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Sánchez-Martín E, Moreno-Sánchez I, Morán-Sánchez M, Pérez-Martín M, Martín-Morales M, García-Ortiz L. Store-and-forward teledermatology in a Spanish health area significantly increases access to dermatology expertise. BMC PRIMARY CARE 2024; 25:227. [PMID: 38914974 PMCID: PMC11197177 DOI: 10.1186/s12875-024-02479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/14/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Teledermatology is the practice of dermatology through communication technologies. The aim of this study is to analyze its implementation in a Spanish health area during its first two years. METHODS Cross-sectional descriptive study. It included interconsultations between dermatologists and family physicians in the Salamanca Health Area (Spain) after the implementation of the non-face-to-face modality over a period of two consecutive years. A total of 25,424 consultations were performed (20,912 face-to-face and 4,512 non-face-to-face); 1000 were selected by random sampling, half of each modality. MAIN MEASURES referral rate, response time and resolution time, type of pathology, diagnostic concordance, and quality of consultation. RESULTS The annual referral rate was 42.9/1000 inhabitants (35.3 face-to-face and 7.6 non-face- to-face). The rate of face-to-face referrals was higher in urban areas (37.1) and the rate of non- face-to-face referrals in rural areas (10.4). The response time for non-face-to-face consultations was 2.4 ± 12.7 days and 56 ± 34.8 days for face-to-face consultations (p < 0.001). The resolution rate for non-face-to-face consultations was 44%. Diagnostic concordance, assessed by the kappa index, was 0.527 for face-to-face consultations and 0.564 for non-face-to-face consultations. Greater compliance with the quality criteria in the non-attendance consultations. CONCLUSIONS Teledermatology appears to be an efficient tool in the resolution of dermatological problems, with a rapid, effective, and higher quality response for attention to skin pathologies. REGISTRY ClinicalTrials.gov Identifier: NCT05625295. Registered on 21 November 2022 ( https://clinicaltrials.gov/ct2/show/ NCT05625295).
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Affiliation(s)
- Elena Sánchez-Martín
- Centro de salud La Alamedilla, Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia Regional de salud de Castilla y León (SACyL), Avenida de Comuneros 27-31, Salamanca, 37003, Spain.
- Instituto de investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
| | - Isabel Moreno-Sánchez
- Centro de salud La Alamedilla, Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia Regional de salud de Castilla y León (SACyL), Avenida de Comuneros 27-31, Salamanca, 37003, Spain
| | - Marta Morán-Sánchez
- Servicio de Pediatría, Hospital La Paz, P.º de la Castellana, 261, Madrid, 28046, España
| | - Miguel Pérez-Martín
- Centro de salud La Alamedilla, Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia Regional de salud de Castilla y León (SACyL), Avenida de Comuneros 27-31, Salamanca, 37003, Spain
| | - Manuel Martín-Morales
- Centro de salud La Alamedilla, Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia Regional de salud de Castilla y León (SACyL), Avenida de Comuneros 27-31, Salamanca, 37003, Spain
| | - Luis García-Ortiz
- Centro de salud La Alamedilla, Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia Regional de salud de Castilla y León (SACyL), Avenida de Comuneros 27-31, Salamanca, 37003, Spain
- Instituto de investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, Salamanca, 37007, Spain
- Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Calle Alfonso X el Sabio s/n, Salamanca, 37007, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Avenida de Portugal 83, Salamanca, 37005, Spain
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Sahu P, Vashisht KR, Agarwal A, Gupta R, Garg R, Saikia B. Navigating dermatological care: Experience with assisted teledermatology practice on e-Sanjeevani platform. J Eur Acad Dermatol Venereol 2024. [PMID: 38959369 DOI: 10.1111/jdv.20181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024]
Affiliation(s)
- Priyadarshini Sahu
- Department of Telemedicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanya Rani Vashisht
- Department of Telemedicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Agarwal
- Department of Telemedicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Gupta
- Department of Telemedicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Garg
- Department of Telemedicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Biman Saikia
- Department of Telemedicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Odeshi O, Turk T, Fiorillo L, Lowe S, Dytoc M. Teledermatology Versus In-Person Visits for the Follow-Up of Atopic Dermatitis Patients. J Cutan Med Surg 2024:12034754241253192. [PMID: 38807447 DOI: 10.1177/12034754241253192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND In recent years, teledermatology has rapidly emerged as a healthcare delivery method with potential implications for managing chronic inflammatory dermatoses like atopic dermatitis (AD). OBJECTIVES This study assesses the utility of telemedicine in the management of AD by comparing virtual care with traditional in-office visits with the aim of identifying differences in clinical outcomes between these 2 healthcare delivery modalities. METHODS Patients of all ages with AD were recruited from 2 dermatology practices. Consecutive patients presenting to the clinics who met the inclusion criteria were invited to enrol in the study. Those who consented to participate were randomly assigned to the virtual or in-person arm of the study, with the opportunity to decline care in either study arm. The inclusion criteria required participants to have a confirmed diagnosis of AD. Exclusion criteria included significant comorbidity that might affect the course of treatment, inaccessibility to teleconsults such as not having a camera for video conferences, and self-declared limitations in operating Zoom. Patients were assessed at baseline (week 0), 4 to 6 weeks, and 8 to 12 weeks using 6 efficacy parameters. RESULTS In the virtual group, all 6 dermatological measures suggested improved outcomes. Average Body Surface Area scores decreased (β = -.07, 95% CI = -0.1, -0.3) over the course of follow-up. Virtual care patients had 80% lower odds of moderate-to-severe uncontrolled disease (OR = 0.2; 95% CI = 0.06, 0.5) and pruritus (OR = 0.2, 95% CI = 0.05, 0.7) over time. CONCLUSIONS This study supports teledermatology as a feasible and effective option for providing follow-up care for atopic dermatitis patients of various demographic standings.
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Affiliation(s)
- Oluwatosin Odeshi
- Division of Dermatology, University of Alberta, Edmonton, AB, Alberta
| | - Tarek Turk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Alberta
- Department of Dermatology and Venereology, Syrian Arab Red Crescent Hospital, Damascus, Syria
| | - Loretta Fiorillo
- Division of Dermatology, University of Alberta, Edmonton, AB, Alberta
| | - Samuel Lowe
- School of Public Health, University of Alberta, Edmonton, AB, Alberta
| | - Marlene Dytoc
- Division of Dermatology, University of Alberta, Edmonton, AB, Alberta
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Van Enst WA, Weng YC, Wanten SAC, Seyger MMB, Baerveldt EM, Arents BWM, De Jong EMGJ, Van den Reek JMPA. Is Telemedicine Suitable for Patients with Chronic Inflammatory Skin Conditions? A Systematic Review. Acta Derm Venereol 2024; 104:adv23901. [PMID: 38751176 PMCID: PMC11110807 DOI: 10.2340/actadv.v104.23901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/14/2024] [Indexed: 05/24/2024] Open
Abstract
Telemedicine, the provision of remote healthcare, has gained prominence, accelerated by the COVID-19 pandemic. It has the potential to replace routine in-person follow-up visits for patients with chronic inflammatory skin conditions. However, it remains unclear whether telemedicine can effectively substitute in-person consultations for this patient group. This systematic review assessed the effectiveness and safety of telemedicine compared with traditional in-person care for chronic inflammatory skin diseases. A comprehensive search in various databases identified 11 articles, including 5 randomized controlled trials (RCTs) and 1 clinical controlled trial (CCT). These studies evaluated telemedicine's impact on patients with psoriasis and atopic dermatitis, with varying methods like video consultations and digital platforms. The findings tentatively suggest that telemedicine does not seem to be inferior compared with in-person care, particularly in terms of condition severity and quality of life for patients with chronic inflammatory skin diseases. However, these results should be interpreted with caution due to the inherent uncertainties in the evidence. There are indications that telemedicine can offer benefits such as cost-effectiveness, time savings, and reduced travel distances, but it is important to recognize these findings as preliminary, necessitating further validation through more extensive research.
