements or controls.
A 19-45 per cent relative risk reduction in cardiovascular events was demonstrated in patients taking omega-3 supplements. The authors advise daily doses of 1g for those with known CHD and at least 250-500mg for primary prevention.
Higher doses may be used to help lower triglyceride levels. Such doses may be impossible to achieve by diet alone, except for primary prevention patients where two fish-based meals per week may provide the desired 500mg/day of omega-3.
Healthcare-seeking behaviour for acute chest pain
Heart 2008; 94: 354-9
There is much research into health-seeking behaviour in patients experiencing chest pain. One argument is: why invest vast amounts of money into ensuring patients receive thrombolysis within 20 minutes of arriving at hospita- then patients may be delaying seeking medical advice for hours?
Of course, the greater the delay, the less effective thrombolysis becomes. There are a number of reasons why patients do not seek help immediately after the onset of chest pain. Reasons suggested include perception of seriousness and self-diagnosis of dyspepsia.
This UK-based prospective study investigated whether ethnicity influenced healthcare-seeking behaviour and management of patients with chest pain.
The authors found that South Asian patients were less likely to arrive at hospital by ambulance than their age and sex-matched counterparts.
Ironically, they were more likely to receive thrombolysis which, in part, may reflect the increased prevalence of CHD in these patients. Whether these patients do not seek help because of poor education of CHD, a lack of understanding of our medical system or access and language barriers is unclear. It is imperative healthcare professionals continue to educate patients to ensure they know how to seek medical help when they experience chest pain.
Dr Thakkar is a GP in Woodburn Green, Buckinghamshire, and a member of our team who regularly review journals
The quick study
- IVF pregnancies and live births are positively affected by acupuncture treatment.
- Suicide rates in men and women have been seen to decline since the 1990s.
- Shared care proved a satisfactory experience for cancer patients and doctors.
- Omega-3 supplements have been shown to reduce the risk of cardiovascular events.
- Thrombolysis is more likely to be received by South Asian patients with chest pain than their counterparts.