CTE found in 99% of former, deceased NFL players’ brains: JAMA study (updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/07/h_research_Figure-4.-Annotated-Normal.-Mild-CTE.-Severe-CTE.jpg” thumb_width=”200″ /]Updated for additional information and analysis at conclusion. In the largest-ever case study published of CTE–chronic traumatic encephalopathyVA Boston Healthcare System (VABHS) and the Boston University School of Medicine’s CTE Center found mild to severe CTE pathology in nearly all of the brains of former football players studied. Jesse Mez, MD, BU Medical assistant professor of neurology and lead author on the JAMA study, said that “The data suggest that there is very likely a relationship between exposure to football and risk of developing [CTE].” The CTE is marked by defective tau (stained red in the brain sample pictures, click to expand), which is also evident in Parkinson’s and Alzheimer’s Disease.

Of the 202 brains donated to the VA-BU-CLF (Concussion Legacy Foundation) Brain Bank:

  • The most dramatic finding is the detection of CTE in 110 of 111 donated former NFL players’ brains (defined as having played one play in a regular NFL season game).
  • In addition, the brains of other football players were studied. CTE was detected in seven of eight Canadian Football League former players (88 percent), nine of 14 semi-professional players (64 percent), 48 of 53 college players (91 percent), and three of 14 high school players (21 percent).
  • The severity increased with length of play, with the majority of former college, semi-professional and professional players having severe pathology. The deceased high school players diagnosed with CTE had mild pathology findings. Age at death ranged from 23 to 89.
  • Player position mattered. Linemen, running backs, defensive backs, and linebackers, who take most of the punishment in football, were the bulk of the donated brains with CTE.

Separately, and with no knowledge of the pathology, backgrounds on each donor were compiled to gather medical history and symptoms. What was striking were the personality changes evident with even mild CTE. Dr. Mez: “We found cognitive, mood and behavioral symptoms were very common, even among players with mild CTE tau pathology. This suggests that tau pathology is only the tip of the iceberg and that other pathologies, such as neuroinflammation and axonal damage, contribute to the clinical symptoms.” 

Preliminary to the current study was UNITE (more…)

Catch-up: what you may have missed whilst on holiday

This was the month when the UK Press seemingly finally woke up to the existence of STPs (Sustainability & Transformation Plans). This article by Derek du Preez and this in Digital Health are two one of a few that pick out the hope that digital health can help with making the NHS more sustainable. Sadly the headlines were grabbed with concern over closing hospital beds, which politicians in the UK still seem to consider to be a Bad Thing. Even though hospital beds have been reduced in most European countries over recent years, and those such as Denmark now trumpet reductions in hospital beds as progress, we have still to break the connection in people’s minds in the UK that beds are a good surrogate for health service delivery volume, (even though when pressed no individual seems keen to spend longer in hospital than absolutely necessary, or would prefer a treatment as an inpatient over treatment as an outpatient.)

Though not directly connected, the NHS offered over £100m to acute care trusts for “global digital excellence” – in line with the previous comments, perhaps the money could alternatively be spent on the UK building on its excellent primary care IT with the specific intention of moving more treatment out of hospitals…and follow that up with a proposal to put the hospital that is judged to be the least “globally digitally excellent” (more…)

Telemedicine finally gets some respect: WSJ

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/06/long-windy-road.jpg” thumb_width=”250″ /]Telemedicine consults between doctors and with their patients are, at long last, progressing on the Long And Winding Road, according to this sizable recap in the Life and Health section of this weekend’s Wall Street Journal. The focus is on virtual visit growth in the US, but it opens with Doctors Without Borders (MSF) connecting their doctors in Africa with their specialist network worldwide. Mercy Health provides 24/7 ICU/ER support for 38 local hospitals out of a Virtual Care Center outside St. Louis manned by ICU specialists. Their results? A 35 percent decrease in patients’ average length of stay and 30 percent fewer deaths than anticipated. The important statistics here are on acceptance: 72 percent of hospitals and 52 percent of practices are finally integrating some form of telemedicine into care; 74 percent of large employers are covering telemedicine cost–yet awareness is still lagging among prospective patients, with only 39 percent familiar with it according to a recent survey. Challenges remain in reimbursement (more…)

‘Separating the wheat from the chaff’ in medical apps daunting: JAMA

Medical apps may not be strangers to doctors’ offices anymore but they also realize that apps are difficult to recommend responsibly to patients or even to find, because there is no real guidance or validation. This current article in JAMA online confirms the perception and the need for care integration that both Editors Charles especially and Donna have pointed out lo these many years. However this Editor is quite disillusioned at the attempts to date to ‘curate’ apps with the Happtique failure and the relatively low profile to date of IMS Health’s AppScript and professional review site iMedical Apps and the stated intentions of SocialWellth which purchased Happtique. The reality is that the numbers are against it–IMS Health in their study estimated 40,000 medical apps–in 2013. For apps that want to take the high road, it’s economically difficult, but could be rewarding in the long term. The WellDoc BlueStar diabetes tracking and management support app did with FDA clearance and prescription-only use, but few so far can see a revenue model there. Also MedCityNews.

Intended use determines degree of health app regulation–and also how you communicate your attributes and performance claims. Bradley Merrill Thompson, who performs an invaluable service by advising our field on regulation, compliance and interacting with FDA, demonstrates how a developer can determine where the intended use of an app might fall (more…)

EHRs *do* take more time! (JAMA)

If your doctor or nurse is frustrated by their EHR, it’s not because they are a technophobe or klutzy on the keyboard. According to a research letter published in JAMA Internal Medicine (8 Sept), internal medicine physicians reported a loss of time of 48 minutes daily due to EHR use. 411 internal medicine attending physicians and trainees who worked in an ambulatory practice and used an EHR system responded to a 19-question survey in December 2012 by the American College of Physicians. The trainees reported a lower time loss–18 minutes. No conclusion is reached for this difference. Other findings indicated what took more time: (more…)

A cornucopia of appy items!

Abilitynet’s top ten apps

When so many items that present themselves for publication are in one way or another pushing a commercial angle, it is so nice to be able to highlight a completely altruistic listing of apps aimed specifically at helping disabled people.

It would clearly be wrong to deprive Abilitynet’s website of the traffic, so rather than list the apps, we will merely comment that they seem very well chosen to cover as wide a range of disabilities as possible. The presence on the list of a number of widely used apps underlines the oft-made observation that if you design something with disabilities in mind, it is easier for everyone to use.

Distimo app analytics

For those wanting to explore the success of their apps and what works in terms of promotion, or who are interested in app download ranking, Distimo has a hugely impressive website, well worth exploring as everything is free.

The absence of much info on health and wellbeing apps is notable though, perhaps because (more…)