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Affiliation(s)
| | - Ying Chao Weng
- Dutch Society for Dermatology and Venereology, Utrecht, The Netherlands
| | - Sophie A C Wanten
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Bernd W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, The Netherlands
| | - Elke M G J De Jong
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Mashoudy KD, Perez SM, Nouri K. From diagnosis to intervention: a review of telemedicine's role in skin cancer care. Arch Dermatol Res 2024; 316:139. [PMID: 38696032 PMCID: PMC11065900 DOI: 10.1007/s00403-024-02884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/03/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024]
Abstract
Skin cancer treatment is a core aspect of dermatology that relies on accurate diagnosis and timely interventions. Teledermatology has emerged as a valuable asset across various stages of skin cancer care including triage, diagnosis, management, and surgical consultation. With the integration of traditional dermoscopy and store-and-forward technology, teledermatology facilitates the swift sharing of high-resolution images of suspicious skin lesions with consulting dermatologists all-over. Both live video conference and store-and-forward formats have played a pivotal role in bridging the care access gap between geographically isolated patients and dermatology providers. Notably, teledermatology demonstrates diagnostic accuracy rates that are often comparable to those achieved through traditional face-to-face consultations, underscoring its robust clinical utility. Technological advancements like artificial intelligence and reflectance confocal microscopy continue to enhance image quality and hold potential for increasing the diagnostic accuracy of virtual dermatologic care. While teledermatology serves as a valuable clinical tool for all patient populations including pediatric patients, it is not intended to fully replace in-person procedures like Mohs surgery and other necessary interventions. Nevertheless, its role in facilitating the evaluation of skin malignancies is gaining recognition within the dermatologic community and fostering high approval rates from patients due to its practicality and ability to provide timely access to specialized care.
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Affiliation(s)
- Kayla D Mashoudy
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Sofia M Perez
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th Street, Miami, FL, 33136, USA
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Wallace MM, Hackstadt AJ, Zhao Z, Patrinely JR, Zic J, Ellis D, Paul L, Sultan M, Danford B, Hanlon AM. The Teledermatology Experience: Cost Savings and Image Quality Control. Telemed J E Health 2024; 30:1411-1417. [PMID: 38150704 DOI: 10.1089/tmj.2022.0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction: Teledermatology adoption continues to increase, in part, spurred by the COVID-19 pandemic. This study analyzes the utility and cost savings of a store-and-forward teledermatology consultative system within the Veterans Health Administration (VA). Methods: Retrospective cohort of 4,493 patients across 14 remote sites in Tennessee and Kentucky from May 2017 through August 2019. The study measured the agreement between the teledermatology diagnoses and follow-up face-to-face clinic evaluations as well as the cost effectiveness of the teledermatology program over the study period. Results: Fifty-four percent of patients were recommended for face-to-face appointment for biopsy or further evaluation. Most patients, 80.5% received their face-to-face care by a VA dermatologist. There was a high level of concordance between teledermatologist and clinic dermatologist for pre-malignant and malignant cutaneous conditions. Veterans were seen faster at a VA clinic compared with a community dermatology site. Image quality improved as photographers incorporated teledermatologist feedback. From a cost perspective, teledermatology saved the VA system $1,076,000 in community care costs. Discussion: Teledermatology is a useful diagnostic tool within the VA system providing Veteran care at a cost savings.
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Affiliation(s)
- Matthew M Wallace
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amber J Hackstadt
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Zijun Zhao
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - John Zic
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Darrel Ellis
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lynn Paul
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Miliyard Sultan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brandon Danford
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Allison M Hanlon
- Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Administration Medical Center, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Du L, Cao Z, Han C, Wei J, Li M, Zhang C. Dermatology Consultation in the Geriatrics Department of a Tertiary Hospital in China: A Retrospective Study of 178 Patients. Clin Cosmet Investig Dermatol 2024; 17:925-930. [PMID: 38699408 PMCID: PMC11063470 DOI: 10.2147/ccid.s461156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/13/2024] [Indexed: 05/05/2024]
Abstract
Objective Dermatological consultation plays an important role in diagnosing and treating skin diseases in the Department of Geriatrics. The objective of this study is to provide an analysis of the factors leading geriatric inpatients to seek dermatological consultation, aiming to facilitate accurate diagnosis and effective treatment of skin diseases by healthcare professionals specializing in geriatrics and dermatology. Methods The electronic health records of hospitalized patients in the Department of Geriatrics who applied for dermatological consultation at the Second Hospital of Shandong University from June 1, 2022, to June 1, 2023, were retrieved. Sex, age, number of consultations, reason for dermatology consultation, and final diagnosis by dermatologists were reviewed. Results A total of 216 consultations of 178 patients (n=178, 95 men and 83 women) were collected in this study, of whom 153 (86.0%) required only one consultation, 19 (10.7%) required two consultations, and 4 (2.2%) required three consultations. The reasons for dermatology consultations were divided into three categories: the first was for the definitive diagnosis of a new skin condition that developed during the patient's hospitalization (n=165, 76.4%), the second was for the follow-up of the condition and adjustment of medication (n=40, 18.5%), and the third was for the evaluation of the patient's disease that existed before admission to the hospital (n=11, 5.1%). In 165 consultations, most of these diseases (n=131, 79.4%) can be diagnosed by patients' conscious symptoms and clinical manifestations. Some of them need to be diagnosed or differentially diagnosed with the help of supplementary examinations, such as microscopic examination of scabies or fungi, and pathological examination. Conclusion This study summarized the reasons for dermatology consultations for geriatric inpatients and found that dermatitis/eczema and infectious diseases were the common types of diseases consulted. The findings of this study contribute to the enhanced comprehension and management of dermatological conditions in hospitalized patients by geriatricians, as well as facilitating more efficient diagnosis and treatment by dermatologists.
