Consulo Indicium - 7/6/22

Information for your Consideration…

On The Alzheimer’s Front – Positive Results From Increased Omega 3 DHA Levels – In a new study reported in Nutrients, higher blood levels of Omega 3 DHA results in a nearly 50% reduction in the likelihood of developing Alzheimer’s disease compared to those who had lower levels. What it means is that simply increasing your dietary Omega-3 DHA – especially for those individuals who carry the ApoE4 gene (which increases the likelihood of developing Alzheimer’s by 50%) – dramatically slows the onset of the disease. Such a cost-effective, low-risk dietary intervention like this could potentially save billions in health care costs. The implications are very significant because of the very significant impact from a relatively simply dietary intervention. It is estimated that the health care costs for Alzheimer’s in 2021 exceeded $350 billion in the US in terms of formal costs. This does not include the cost of family care-giving or unpaid caregivers – which are a significant cost as well. 

Tattoos For Good, Not Just Show – Researchers at The University of Texas at Austin and Texas A&M University recently reported on a development that adds “function to show”. It comes in the form of an electronic tattoo that is worn on the wrist to deliver continuous blood pressure measurements. But the more remarkable feature is that the device is more accurate that virtually all available options for measuring blood pressure on a digital basis. This is a very important development because blood pressure monitoring has been shown to be an invaluable resource for the management of hypertension and other more long-term problems associated with the disease. The new devices use graphene which is a very strong, thin material for the e-tattoo. It is like the pencil graphite but instead of a random pattern to the graphite, it is organized into precise thin layers. The devices have a “stickiness” which allows them to comfortably lay on the skin for monitoring blood pressure.

Federation of State Medical Boards (FSMB) Promotes New Telemedicine Policy – Time seems to be slipping by too fast. Last April, the FSMB House of Delegates unanimously adopted a new telemedicine policy that will (hopefully) lead to more effective and efficient use of telemedicine by all physicians and clinical providers. The new policy came about through recommendations of a FSMB work group that included a broad array of leaders from across the provider sector. The intent of the new policy is to allow telemedicine and telehealth services across state lines without the need for a physician to be licensed in every state. Specifically, the new policy allows for physician-to-physician consultations, prospective patient screening for complex referrals, episodic follow-up care for established patients, follow-up after travel for surgical/medical treatment and patient interactions involving clinical trials. For a more comprehensive review of the policy and its implications, check out the AMA Advocacy Insights webinar series.

In general, there is strong interest among the physician community for the new policy. However, the new policy comes at a time when it could be particularly useful in support of the growing primary care shortage. However, a new report released a month ago from a Walmart-Medscape poll of physicians revealed paltry use of the tools at the present time. For example, only 28% of urban and 22% of rural health care providers currently use remote patient monitoring (RPM) practices. On the other hand, the patients are a bit ahead of the providers with 32% of urban and 29% of rural respondents using fitness apps, smartwatches, Fitbits, and other similar information devices. These results stand in contradistinction from the perceived benefits of the providers who by and large feel that RPM would be beneficial for their patients.

Based on my experience, there are two impediments to adoption. First, the vast majority of physicians and other health care providers have not been adequately trained on how to use these tools as adjuncts for their practices. Too frequently, it’s just “another thing to do” in the increasingly long list of requirements in patient care under a fee-for-service system. Second, the use of these tools requires a revision of the “process” on how the tools are integrated into the practice of the providers. Without revising the outpatient clinical process, RPM and other telemedicine tools can be seen as a distraction from the need for direct patient care. The end result? We – the medical care delivery leaders and educators – need to do a better job of helping these providers resolve these problems. There are existing programs that have been shown to make a difference. 

Ongoing COVID Update – As you no doubt heard, the CDC recently authorized the second mRNA COVID-19 vaccine booster (= the 4th shot for those who are keeping count like me). The approval was for middle-aged and older adults (= greater than 50 years of age). Their decision was based on two studies from Israel that included more than 1 million older adults as reported in the New England Journal of Medicine. In essence, the studies confirmed that protection from the fourth shot peaked roughly 4 weeks after injection. However, protection against “severe” COVID-19 infections continued for longer periods of time!! Long story short, I had my 4th booster in early May. They have not resolved the question of what to do after the period where coverage wanes (i.e., after 8 – 10 weeks following the 4th vaccination). It still seems to provide protection against “severe” infections at this point. So, it would still be advisable from my perspective to mask up, use prudence in attending large events especially if in compressed areas, and stay home if you’re not feeling well. We’ll keep an eye on it…

COVID & Impact On The Brain – One of the issues us “older folks” are concerned with is the potential impact of COVID-19 on brain function. A new study out of the United Kingdom Biobank databased documents important changes as reported in the April 2022 issues of Nature[1]. They studied individuals who had previously had an MRI (brain scan) as part of general longitudinal study of aging and who had experienced a COVID-19 infection. 401 cases of COVID-19 patients were compared to 384 controls that were matched for socioeconomic status, health status, age, sex, ethnicity and other factors. The COVID-19 patients had important changes in the brain, including: damage to the olfactory (= smell function) cortex, reduction in gray matter in the frontal cortex over the eyes and the areas around the hippocampal gyrus, general reduction in overall brain size, AND – most importantly – greater cognitive decline. So, the conclusion was that a COVID-19 infection definitely caused changes in the brain in areas that have been shown to exhibit clinical signs as well (e.g. loss of smell, confusion, etc.). Obviously, this is a big deal and relates to question of “Long COVID” and its potential impact. I suspect information on this topic will continue to percolate forward as the researchers “peel the onion” of COVID-19. 

A Final Note (This Time) On The Importance Of Coffee 😊 – There is a new report in the journal Kidney International Reports noting that coffee consumption may be protective of kidney function. If that’s the case, my kidneys are doing very well. The report notes that coffee consumptions appears to reduce the risk of acute kidney injury (AKI) with people who consumed any amount of coffee exhibiting a 15% lower risk of acute kidney industry but those who drank 2 – 3 cups per day has a 23% lower risk. I wonder what happens among those who consume more than 10 cups a day 😊.



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