Category Archives: Research Blog

Robots Performing Surgery

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Robotic surgery is a relatively new technique being performed, and believe it or not it’s been spreading like wildfire. Well, the robots do not actually perform the surgery by themselves…but human controlling robotic arms do performing surgery, taking the place of hands and in some cases steel instruments.

The thinking is that robotic techniques require less training in many circumstances, can be performed with potentially less tissue trauma, and could even be performed remotely.  If all this is true, are these robotic techniques more reliable than humans in the OR?  A perhaps not so obvious downside is that robotic techniques frequently costs a lot more than a lower-tech approaches, such as the surgeon doing the technique with their hands and usual equipment. So- which is better?

Earlier this year, the Journal of Clinical Oncology did research on women with endometrial cancer to see if there was a decrease in complications when the surgery was done with a robot. Researchers found that there was not a decrease in complications when robotics were involved.

This study did demonstrate that the cost was much higher using the robots, but the bottom line benefit to the patient was no different.  Complication rates were even the same.

Thus, the take-home point, at least until there’s more research, is that using robotic surgery for some surgeries doesn’t offer more benefits, but it might cost you more.  Ask questions. Challenge assumptions, See the data yourselves.

Snowboarding Injury Alert

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Are you or your kids giving up skiing to try snowboarding? Or are you trying snowboarding for the first time? If you’ve already tried snowboarding you don’t need us to tell you it requires a different skill set then skiing and can be extremely challenging.

The American Journal of Sports Medicine did a study at a ski resort in Vermont looking at over 12,000 injuries over 18 winter seasons. The results showed that most injuries occurred in young, inexperienced snowboarders.

What this study tells us is that snowboarding incorporates a crucial balancing aspect to it that skiing doesn’t have to the same degree. The difference is so drastic that they have a greater potential to become injured snowboarding then they do skiing.

So we think, as parents, having the conversation and being sure that your child (or you) has more experience with snowboarding before advancing and doing things that could cause more injury is an important one to have before they hit the slopes each winter (however mild).

Positive Thinking and Healing

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The Archives of Internal Medicine reported on a study that examined the impact of positive psychology; if we think we’re better are we actually going to be better?

The researchers looked at the impact of positive thought on exercise after a cardiac procedure.  They found that patients who had positive thoughts had sustained and clinically significant increases in physical activity over a year compared to those that did not receive this additional intervention. In another study from this group, they looked at exercise among asthma patients and found that the positive thought group may have benefited those asthma patients with the most severe asthma.

While positive thinking in these studies did not always lead to health benefits, this is pretty good considering that there does not appear to be a real downside to the therapy!  This is positively (pun intended) good news.
For a lot of people, it’s the right way of approaching things because it’s intrinsically beneficial and can and will deeply impact your life.

Fish Oil and MUSCLES

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The American Journal of Clinical Nutrition published a study that looked at whether fish oil had potential benefits for muscle and exercise.

We know that people who get more Omega 3 fish oils have been found to have a lower risk of heart disease.  This study was done with a group of older women to see if they would be able to boost their muscle strength by adding fish oil supplements to their exercise routine.

The women were assigned to 1 of 3 different exercise groups where they performed strengthening exercises 3 times a week for 3 months.  The other groups had the same sort of exercise regimen but they also took 2 grams of fish oil a day to see if that had different health impacts.

Researchers found that doing the strength training for 3 months plus taking fish oil did help increase muscle strength among patients who did both things.  It is a bit unclear whether or not that translates into overall better health or if being a little stronger makes a difference to decrease accidents such as falls.

Although this was a good study, we would not recommend that you start taking fish oil if you have no other reason to (such as high triglycerides, elevated cardiac risks, etc.).  If you are taking fish oil already and are having no side effects, this may be an extra benefit.

What’s a “T” Score and Why Does it Matter?

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An article published in the New England Journal of Medicine (by our own UNC Family Medicine colleague, Dr. Margaret Gourlay) did a study looking at how often women should get bone density screening.  Researchers studied 4,000 women over a 15-year period.  They looked at those who were screened  and what happened to their bones over time, to try to help us get a better understanding of how often we should screen and which populations we should focus on.

They calculate from the bone density screening what’s called the “T” score.  Depending on your “T” score, which is a risk of developing osteoporosis, or osteopenia, a less severe form of thinning of the bones, what you need to do and how often you need to do it.

Researchers found in women 67 years of age and older, if you have a normal “T” score  (starting out with a “T” score of negative 1.00 or higher), it took an average of almost 17 years for only 10% of that group to develop osteoporosis.   What this information tells us is that for such women, they could go from age 67 to age 82 and have a very low osteoporosis risk, so in such women, they might not need to have that bone density screening done again for at least 15 years.

If you had moderate osteopenia  and had a “T” score, from negative 1.5 to negative 2, the testing interval drops to 4-5 years, and if you have advanced osteopenia, it drops to almost every year.  The younger you are the less frequent you need screening. This is begins to give us some idea of which group of women need to have more aggressive screening and which group of women (and men) might not need to be followed up nearly as aggressively.
Bottom line answer: If you have osteoporosis risks or have had a bone density study in the past, know your “T score, as this is practice-changing revelation.