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Affiliation(s)
- Lingyun Du
- Department of Dermato-venereology, the Second Hospital of Shandong University, Jinan, 250033, People’s Republic of China
| | - Zhiqiang Cao
- Department of Dermatology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, 710004, People’s Republic of China
| | - Changyu Han
- Department of Dermato-venereology, the Second Hospital of Shandong University, Jinan, 250033, People’s Republic of China
| | - Jingjing Wei
- Department of Dermato-venereology, the Second Hospital of Shandong University, Jinan, 250033, People’s Republic of China
| | - Mingming Li
- Department of Dermato-venereology, the Second Hospital of Shandong University, Jinan, 250033, People’s Republic of China
| | - Chunhong Zhang
- Department of Dermato-venereology, the Second Hospital of Shandong University, Jinan, 250033, People’s Republic of China
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Jasly K, Goyal S, Ashwini PK, Kanthraj GR, Chethana SG, Ranugha S. Three-part scoring system (tripartite) for teledermatology versus International Contact Dermatitis Research Group criteria to interpret patch test readings: A comparative, observational study. Indian J Dermatol Venereol Leprol 2024; 0:1-7. [PMID: 38594974 DOI: 10.25259/ijdvl_118_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/10/2023] [Indexed: 04/11/2024]
Abstract
Background The International Contact Dermatitis Research Group (ICDRG) grading is the gold standard and is used to interpret patch test results in allergic contact dermatitis (ACD). The ICDRG readings include a combination of visual and palpation findings. Digital photography limits palpation. An alternative scoring system exists to analyse 2D images and interpret patch test readings in teledermatology (TD). Aims To compare tri-partite scoring system (TPSS) (TD) with ICDRG (face-to-face) and to assess the feasibility of TPSS by TD. Methods In this observational study, two investigators each scored the patch test readings for 78 patients at the 48th h, 96th h and on the 7th day. Results The TPSS has a sensitivity of 100%, specificity of 93.34%, positive predictive value of 91.67% and negative predictive value of 100%. At a confidence interval of 95%, Cohen's kappa (0.90) indicated excellent agreement between both investigators. The concordance between both scoring systems was at 93.2% for agreement and 6.82% for disagreement. Polysensitisation (6 patients with 16 allergens) was detected equally in both methods. Limitations A single centre study. Conclusion The readings obtained by TPSS were in agreement with ICDRG. TPSS can reduce the number of patient visits by 50% and may be used during COVID-19 times and beyond.
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Affiliation(s)
- Kuttiali Jasly
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - Sakshi Goyal
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - P K Ashwini
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - Garehatty Rudrappa Kanthraj
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - S Gurumurthy Chethana
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - Subramaniam Ranugha
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
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Jaklitsch E, Shah VK, Smith B, Agarwal A, Chen J, Sweeney A, English JC, Ferris LK. Melanoma Detected Through Teledermatology Versus In-Person Visits. Telemed J E Health 2024; 30:e1192-e1196. [PMID: 37937942 DOI: 10.1089/tmj.2023.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background: Early detection of melanoma improves survival; however, patients face long wait times to receive dermatology care. Teledermatology (TD) is a promising tool to optimize access to care and has shown promise for the identification of malignancies but has not been well studied for melanoma. We evaluated the utility of TD as a triage tool to allow high-risk lesions of concern to be seen more expeditiously. Methods: Patient sociodemographic factors and histological characteristics of 836 melanomas biopsied between March 2020 and November 2022 in the University of Pittsburgh Medical Center health system were retrospectively evaluated, stratified by initial appointment type of TD versus in-person visit. Results: Patients first seeking care through teledermatology had shorter wait times to initial evaluation (p < 0.001) and eventual biopsy (p < 0.001), and these melanomas had higher Breslow thickness (p < 0.001), were more ulcerated (p = 0.002), invasive (p = 0.001), and of a more aggressive subtype (p = 0.007) than those initially evaluated in-person. TD was also utilized by a higher proportion of younger (p = 0.001) and non-white (p = 0.03) patients who identified their own lesion (p < 0.001). Conclusions: TD may be a strategy to improve melanoma outcomes by providing an accessible avenue of expedited care for high-risk lesions associated with worse clinical prognosticators of disease.
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Affiliation(s)
- Erik Jaklitsch
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vrusha K Shah
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brandon Smith
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ashima Agarwal
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Chen
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anna Sweeney
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Accorsi TAD, dos Santos GGR, Nemoto RP, Moreira FT, De Amicis K, Köhler KF, Cordioli E, Pedrotti CHS. Telemedicine and patients with heart failure: evidence and unresolved issues. EINSTEIN-SAO PAULO 2024; 22:eRW0393. [PMID: 38451690 PMCID: PMC10948100 DOI: 10.31744/einstein_journal/2024rw0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 10/26/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Heart failure is the leading cause of cardiac-related hospitalizations. Limited access to reevaluations and outpatient appointments restricts the application of modern therapies. Telemedicine has become an essential resource in the healthcare system because of its countless benefits, such as higher and more frequent appointments and faster titration of medications. This narrative review aimed to demonstrate the evidence and unresolved issues related to the use of telemedicine in patients with heart failure. No studies have examined heart failure prevention; however, several studies have addressed the prevention of decompensation with positive results. Telemedicine can be used to evaluate all patients with heart failure, and many telemedicine platforms are available. Several strategies, including both noninvasive (phone calls, weight measurement, and virtual visits) and invasive (implantable pulmonary artery catheters) strategies can be implemented. Given these benefits, telemedicine is highly desirable, particularly for vulnerable groups. Although some questions remain unanswered, the development of new technologies can complement remote visits and improve patient care.
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Affiliation(s)
| | | | - Renato Paladino Nemoto
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Flavio Tocci Moreira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karine De Amicis
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karen Francine Köhler
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Eduardo Cordioli
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Luo J, Yang Z, Xie Y, He Y, Wu M, Fang X, Liao X. Emerging Trends in Teledermatology Research: A Scientometric Analysis from 2002 to 2021. Telemed J E Health 2024; 30:393-403. [PMID: 37449779 DOI: 10.1089/tmj.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
Background: With advances in technology, teledermatology (TD) research has increased. However, an updated comprehensive quantitative analysis of TD research, especially one that identifies emerging trends of TD research in the coronavirus disease 2019 (COVID-19) era, is lacking. Objective: To conduct a scientometric analysis of TD research documents between 2002 and 2021 and explore the emerging trends. Methods: CiteSpace was used to perform scientometric analysis and yielded visualized network maps with corresponding metric values. Emerging trends were identified mainly through burst detection of keywords/terms, co-cited reference clustering analysis, and structural variability analysis (SVA). Results: A total of 932 documents, containing 27,958 cited references were identified from 2002 to 2021. Most TD research was published in journals from the "Dermatology" and "Health Care Sciences & Services" categories. American, Australian, and European researchers contributed the most research and formed close collaborations. Keywords/terms with strong burst values to date were "primary care," "historical perspective," "emerging technique," "improve access," "mobile teledermoscopy (TDS)," "access," "skin cancer," "telehealth," "recent finding," "artificial intelligence (AI)," "dermatological care," and "dermatological condition." Co-cited reference clustering analysis showed that the recently active cluster labels included "COVID-19 pandemic," "skin cancer," "deep neural network," and "underserved population." The SVA identified two reviews (Tognetti et al. and Mckoy et al.) that may be highly cited in the future. Conclusion: During and after the COVID-19 era, emerging trends in research on TD (especially mobile TDS) may be related to skin cancer and AI as well as further exploration of primary care in underserved areas.
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Affiliation(s)
- Jianzhao Luo
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ziyu Yang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Xie
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang He
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Miaomiao Wu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Fang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
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12
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Hwang JK, Del Toro NP, Han G, Oh DH, Tejasvi T, Lipner SR. Review of Teledermatology: Lessons Learned from the COVID-19 Pandemic. Am J Clin Dermatol 2024; 25:5-14. [PMID: 38062339 DOI: 10.1007/s40257-023-00826-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 01/23/2024]
Abstract
Utilization of telemedicine for dermatology has greatly expanded since the start of the COVID-19 pandemic, with over 500 new teledermatology studies published since 2020. An updated review on teledermatology is necessary to incorporate new findings and perspectives, and educate dermatologists on effective utilization. We discuss teledermatology in terms of diagnostic accuracy and clinical outcomes, patient and physician satisfaction, considerations for special patient populations, published practice guidelines, cost effectiveness and efficiency, as well as administrative regulations and policies. Our findings emphasize the need for dermatologist education, prioritization of reliable reimbursement systems, and technological innovations to support the continued development of teledermatology in the post-pandemic era.
