AcuteCare Telemedicine Blog


Now is the Time

Like any other year, the beginning of 2013 brings a great deal of optimism about what surprising changes and exciting opportunities and a new year will bring, not just to healthcare, but to our everyday lives. We are living in an age of constant innovation and untamed enthusiasm for what is new. Every day, we read news about the pioneering of new solutions for age-old problems and find ourselves astonished by what we can accomplish with the collective knowledge of generations past and a zeal for moving towards the future.

Telemedicine is a prime example of an entire industry fueled by this fervor for innovation, and the resulting advances it has brought to the way we think about healthcare are nothing short of remarkable. Unfortunately, the level of investment in terms of initial costs and putting trust in new technologies has been enough of an obstacle to prevent many facilities to postpone the adoption of telemedicine.

Embracing telemedicine is about far more than flashy new technology and the promise of saving costs; it is about taking steps forward to make our world a better place. For example, the latest tragedy to make national news out of Newtown, CT served as a stark reminder that there are still great strides that need to be made in order to address the needs of individuals with psychiatric conditions. Fortunately, through telepsychiatry programs and the drastic improvements in patient monitoring capabilities afforded by telemedicine, it is easier than ever before to get help. Extending the attention and the care that is so desperately needed in cases such as these will undoubtedly help us prevent many such worst-case scenarios.

It is the hope of AcuteCare Telemedicine and other proponents of telehealth that the plethora of new equipment and methods available to providers will continue to propel healthcare towards an era in which every individual has unhindered access to the care they need. There has never been a more important time to push the many benefits of telemedicine into the spotlight, and take the first steps towards achieving this goal.



Think of Your Brain!

It is without a doubt the most vital organ in the human body, but too often we neglect the importance of taking good care of our brain. The development and organization of the brain are incredibly complex, but the intricacies of this central body belie the simplicity of its proper day to day caretaking. We only get one – why not give some thought (pun intended) to it.

Prevention of traumatic head injuries is likely the most obvious consideration for avoiding significant damage to the brain. Unfortunately, we cannot always predict when an accident might occur, but we can take basic steps like fastening our seat belts while riding in automobiles and wearing helmets when engaging in physical activities carrying risk of trauma. Beneath the skull, we must be concerned with degenerative disorders of the brain affecting motor skills and cognition, such as Alzheimer’s Disease and Parkinson’s. Depression and anxiety also afflict millions of individuals across the country. It is important to remember that although our fast paced, high-stress lives can seem overwhelming, these conditions are chemical, and there are measures we can take to mitigate their negative effects.

Perhaps the most severe threat to the brain is stroke and other cardiovascular disease. The American lifestyle has taken a significant toll on the health of the blood vessels that deliver vital oxygen and nutrients to the brain. We have seen it most exaggerated throughout the southeastern US, a part of the country known as the ‘Stroke Belt,’ where residents face significantly higher rates of stroke morbidity and mortality.

The experts offering advice to citizens on how to minimize their risk of stroke sound like a veritable broken record; sleep more. Eat better. Exercise. Although stroke care has made huge advances in technology and technique over the course of the past decade, there is truthfully no more powerful plan of action than that of prevention. Telemedicine may soon be able to play a bigger role in opening lines communications between physicians and patients at risk of having a stroke, helping them take the necessary steps to avoid an emergency situation where the health of their brain and their life are in danger. As neurologists become more familiar with the advantages of new telemedicine technologies, they are realizing that the “ounce of prevention” is more readily available than ever before.



Check Your Head

In the wake of countless notable events including the deaths of several professional athletes in the past 5 years, new light has been shed on an epidemic which we are beginning to learn may be far more widespread than initially thought.

Researchers at Boston University recently published the largest study of chronic traumatic encephalopathy (CTE) to date. CTE, a progressive degenerative brain disease thought to stem from concussive trauma to the head, has been known to affect boxers since the 1920s, but only recently has gained notoriety as a serious concern for athletes of all ages across many sports. In these latest findings, 68 of 85 donated brains from deceased veterans and athletes with histories of head trauma showed visible evidence of the disease, including a staggering 34 of the 35 brains from former professional football players.

CTE

The greatest concerns sparked by our growing understanding of CTE’s causes and pathology are without a doubt related to the protection of younger children participating in sports and other activities where risk of injury to the brain is involved. The work of the BU researchers has led to drastically improved protective equipment and restructuring of rules and regulations to minimize the number and force of hits to the head, but it is nearly impossible to remove the potential for these injuries from sports at any level.

Thus, the best possible measures that can be taken are to prevent any repeat injury of the brain. Taking the lead, the NFL has instituted mandatory on-field concussion screening following hard hits. The NHL has also ordered that players with potential head injuries spend time in a ‘quiet room’ off the ice. Youth leagues are particularly concerned with preventing any participant who may have sustained an injury from getting back into the game and facing further danger.

Telemedicine offers the potential for significant further contribution to these efforts. With the help of technology, expert neurologists can always be on hand to examine potential head injuries, and monitor patients in the aftermath of an injury, aiding the recovery process. Thanks to telemedicine’s advances, logistics and associated costs are no longer obstacles to immediate and accurate concussion diagnosis and treatment.

The fight against CTE and other trauma-induced brain disease starts long before the first injury happens, but when it cannot be entirely prevented, telemedicine could play a role in ensuring fewer players incur more severe consequences later in life.



Stroke Treatment Gets a Boost

Fifty years ago, the only advice medical textbooks gave physicians for someone suffering with a stroke was to put him to bed and keep him comfortable, hoping that with time, the brain would heal as best it could. For 30 years, promising techniques preceded disappointing trials. First, heparin was going to be the savior, and for most of the 70s and 80s, it almost served as a standard, but better studies eventually showed that the treatment was not just worthless, but in reality dangerous, causing more brain hemorrhages than no treatment at all. Later, drugs that were intended to clear out “free radicals” were going to save the ischemic penumbra, part of viable brain tissue around a central core of dead cells, but all studies showed that either the medication didn’t get to the target, didn’t work, or could even be toxic to the brain.

In the mid 90s, tissue plasminogen activator (TPA), long used for heart attack victims to break up the clots inside arteries of the heart, was shown to be effective in doing the same in arteries of the brain. For the first time, physicians had something to offer patients that actually made a difference. About a third of patients who received TPA had better three month outcomes than those that did not. This success rate was quite good, but patients with severe strokes still did not respond as well because, in most cases, thrombi in the large arteries were not effectively dissolved.

Only in the last few years have studies been done to consider the effectiveness of a thrombectomy, the process of physically pulling out a thrombus inside an artery in the brain or neck, The early devices available to physicians are fairly good at the task, but a substantial number of patients continue to suffer from residual blockages of the arteries following the procedure.

A report of clinical trials using two new types of thrombectomy devices, called Solitaire and Trevo Retriever, show both of these new devices as being up to five times more effective than their predecessors in opening up arteries. Advances this drastic are rare in medicine, but physicians should be optimistic about the potential for these instruments in improving outcomes. Provided that patients can have access to skilled practitioners in time, within eight hours or sooner, the treatment of stroke may be about to enter a dramatic new phase.

Stroke is the most serious disabling condition in adults, resulting in hundreds of thousands of permanent injuries and deaths every year. This decade may witness the greatest advances in the history of stroke treatment. There are still further trials to run, but with these exciting new prospects, the importance of stroke neurologists like the doctors of ACT being present in every emergency room, either in person or by remote presence, cannot be overstated.