Crossword Puzzles Unlock Health Keys

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It’s estimated that 36 Million people suffer from Alzheimer’s disease worldwide, and as the population ages, that number is expected to increase to 66 million by 2030 and 115 million by 2050.

The Archives of Neurology published a study in which researchers looked at 75 healthy people who are 60 years of age and older. They looked at mental activity such as reading, writing, and playing games. The researchers then compared brain scans of healthy people versus people with Alzheimer’s disease.

Researchers found that people who challenge their brains throughout their lifetime are less likely to develop these protein deposits in the brain that are linked with Alzheimer’s compared with people who didn’t do those brain activating things throughout their lives.

The study also showed that if the Alzheimer’s patients took up these reading and writing games or exercises later in their life it didn’t make a difference. The key to reducing the chances of Alzheimer’s was to have this life-long brain-challenging pattern.

On one hand, we aren’t sure this was the most effective study because it required people to remember back to what they did when they were growing up, but we do like that it reinforces a lot of what people believe, that trying to keep your brain sharp seems to protect you.

So whether it’s something as simple as crossword puzzles, bingo or computer games, do something to stay mentally sharp- it may not save your life, but it could save your mind!

Vitamin D & Chronic Obstructive Pulmonary Disease

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A recent study looked at 182 people suffering from COPD (Chronic Obstructive Pulmonary Disease) and the impact taking Vitamin D would have on the disease.

Vitamin D is the vitamin “du jour” , with multiple proposed benefits , and the thought was that since it helps reduce inflammation, it might help people who have chronic lung disease have fewer flare ups.
Had this study showed positive results, it could have provided hope to patients suffering from COPD. Unfortunately, the study tell us otherwise.

Results of the study showed that almost everyone was still suffering from the same type of exacerbations or hospitalizations that they had before they started taking Vitamin D. So, if you have vitamin D deficiency it’s okay to be taking vitamin D, but we wouldn’t advise taking it just to improve your lung health.

Pomegranate Seed Oil & HOT FLASHES?

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This is really the first clinical study (we’ve ever seen) that looks at pomegranate seed oil as a treatment to help ease hot flashes. Researchers had 81 women who had experienced lots of hot flashes and gave half pomegranate seed oil while half got a placebo that didn’t have any extract of pomegranate seed.

Pomegranate is high in phyto-estrogens that mimic estrogen, and we know that estrogens reduce hot flashes, but also have many adverse side effects.

The result of the study:  the two groups of women actually both had significant reduction of their hot flashes.  How is that possible?

It appears both groups of women saw reduced symptoms from something commonly known as the placebo effect, where people believe they are receiving an active treatment but they actually are not.  But in this study, there was not a significant difference between the people who took the pomegranate seed oil and the people who took placebo.
To be exact, researchers saw a 13% difference between groups, but since they had small numbers in the study (only 81 women), our concern is there could be a small difference but maybe they just didn’t have enough people to actually show it statistically.

At this point, we think if you’ve been taking pomegranate seed oil and you feel like it’s helpful, then we don’t necessarily recommend stopping it, but we wouldn’t, as physicians, recommend this to our patients otherwise just yet- check back when we see more research.

Biofeedback- Mind over Matter?

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Three questions:

1)      Do you know any child with leakage of urine or incontinence of bladder, or constipation?

2)      Do you know anyone who believes that biodfeedback, regulating your body with your mind, is valuable to help live a healthier life?

3)      Do yo know a kid who likes to play video games?

Well, if you (or your children) would answer yes to any of the above three questions, we have a great research study to share.  This research, in the Journal of Urology, shows that biofeedback is a useful method to help young children who wet their pants or leak urine, even those with constipation. 

These kids can learn to control such problems better than if they do not use biofeedback.

Researchers published a study looking at animated biofeedback, using video game technology and pictures of animals, with kids to teach them the biofeedback technique of controlling the muscles of their pelvis. Half the kids (8-9 years old) had multiple sessions of animated feedback and half got the traditional messages about behavior change and diet.  Kids in the animated biofeedback improved a great deal, reducing their bed wetting from 28% to 8%, more than the traditional approach.

These kids did not experience any bad side effects or bad drug reactions, although we do not know if this technique can be taught more widely in our current health care system without changes in health reimbursement and insurance.  But, we strongly support more research and exploration of this safe alternative that might help these children and their families.

Smoking, Strokes & Lung Cancer

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A study in the Journal of Stroke looked at 150,000 adults who have lung cancer to see if they were at a higher risk of having a stroke.

As doctors, this study wasn’t much of an eye-opener because when you think about how cancer in the lungs can spread to the brain, that is a set-up for stroke.  There is more likelihood of clots, which can lead to stroke.
This study highlights a very important point about smoking, which is that it can have many other risks, like the one we just talked about.  If you or anyone you know is diagnosed with lung cancer it is important to have a conversation with your doctor about reducing the chance of having a stroke.