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Affiliation(s)
- Jonathan K Hwang
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA
| | - Natalia Pelet Del Toro
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Ave, New Hyde Park, NY, 11042, USA
| | - George Han
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Ave, New Hyde Park, NY, 11042, USA
| | - Dennis H Oh
- Department of Dermatology, University of California, San Francisco, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan Medicine, 1910 Taubman Center, Ann Arbor, MI, 48109, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA.
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13
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Aghazadeh Mohandesi N, Puiu T, Mittal S, Hall MR, Sokumbi O, Mangold AR, Colgan MB, Tollefson MM, Sartori-Valinotti JC. Teledermatology in practice: Report of Mayo Clinic experience. Digit Health 2024; 10:20552076241234581. [PMID: 38410791 PMCID: PMC10896044 DOI: 10.1177/20552076241234581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Background Delivery of dermatologic care through telemedicine was accelerated by the COVID-19 pandemic. We sought to analyze the teledermatology experience across Mayo Clinic's health care system to identify strengths and limitations of teledermatology. Methods Electronic health records of dermatology televisits were reviewed from multiple U.S. Mayo Clinic sites from January 2020 through January 2021. Results A total of 13,181 dermatology televisits were conducted in 6468 unique patients. Patients were primarily female (60.2%), and mean age of all patients was 34.1 years. Synchronous / live video conferencing visits were the most common (40.0%) telecare modality. Synchronous / live audio conferencing and asynchronous / store-and-forward visits comprised 33.0% and 27.0% of appointments. In total, 3944 televisits (29.9%) were successfully concluded via a single appointment. An in-person appointment was needed for 1693 patients (26.2%) after their initial televisit. For patients with a single televisit, synchronous / live video conferencing was the most common virtual modality (58.0% vs 32.2% of patients with multiple visits, p < 0.001). Patients needing in-person follow-up visits were slightly older than those who did not (mean [SD], 38.8 [22.3] vs 35.0 [23.6] years; p < 0.001) but without any sex-based difference. Around one-third of patients needed an in-person follow-up visit after their initial asynchronous / store-and-forward visit which was higher when compared with synchronous / live audio and video conferencing. Conclusion Single dermatology televisits effectively managed nearly one-third of patients who did not require in-person follow-up. An initial synchronous / live video conferencing was more likely to yield a single clinical encounter, whereas asynchronous / store-and-forward visits required more in-person follow-up. Future studies are required that focus on dermatology-specific cost, diagnoses, access, quality of care, and outcomes.
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Affiliation(s)
| | - Tudor Puiu
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| | - Setu Mittal
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Matthew R Hall
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Michael B Colgan
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Dermatology, Mayo Clinic Health System, Eau Claire, WI, USA
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14
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Shah VK, Jaklitsch E, Agarwal A, Chen J, James AJ, Ferris LK, English JC, Nekooie B, Choudhary S. Descriptive and Concordance Data for Asynchronous Teledermatology Consultations for Dermatitis: A Retrospective Study. Telemed J E Health 2024; 30:204-213. [PMID: 37358607 DOI: 10.1089/tmj.2023.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Background: Implementation of teledermatology for assessing dermatitis patients provides comparable diagnostic and management outcomes to in-person visits, but studies on consumer to physician asynchronous teledermatology (eDerm) consults submitted by patients in large dermatitis cohorts are limited. The objective of this study was to retrospectively assess associations of eDerm consults with diagnostic accuracy, management, and follow-up in a large cohort of dermatitis patients. Methods: One thousand forty-five eDerm encounters between April 1, 2020, and October 29, 2021, recorded in the University of Pittsburgh Medical Center Health System Epic electronic medical record were reviewed. Descriptive statistics and concordance were analyzed using chi-square. Results: Asynchronous teledermatology modified/changed treatment in 97.6% of cases and had the same diagnosis between teledermatology and in-person follow-up in 78.3% of cases. Patients following up in the time line requested were more likely to follow-up in person (61.2% vs. 43.8%) than those who did not. Patients with intertriginous dermatitis (p = 0.003), preexisting conditions (p = 0.002), who required follow-ups (<0.0001), and moderate-high severity scores of 4-7 (p = 0.019) were more likely to follow up in the time line requested. Limitations: Lack of similar in-person visit data did not allow us to compare descriptive and concordance data between eDerm and clinic visits. Conclusions: eDerm offers a quick accessible solution to provide comparable dermatologic care for patients with dermatitis.
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Affiliation(s)
- Vrusha K Shah
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Erik Jaklitsch
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ashima Agarwal
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Chen
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alaina J James
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Batool Nekooie
- Department of Electrical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Sonal Choudhary
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Nurtsch A, Teufel M, Jahre LM, Esber A, Rausch R, Tewes M, Schöbel C, Palm S, Schuler M, Schadendorf D, Skoda EM, Bäuerle A. Drivers and barriers of patients' acceptance of video consultation in cancer care. Digit Health 2024; 10:20552076231222108. [PMID: 38188860 PMCID: PMC10768612 DOI: 10.1177/20552076231222108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Background Due to digitization in the medical sector, many healthcare interactions are switched to online services. This study assessed the acceptance of video consultations (VCs) in cancer care, and determined drivers and barriers of acceptance. Methods A cross-sectional online-based survey study was conducted in Germany from February 2022 to February 2023. Recruitment took place at oncology outpatient clinics, general practitioners, oncology practices and via cancer-related social media channels. Inclusion criteria were a cancer diagnosis, cancer treatment and internet access. Sociodemographic, medical data, eHealth-related data were acquired via an online assessment. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was used to determine the acceptance of VC and its predictors. Results Of N = 350 cancer patients, 56.0% (n = 196) reported high acceptance of VC, 28.0% (n = 98) stated moderate acceptance and 16.0% (n = 56) indicated low acceptance. Factors influencing acceptance were younger age (β = -.28, p < .001), female gender (β = .35, p = .005), stage of disease (β = .11, p = .032), high digital confidence (β = .14, p = .010), low internet anxiety (β = -.21, p = .001), high digital overload (β = -.12, p = .022), high eHealth literacy (β = .14, p = .028), personal trust (β = -.25, p < .001), internet use (β = .17, p = .002), and the UTAUT predictors: performance expectancy (β = .24, p < .001), effort expectancy (β = .26, p < .001), and social influence (β = .34, p < .001). Conclusions Patients' acceptance of VC in cancer care is high. Drivers and barriers to acceptance identified should be considered for personalized applications. Considering the growing demand for cancer care establishing digital healthcare solutions is justified.
