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03-03-2013 | Article

Global medical news in review: February 25 – March 2, 2013

medwireNews: A roundup of select stories of interest to US physicians from the MerckMedicus Medical News wire.

Ills of a bleak outlook

Psychological factors have increasingly been shown to affect the outcome of patients being treated for rheumatoid arthritis (RA). This is especially relevant when these patients have learned helplessness (LH) and become overly passive about their health problem and resigned to having little control over it.

But little is known about the long-term impact of LH with previous studies producing varied results. To address this, a study in Rheumatology looked at data from a large cohort of patients to confirm how LH impacts RA outcomes down the line.

Researchers found that feeling a lack of control over life along with a passive response to problems at the time of diagnosis significantly influenced patients' pain and fatigue stemming from inflammatory polyarthritis.

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Stomaching bad news

The portion of healthcare costs in the USA going toward the treatment of obesity and its related conditions has reached 16% with signs of its subsidence nowhere in site as more patients resort to bariatric surgery.

In a sobering critique in JAMA Surgery about the supposed benefits of bariatric surgery, the journal's deputy editor concluded that the procedure could only be viewed through the lens of how it benefits an individual patient; proof of any gain in cost savings or reduced resource utilization is not only absent, but also likely to be the opposite.

In addition to the weight loss surgery providing no cost advantage to the healthcare system, he pointed out that postoperative follow-ups have found "little to no long-term survival benefit," thus concluding that bariatric surgery brings no "overall societal benefit."

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Catered communication needed

Telehealth and its use of telecommunication technologies ranges from being applied clinically, such as the transmission of medical images for diagnosis, to nonclinical purposes, including continuing medical education from a distance.

However, the advantages that telehealth bestows on improvements in clinical outcomes is still a debatable topic. Recently, findings in a BMJ study served as a shot across the bow by finding that telehealth intervention failed to improve health-related quality of life, anxiety, or depressive symptoms in patients with a variety of long-term ailments.

The researchers accede that their assessment was based on a more outdated version that did not deliver healthcare and responsive intervention in as tailored a manner as do more recent versions of the technology.

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Robotic splurge

Until recently, robotic surgery has predominantly been used in urology for prostatectomy. But over the past 4 years, gynecological surgeons have increasingly turned to robotics specifically for hysterectomies.

To date, precious little is known about the spread in use of robotic hysterectomies or its efficacy; a gap in knowledge that motivated researchers to conduct a population-based study of a national database to look at procedures that women had for benign gynecological conditions across the USA.

An assessment of 260,000 women who were treated at over 440 hospitals found no real difference in outcomes between laparoscopic and robotic hysterectomies, while the latter procedure had a much heftier hit on the wallet.

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Facing tradition

According to traditional Chinese medicine, a state that is elicited by certain acupuncture stimulation, de qi, is necessary if clinical efficacy is to be achieved. Studies that have looked at the underlying neurophysiology that is impacted by this technique have suggested the involvement of a large variety of myelinated and unmyelinated nerve fibers.

Yet, evidence still remains scant about the true clinical benefits of de qi - a more forceful technique that manipulates acupuncture needles in a way that elicits soreness, tingling, fullness, and aching, among other sensations.

A study in the Canadian Medical Association Journal that conducted a randomized controlled trial found that the intense form of acupuncture along with prednisone treatment elicited a greater improvement in facial function in Bell's palsy patients than low-intensity acupuncture.

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By Peter Sergo, medwireNews Reporter