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Responding to increasing concerns around adverse brain health outcomes among former football (soccer) players, the Football Association of England recently announced a trial ban on heading in matches for players aged under 12 years. This is a step in the right direction, but wider interventions to preserve brain health should not be forgotten.
Low-resource settings lag behind the rest of the world in achieving good health, in part owing to poor translation of clinical evidence into practice. Focusing on neurological disorders — in particular, stroke — this Comment identifies barriers to translation at the individual, provider and health systems levels and proposes theory-driven mitigating solutions.
Effective translation of evidence from clinical trials into clinical practice requires the enrolment of diverse, representative trial populations. However, this diversity is still often lacking, with negative clinical implications for under-served groups. Changes are needed to research practices and the broader research landscape to correct this problem.
The past 5–10 years have seen rapid advances in digital sensors and imaging-based technologies for the diagnosis of neurological conditions. However, the majority of these technologies are in the early stages of development — now is the time to consider how we validate these tools and safely integrate them into clinical practice.
A growing number of clinical practice guidelines are being developed for neurological diseases, and they have the potential to benefit patients, clinicians, policymakers and payers. However, the effectiveness of these guidelines has not been evaluated, so we do not yet know whether they improve patient outcomes in a real-world setting.
Neurological diseases cause a massive burden, which will increase as populations age. Rapid advances in our understanding of disease mechanisms must be translated into human benefits. We cannot stop once technologies have been developed, but must ensure that evidence and pipelines are in place for their implementation to reduce burden and inequalities.
On the basis of a coverage decision for anti-amyloid monoclonal antibodies recently issued by the US Centers for Medicare and Medicaid Services, Medicare will offer ‘coverage with evidence development’ to allow more information on the clinical benefits of these antibodies to be gathered. Here, we discuss the implications of this decision for future clinical trials and Alzheimer disease care.
Demographically adjusted norms that include sociocultural factors such as race can provide an evidence-based approach for addressing the chronic systemic and diagnostic inequities in the interpretation of neuropsychological tests. However, these norms have important limitations, and more work is needed to improve the diagnostic validity of neuropsychological assessments in diverse populations.