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Affiliation(s)
- Angelina Nurtsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lisa Maria Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - André Esber
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Raya Rausch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Mitra Tewes
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Palliative Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christoph Schöbel
- Faculty of Sleep Medicine and Telemedicine, West German Lung Center, University Medicine Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Stefan Palm
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Schuler
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Medical Oncology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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16
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Music M, Elsawi R, Li C, Tang E, Wang R, Jia J, Lee D, Liu A. Canadian patient attitudes toward virtual dermatology care. JAAD Int 2023; 13:56-59. [PMID: 37692974 PMCID: PMC10483039 DOI: 10.1016/j.jdin.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Affiliation(s)
- Milena Music
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rawaan Elsawi
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Calandra Li
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Evan Tang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Wang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyn Jia
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Uhrin E, Domokos Z, Czumbel LM, Kói T, Hegyi P, Hermann P, Borbély J, Cavalcante BGN, Németh O. Teledentistry: A Future Solution in the Diagnosis of Oral Lesions: Diagnostic Meta-Analysis and Systematic Review. Telemed J E Health 2023; 29:1591-1600. [PMID: 36976779 PMCID: PMC10654653 DOI: 10.1089/tmj.2022.0426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 03/29/2023] Open
Abstract
Introduction: Teledentistry (TD) can offer a wide range of possibilities in the field of oral medicine. Oral potentially malignant disorders (OPMDs) are hard to detect, and even harder to diagnose correctly. With the help of TD, OPMDs can be detected and diagnosed by a remote specialist. Our aim was to investigate whether TD could provide a reliable diagnostic method compared with clinical oral examination (COE) in the diagnosis of OPMDs. Methods: A systematic search was conducted in three databases (Medline, EMBASE, CENTRAL) until November 2021. We included studies that compared telediagnosis and COE, both made by experts. Pooled specificity and sensitivity were calculated and visualized on a two-dimensional plot. Risk of bias was assessed using the QUADAS-2 tool, and the level of evidence is shown with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool. Results: Of the 7,608 studies, 13 were included in the qualitative and 9 in the quantitative synthesis. Using TD tools in the detection of oral lesions (OLs) showed high specificity (0.92 confidence interval [95% CI] = 0.59-0.99) and sensitivity (0.93 95% CI = 0.17-1.00). In the differential diagnosis of lesions, we found high sensitivity and specificity (0.942 95% CI = 0.826-0.982 and 0.982 95% CI = 0.913-0.997), respectively. We summarized the available data on time-effectiveness, screening person, referral decision, and technical settings. Conclusion: Detecting OLs with TD tools might lead to earlier diagnosis, treatment, and stricter follow-up of OPMD. TD may offer a great substitution for COE in the diagnosis of OLs, and thus, fewer referrals could be made to special care, resulting in a greater number of treated OPMDs.
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Affiliation(s)
- Eszter Uhrin
- Department of Community Dentistry, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Domokos
- Department of Community Dentistry, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - László Márk Czumbel
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Hermann
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Prosthodontics and Semmelweis University, Budapest, Hungary
| | - Judit Borbély
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Prosthodontics and Semmelweis University, Budapest, Hungary
| | - Bianca Golzio Navarro Cavalcante
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Orsolya Németh
- Department of Community Dentistry, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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18
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Santosa A, Li Z, Chandran NS. Teledermatology in an emergency department: benefits and gaps. BMC Emerg Med 2023; 23:115. [PMID: 37794332 PMCID: PMC10552197 DOI: 10.1186/s12873-023-00854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 07/21/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Teledermatology has provided new avenues through which dermatologists can provide healthcare. Teledermatology was introduced to the Emergency Department (ED) to enable immediate dermatological consult. We aimed to assess the impact of teledermatology on the management of dermatological conditions by emergency medicine physicians and subsequent health resource utilization. METHODS We conducted a retrospective review of teledermatology referrals from the ED of our tertiary hospital in Singapore from June 2015 to December 2019. The dermatological conditions, the triaging and treatment recommendations were analyzed. Follow-up plans were recorded. RESULTS Between June 2015 and December 2019, 147 patients were referred from the ED via teledermatology; 11 (7.5%) were admitted, and 136 (92.5%) were recommended to be discharged with a dermatological diagnosis and management plan. If required, a follow-up appointment in the dermatology specialist clinic was arranged. Of the 136 patients who were discharged, 129 (94.9%) patients were provided with outpatient appointment in the dermatology clinic, out of which 110 patients returned for follow-up. 90 (81.8%) patients retained the initial teledermatology diagnoses and 20 (18.2%) patients had their teledermatology diagnoses revised after in-person review. CONCLUSIONS Teledermatology allows for more efficient triaging of patients with dermatological conditions. Reliability between teledermatology and clinic-based examination is good. Patients may be managed mainly in the outpatient setting with appropriate specialty-directed treatment, return advice, and appropriately-triaged follow-up outpatient appointment.
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Affiliation(s)
- Adinia Santosa
- Division of Dermatology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Zisheng Li
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nisha Suyien Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Bourkas AN, Barone N, Bourkas MEC, Mannarino M, Fraser RDJ, Lorincz A, Wang SC, Ramirez-GarciaLuna JL. Diagnostic reliability in teledermatology: a systematic review and a meta-analysis. BMJ Open 2023; 13:e068207. [PMID: 37567745 PMCID: PMC10423833 DOI: 10.1136/bmjopen-2022-068207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES To compare teledermatology and face-to-face (F2F) agreement in primary diagnoses of dermatological conditions. DESIGN Systematic review and meta-analysis METHODS: MEDLINE, Embase, Cochrane Library (Wiley), CINAHL and medRxiv were searched between January 2010 and May 2022. Observational studies and randomised clinical trials that reported percentage agreement or kappa concordance for primary diagnoses between teledermatology and F2F physicians were included. Titles, abstracts and full-text articles were screened in duplicate. From 7173 citations, 44 articles were included. A random-effects meta-analysis was conducted to estimate pooled estimates. Primary outcome measures were mean percentage and kappa concordance for assessing diagnostic matches between teledermatology and F2F physicians. Secondary outcome measures included the agreement between teledermatologists, F2F dermatologists, and teledermatology and histopathology results. RESULTS 44 studies were extracted and reviewed. The pooled agreement rate was 68.9%, and kappa concordance was 0.67. When dermatologists conducted F2F and teledermatology consults, the overall diagnostic agreement was significantly higher at 71% compared with 44% for non-specialists. Kappa concordance was 0.69 for teledermatologist versus specialist and 0.52 for non-specialists. Higher diagnostic agreements were also noted with image acquisition training and digital photography. The agreement rate was 76.4% between teledermatologists, 82.4% between F2F physicians and 55.7% between teledermatology and histopathology. CONCLUSIONS AND RELEVANCE Teledermatology can be an attractive option particularly in resource-poor settings. Future efforts should be placed on incorporating image acquisition training and access to high-quality imaging technologies. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/FJDVG.
