Store-and-forward teledermatology versus in-person visits: A comparison in pediatric teledermatology clinic

Do generalists and specialists agree on descriptive acne morphology?

BACKGROUND

Acne is a common skin disease, which is treated by many different specialities. Clinical guidelines for treatment are based on the recognition of acne morphology. The assessment of acne morphology is therefore an important element of the proper diagnosis and treatment of acne.

OBJECTIVE

To evaluate the level of congruence in the assessment of acne morphology in General Practitioners (GPs) and Dermatologists compared to the assessment of an expert.

METHODS

The study was conducted during 2008-2009. Randomly selected GP and Dermatologists Practitioners, (DPs) from Denmark were invited to complete an on-line questionnaire. The questionnaire was based on seven cases, each presented with digital photos and a short history. The respondents were asked to identify the morphology by marking their answer on a closed list. Congruence, variation and the participants' assessment were compared with a priori expert assessment using odds ratios, Fishers exact test and Index of Qualitative Variation.

RESULTS

Of the 1700 GPs and 110 DPs invited, 355 GPs and 99 DPs participated. In all seven cases, DPs were more in accordance with expert opinion than were GPs. In addition, the GPs had a greater variation in the distribution of answers.

CONCLUSION

GPs described acne morphology recognized clinical hallmarks of severity in acne less well than dermatologists and were far less consistent.

Agreement between dermatological diagnoses made by live examination compared to analysis of digital images

BACKGROUND

Teledermatology is seldom used in Brazil, although some incipient initiatives have been implemented in the state of Amazonas. Further studies are still required to confirm the feasibility and efficacy of this diagnostic tool.

OBJECTIVES

To evaluate the efficacy of an asynchronous method of teledermatology using simple, inexpensive technological resources.

METHODS

One hundred and seventy-four patients were examined by four dermatologists, two clinic-based dermatologists, who diagnosed the patients following live examination (A1 and A2), and two consultant specialists in image dermatology, who reached diagnoses by examining images of the lesions and the patients' clinical histories (B1 and B2). The agreement between live examination and examination of images was evaluated.

RESULTS

Agreement between the two live examiners (A1 and A2) with respect to the principal diagnosis was 83.3% compared to 81.0% between the physicians who diagnosed by examining images (B1 and B2). Agreement between the principal diagnosis established by live examination and that obtained from examining images ranged from 78.2% to 83.9%,

CONCLUSION

Agreement between diagnoses of dermatological diseases reached following examination of digital images and those reached following live examination of the patient was excellent.

Geriatric teledermatology: store-and-forward vs. face-to-face examination

BACKGROUND

Telemedicine could be useful in countries like Italy to meet the needs of elderly patients and in particular in those in precarious general conditions, for whom travelling even short distances can pose considerable practical and economical difficulties.

OBJECTIVE

The aim of this study was to determine the efficacy of store-and-forward teledermatology vs face-to-face consultations in elderly patients.

METHODS

A total of 130 geriatric patients with skin diseases requiring dermatological examination were enrolled. The patients examined, consisting of 60 men (46.15%) and 70 women (53.85%), were aged between 66 and 97 years (mean age 80.58 years). Three dermatologists of the department, with equal experience took turns in face-to-face examination and teledermatology (store-and-forward). To compare face-to-face dermatological examinations with the asynchronous store-and-forward approach of teledermatology, we considered diagnostic agreement (ICD-9 code), therapeutic agreement and concordance of diagnostic confidence.

RESULTS

One hundred and fourteen of 130 patients were diagnosed with the same ICD-9 code, making a total observed agreement of 87.7% with a Cohen's κ estimated of 0.863. Agreement between therapies was 69.6% (Cohen's κ = 0.640). As it concerns diagnostic confidence, dermatologists appeared generally slightly less certain of their diagnosis by telemedicine.

CONCLUSIONS

Store-and-forward teledermatology can improve diagnostic and therapeutic care for skin disease in elderly who lack easy and/or direct access to dermatologists.

E-mail and photographs: a case report of a patient-initiated diagnostic tool in the era of electronic communication

This case report reviews some of the clinical aspects of epidermal growth factor receptor (EGFR) inhibitor-induced rash, and, more importantly, it describes a specific case in which the diagnosis of such a rash occurred by means of a patient-initiated photographic electronic communication. The fact that this electronic communication was patient-initiated suggests that health care providers will likely be asked to make clinical decisions based on this type of communication soon and that this type of seemingly low-cost approach will likely become an important aspect of cancer symptom control and palliative care in the future.