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Affiliation(s)
| | - Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University Montreal, Montreal, Quebec, Canada
| | | | | | - Robert D J Fraser
- Nursing, Western University Arthur Labatt Family School of Nursing, London, Ontario, Canada
- Swift Medical, Toronto, Ontario, Canada
| | - Amy Lorincz
- Independent Researcher, Montreal, Qubec, Canada
| | - Sheila C Wang
- Swift Medical, Toronto, Ontario, Canada
- Dermatology, McGill University Department of Medicine, Montreal, Qubec, Canada
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20
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von Büren M, Wülfing C, Schlager D, Träger MM, Daoud M, Schröder F, Brookman-May SD, Gratzke C, von Büren J. Assessment of Patient Risk Profiles by a Male Sexual Health Direct-to-Consumer Prescription Platform: A Cross-Sectional Study. TELEMEDICINE REPORTS 2023; 4:118-125. [PMID: 37351463 PMCID: PMC10282969 DOI: 10.1089/tmr.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/24/2023]
Abstract
Background Direct-to-consumer (DTC) online prescription platforms (OPP) for sexual health represent a potential paradigm shift in the diagnosis and treatment for sexual dysfunctions in the way men seek care. Knowledge of patients' risk profile using these platforms is limited. Aim To assess risk profiles of patients reaching out to health care professionals through their DTC. Methods Anonymized data originally collected between February 2021 to May 2022 by a DTC platform in the men's health care space were retrospectively analyzed. Data included the content of patient requests through a communication function, as well as the corresponding responses by the attending physician on staff. Each request was then assessed by two independent urologists and categorized by the level of the risk profile as well as the need to refer the patient to further medical evaluation. Results Of 585 patient requests, 531 (90.8%) were classified as low risk. In the high-risk group, 32 patients were recommended to schedule an urgent appointment at a specialist. Only three patients (0.5%) were advised to seek emergency care. The overall referral rate for both risk groups was 52.3%. The requests of 279 patients (47.7%) were assessed as digitally treatable. Almost all patients who were digitally treatable were low risk. Side effects accounted for only 9.6% of all requests in the low-risk group, compared with 46.3% in the high-risk group. Conclusion Overall, low-risk levels in the requests of patients using a DTC platform were reported, with almost half of them suitable to be solved digitally, whereas the other half required referral to an in-person specialist.
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Affiliation(s)
- Moritz von Büren
- Department of Urology, University of Freiburg, Freiburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
- Wellster Healthtech Group, Munich, Germany
| | - Daniel Schlager
- Department of Urology, University of Freiburg, Freiburg, Germany
| | | | - Marcel Daoud
- Wellster Healthtech Group, Munich, Germany
- Technical University of Munich, Munich, Germany
| | | | - Sabine D. Brookman-May
- Wellster Healthtech Group, Munich, Germany
- Janssen Research and Development, LLC, Spring House, Pennsylvania, USA
- Department of Urology, Ludwig Maximilian University of Munich, Munich, Germany
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Shah A, Saliba E. Gender and Ethnic Disparities in Teledermatology Clinical Trial Participants: Cross-Sectional Analysis of ClinicalTrials.gov-Registered Trials. JMIR DERMATOLOGY 2023; 6:e46031. [PMID: 37632945 PMCID: PMC10335118 DOI: 10.2196/46031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/05/2023] [Accepted: 05/25/2023] [Indexed: 08/28/2023] Open
Affiliation(s)
- Asghar Shah
- Division of Biology and Medicine, Brown University, Providence, RI, United States
| | - Elie Saliba
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, United States
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22
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Ren Z, Li X, Pietralla D, Manassi M, Whitney D. Serial Dependence in Dermatological Judgments. Diagnostics (Basel) 2023; 13:diagnostics13101775. [PMID: 37238260 DOI: 10.3390/diagnostics13101775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Serial Dependence is a ubiquitous visual phenomenon in which sequentially viewed images appear more similar than they actually are, thus facilitating an efficient and stable perceptual experience in human observers. Although serial dependence is adaptive and beneficial in the naturally autocorrelated visual world, a smoothing perceptual experience, it might turn maladaptive in artificial circumstances, such as medical image perception tasks, where visual stimuli are randomly sequenced. Here, we analyzed 758,139 skin cancer diagnostic records from an online app, and we quantified the semantic similarity between sequential dermatology images using a computer vision model as well as human raters. We then tested whether serial dependence in perception occurs in dermatological judgments as a function of image similarity. We found significant serial dependence in perceptual discrimination judgments of lesion malignancy. Moreover, the serial dependence was tuned to the similarity in the images, and it decayed over time. The results indicate that relatively realistic store-and-forward dermatology judgments may be biased by serial dependence. These findings help in understanding one potential source of systematic bias and errors in medical image perception tasks and hint at useful approaches that could alleviate the errors due to serial dependence.
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Affiliation(s)
- Zhihang Ren
- Vision Science Graduate Group, University of California, Berkeley, Berkeley, CA 94720, USA
- Department of Psychology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Xinyu Li
- Department of Psychology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Dana Pietralla
- Institute of Sociology and Social Psychology, University of Cologne, Albertus-Magnus-Platz, D-50923 Cologne, Germany
| | - Mauro Manassi
- School of Psychology, King's College, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - David Whitney
- Vision Science Graduate Group, University of California, Berkeley, Berkeley, CA 94720, USA
- Department of Psychology, University of California, Berkeley, Berkeley, CA 94720, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA
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23
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Leslie K, Myles S, Schiller CJ, Alraja AA, Nelson S, Adams TL. Protecting the public interest while regulating health professionals providing virtual care: A scoping review. PLOS DIGITAL HEALTH 2023; 2:e0000163. [PMID: 37115785 PMCID: PMC10146454 DOI: 10.1371/journal.pdig.0000163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Abstract
Technology is transforming service delivery in many health professions, particularly with the rapid shift to virtual care during the COVID-19 pandemic. Health profession regulators must navigate legal and ethical complexities to facilitate virtual care while upholding their mandate to protect the public interest. The objectives of this scoping review were to examine how the public interest is protected when regulating health professionals who provide virtual care, discuss policy and practice implications of virtual care, and make recommendations for future research. We searched six multidisciplinary databases for academic literature published in English between January 2015 and May 2021. We also searched specific databases and websites for relevant grey literature. After screening, 59 academic articles and 18 grey literature sources were included for analysis. We identified five key findings: the public interest when regulating health professionals providing virtual care was only implicitly considered in most of the literature; when the public interest was discussed, the dimension of access was emphasized; criticism in the literature focused on social ideologies driving regulation that may inhibit more widespread use of virtual care; subnational licensure was viewed as a barrier; and the demand for virtual care during COVID-19 catalyzed licensure and scope of practice changes. Overall, virtual care introduces new areas of risk, potential harm, and inequity that health profession regulators need to address as technology continues to evolve. Regulators have an essential role in providing clear standards and guidelines around virtual care, including what is required for competent practice. There are indications that the public interest concept is evolving in relation to virtual care as regulators continue to balance public safety, equitable access to services, and economic competitiveness.
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Affiliation(s)
| | - Sophia Myles
- Athabasca University, Athabasca, Alberta, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Catharine J Schiller
- University of Northern British Columbia, Prince George, British Columbia, Canada
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24
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Shah VK, English JC. Store-and-forward outpatient teledermatology improves care for patients with periorificial dermatitis after an initial primary care consultation: A retrospective study. J Am Acad Dermatol 2023; 88:904-906. [PMID: 36280002 DOI: 10.1016/j.jaad.2022.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/28/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Vrusha K Shah
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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25
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Maita KC, Palmieri-Serrano L, Avila FR, Torres-Guzman RA, Garcia JP, S. Eldaly A, Haider CR, Felton CL, Paulson MR, Maniaci MJ, Forte AJ. Imaging evaluated remotely through telemedicine as a reliable alternative for accurate diagnosis: a systematic review. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-023-00745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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26
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Laskowski M, Schiöler L, Wennberg AM, Torén K, Gustafsson H. Translation and Validation of the Self-Assessment Psoriasis Area Severity Index. Dermatology 2023; 239:794-801. [PMID: 36907178 PMCID: PMC10614249 DOI: 10.1159/000530045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The self-assessment psoriasis area severity index (SAPASI) is a patient-administered psoriasis assessment tool for which we present a validated translation from English to Swedish. METHODS Validity was evaluated in this single-centre study using the psoriasis area severity index (PASI) as the standard. Test-retest reliability was assessed using repeated SAPASI measurements. RESULTS Significant correlations (p < 0.0001) using Spearman's correlation coefficient (r) were found between PASI and SAPASI scores (r = 0.60) for 51 participants (median baseline PASI 4.4, interquartile range [IQR]: 1.8-5.6) and repeated SAPASI measurements (r = 0.70) among 38 participants (median baseline SAPASI 4.0, IQR: 2.5-6.1). Bland-Altman plots showed generally higher SAPASI scores than PASI scores. CONCLUSION The translated version of SAPASI is valid and reliable, although patients generally tend to overrate their disease severity compared to PASI. Keeping this limitation in mind, SAPASI has the potential of being implemented as a time- and cost-efficient assessment tool in a Scandinavian context.
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Affiliation(s)
- Marta Laskowski
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Marie Wennberg
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Gustafsson
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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27
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Yardman-Frank JM, Nambudiri V. Ending the pandemic of inaccessibility in dermatology. Clin Dermatol 2023; 41:280-283. [PMID: 37105502 DOI: 10.1016/j.clindermatol.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Dermatology in the United States is among the global leaders in advancing scientific discovery and practicing evidence-based medicine; however, many patients face limited access to dermatologic care due to a national shortage of dermatologists, provider clustering, and the interplay of sociodemographic and socioeconomic factors. These intertwined barriers have created a landscape where race, ethnicity, insurance subtype, education, and socioeconomic status negatively impact access to dermatologic services. Leveraging the utilization of technology and community engagement provides inroads to improve access to care. We outline how teleconsultations, telementoring, specialty care extension for community health outcomes (Project ECHO), community health centers, donated specialty care models, and community health workers can be bolstered to create more equitable access to care.
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Affiliation(s)
- Joseph Michael Yardman-Frank
- Department of Internal Medicine, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts, USA; Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA.
| | - Vinod Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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28
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Hansen I, Abeck D, Kött J, Schneider SW, Abeck F. Das Potenzial der Telemedizin für die dermatologische Versorgung pädiatrischer Patienten in Deutschland. J Dtsch Dermatol Ges 2023; 21:141-146. [PMID: 36808439 DOI: 10.1111/ddg.14979_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 11/23/2022] [Indexed: 02/22/2023]
Affiliation(s)
- Inga Hansen
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | | | - Julian Kött
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Stefan W Schneider
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Finn Abeck
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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29
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Hansen I, Abeck D, Kött J, Schneider SW, Abeck F. The potential of telemedicine for dermatological care of pediatric patients in Germany. J Dtsch Dermatol Ges 2023; 21:141-145. [PMID: 36772923 DOI: 10.1111/ddg.14979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 11/23/2022] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Skin diseases are a common reason for consultations in pediatric practice. The present study aims to characterize the dermatological requests of resident pediatric specialists using teledermatology in Germany. PATIENTS AND METHODS This analysis of consultation requests, submitted by pediatricians to a designated pediatric dermatologist via a telemedical consultation system (PädExpert) using the store-and-forward technology, was performed between February 2021 and December 2021. RESULTS The study analysis included 504 telemedical consultation requests. The mean age of the patients was 6.5 ± 5.0 years with 45.5% of the patients being female. Telemedicine was useful in providing a definite diagnosis in 88.3%. The diagnoses were most frequently assigned to the group of infectious skin diseases (28.8%). Referral to a dermatologist was recommended in 11.5%. The requests were answered on the same day in 63.8% of the cases. CONCLUSIONS The study data shows the great potential of teledermatology to improve access for children with skin diseases to specialized dermatological care. Another advantage is its function as a triage instrument. Since most cases could be managed by teledermatology only, it is possible to reduce the need for an in-person visit to the dermatologist, thus saving resources.
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Affiliation(s)
- Inga Hansen
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Julian Kött
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Finn Abeck
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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30
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Nguyen CN, Urquieta E. Contemporary review of dermatologic conditions in space flight and future implications for long-duration exploration missions. LIFE SCIENCES IN SPACE RESEARCH 2023; 36:147-156. [PMID: 36682824 DOI: 10.1016/j.lssr.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/23/2022] [Accepted: 10/11/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Future planned exploration missions to outer space will almost surely require the longest periods of continuous space exposure by the human body yet. As the most external organ, the skin seems the most vulnerable to injury. Therefore, discussion of the dermatological implications of such extended-duration missions is critical. OBJECTIVES In order to help future missions understand the risks of spaceflight on the human skin, this review aims to consolidate data from the current literature pertaining to the space environment and its physiologic effects on skin, describe all reported dermatologic manifestations in spaceflight, and extrapolate this information to longer-duration mission. METHODS AND MATERIALS The authors searched PubMed and Google Scholar using keywords and Mesh terms. The publications that were found to be relevant to the objectives were included and described. RESULTS The space environment causes changes in the skin at the cellular level by thinning the epidermis, altering wound healing, and dysregulating the immune system. Clinically, dermatological conditions represented the most common medical issues occurring in spaceflight. We predict that as exploration missions increase in duration, astronauts will experience further physiological changes and an increased rate and severity of adverse events. CONCLUSION Maximizing astronaut safety requires a continued knowledge of the human body's response to space, as well as consideration and prediction of future events. Dermatologic effects of space missions comprise the majority of health-related issues arising on missions to outer space, and these issues are likely to become more prominent with increasing time spent in space. Improvements in hygiene may mitigate some of these conditions.
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Affiliation(s)
| | - Emmanuel Urquieta
- Department of Emergency Medicine and Center for Space Medicine, Baylor College of Medicine. Houston TX, United States; Translational Research Institute for Space Health, Houston, TX, United States
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31
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Esber A, Teufel M, Jahre L, in der Schmitten J, Skoda EM, Bäuerle A. Predictors of patients' acceptance of video consultation in general practice during the coronavirus disease 2019 pandemic applying the unified theory of acceptance and use of technology model. Digit Health 2023; 9:20552076221149317. [PMID: 36815005 PMCID: PMC9940186 DOI: 10.1177/20552076221149317] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 12/18/2022] [Indexed: 01/20/2023] Open
Abstract
Background The coronavirus disease 2019 pandemic has led to an increase in remote consultations in health care. This study aimed to assess the acceptance of video consultation as an alternative to face-to-face in-office visits in general practice (GP) and to investigate its drivers and barriers. Methods A cross-sectional study was conducted in Germany during the coronavirus disease 2019 pandemic from December 2020 to April 2021. Participants were recruited among patients in 16 GP surgeries. Assessed were sociodemographic and medical data as well as information and communications technology related data. Acceptance of video consultation and its predictors were determined using a modified questionnaire based on a short version of the renowned unified theory of acceptance and use of technology model. Results In total, 371 participants were included in the data analysis. Acceptance of video consultation was moderate. A hierarchical regression revealed acceptance was significantly predicted by the PHQ-2, taking no regular medication, computer proficiency, knowledge about digital health care solutions, no prior use of video consultation, and the unified theory of acceptance and use of technology predictors performance expectancy, effort expectancy, and social influence. The extended unified theory of acceptance and use of technology model explained significantly more variance than the restricted unified theory of acceptance and use of technology model in acceptance of video consultation. Conclusions In this study computer proficiency, existing knowledge about digital health care solutions and depressive symptoms functioned as drivers to acceptance, no prior use of video consultation could be identified as a potential barrier. Patients with regular medication have been particularly receptive to video consultation. The study confirmed the validity of the unified theory of acceptance and use of technology model in determining acceptance of video consultation. Considering that there is growing demand and acceptance for different approaches to engage with health care providers, additional steps should be taken to establish video consultation as a genuine alternative.
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Affiliation(s)
- André Esber
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lisa Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Jürgen in der Schmitten
- Institute of General Practice, Center for Translational Neuro- and Behavioral Sciences, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany,Alexander Bäuerle, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Demo MLO, Nunes DH, Marcon CEM. Psoriasis in teledermatology: analysis of the 2016‒2020 period in Santa Catarina. An Bras Dermatol 2023; 98:47-58. [PMID: 36335044 PMCID: PMC9837650 DOI: 10.1016/j.abd.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Psoriasis is a skin disease that affects 1.3% of Brazilians. The use of teledermatology (TD) in the public health sector has democratized access to dermatological care. OBJECTIVE To analyze TD exams with suspected and/or diagnosed psoriasis performed between 2016‒2020 in the state of Santa Catarina (SC). METHODS Analytical cross-sectional observational study that used secondary data collected from the records of TD exams from the Telemedicine and Telehealth System (TTS) of SC. The associations were evaluated by the chi-square test and Student'st test. The significance level was set at 5% (p < 0.05). RESULTS During the period, 6,146 TD exams were related to psoriasis, 58% due to the diagnosis provided by the reporting dermatologist and 42% exclusively due to the suspected disease on the request of the examination. The male sex predominated among the diagnoses of dermatosis (51%; p < 0.001). Regarding risk classification, psoriasis diagnoses were predominantly yellow (58.7%; p < 0.001) or blue (39.7%; p < 0.001) risk, respectively indicating moderate to severe psoriasis (referral to tertiary care) and mild psoriasis (treatment in the primary health care [PHC] level). True positive tests, suspected by PHC and diagnosed with psoriasis through TD, were 34.1% (p < 0.001). STUDY LIMITATIONS The TD service is available only for the public health network and analysis for a limited period (five years). CONCLUSIONS Psoriasis diagnoses performed by TD, when compared to other dermatoses, tend to receive treatment at the primary (p < 0.001) or tertiary (p < 0.001) health care level, reducing the number of referrals to the secondary care level.
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Affiliation(s)
- Maria Laura Orlandi Demo
- Faculty of Medicine, Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil,Corresponding author.
| | - Daniel Holthausen Nunes
- Service of Dermatology, Hospital Universitário Polyodoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Giraud-Kerleroux L, Ingen-Housz-Oro S, De Prost N, Zeghbib N, Fiani C, Mongereau M, Gary C, Hirsch G, Hua C, Duong TA. Store and forward Teledermatology for epidermal necrolysis management: Experience of a French reference centre. J Eur Acad Dermatol Venereol 2023; 37:e110-e112. [PMID: 35993679 DOI: 10.1111/jdv.18550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Laura Giraud-Kerleroux
- Department of Dermatology AP-HP, Henri Mondor Hospital, Créteil, France.,Department of Dermatology, Groupe Hospitalier de l'est Francilien - Site Marne-La-Vallée, Jossigny, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France.,Univ Paris Est Créteil Epiderme, Créteil, France
| | - Nicolas De Prost
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France.,Intensive Care Unit APHP, Henri Mondor Hospital, Créteil, France
| | - Narimane Zeghbib
- Department of Dermatology AP-HP, Henri Mondor Hospital, Créteil, France
| | - Caroline Fiani
- Department of Dermatology AP-HP, Henri Mondor Hospital, Créteil, France
| | - Margaux Mongereau
- Department of Dermatology AP-HP, Henri Mondor Hospital, Créteil, France
| | - Charlotte Gary
- Department of Dermatology AP-HP, Henri Mondor Hospital, Créteil, France
| | - Gaëlle Hirsch
- Department of Dermatology, Groupe Hospitalier de l'est Francilien - Site Marne-La-Vallée, Jossigny, France
| | - Camille Hua
- Department of Dermatology AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Tu-Anh Duong
- Department of Dermatology AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
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Vasavda C, Tang O, Kwatra SG, Ho BK, Grossberg AL. Asymmetric patterns of patient access to in-person and teledermatologic health care during the COVID-19 pandemic. J Am Acad Dermatol 2023; 88:167-169. [PMID: 34933041 PMCID: PMC9726204 DOI: 10.1016/j.jaad.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Chirag Vasavda
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olive Tang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Byron K. Ho
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anna L. Grossberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland,Reprint requests: Anna L. Grossberg, MD, Department of Dermatology, Johns Hopkins University School of Medicine, 200 N Wolfe St, Rubenstein 2107, Baltimore, MD 21287
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Waschkau A, Traulsen P, Steinhäuser J. Evaluation of Synchronous and Asynchronous Telemedical Applications in Primary Care in Rural Regions of Northern Germany-Results and Lessons Learned from a Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214860. [PMID: 36429577 PMCID: PMC9690306 DOI: 10.3390/ijerph192214860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 05/30/2023]
Abstract
(1) Background: Telemedical applications (TAs) that are centered around General practitioners' (GP) practices could be beneficial for patients in rural areas in order to better their access to care. This could become more and more relevant as specialists favor practicing in more urban regions, leaving GPs as the first medical contact of patients in rural areas. (2) Methods: Three TAs, one synchronous, one asynchronous and one used in delegation were implemented and evaluated in ten GP practices and two specialists' practices in rural areas of northern Germany. (3) Results: Overall satisfaction with the TAs was generally high. GPs as well as specialists were especially satisfied with asynchronous TAs. A number of valuable "Lesson learned" were obtained and can be used as recommendations for further studies, e.g., taking time to identify market-ready technologies prior to implementation, developing dedicated trainings for users, and preparation of a technical support plan. Overall, the benefits of the TAs were rated high for the patients by the medical professionals. (4) Conclusion: Especially asynchronous TAs that are based on existing technology can be successfully implemented into a developing digital health care system such as the one in Germany. The impact on treatment of those TAs needs to be further investigated.
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Lamb JE, Fitzsimmons R, Sevagamoorthy A, Kovarik CL, Shin DB, Takeshita J. Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis. JMIR DERMATOLOGY 2022; 5:e38694. [PMID: 37632882 DOI: 10.2196/38694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/10/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated the widespread adoption of teledermatology, and this continues to account for a significant proportion of dermatology visits after clinics have reopened for in-person care. Delivery of high-quality teledermatology care requires adequate visualization of the patient's skin, with photographs being preferred over live video for remote skin examination. It remains unknown which patients face the greatest barriers to participating in a teledermatology visit with photographs. OBJECTIVE The aim of this study was to identify patient characteristics associated with type of telemedicine visit and the factors associated with participating in teledermatology visits with digital photographs versus those without photographs. METHODS We performed a cross-sectional analysis of the University of Pennsylvania Health System electronic health record data for adult patients who participated in at least 1 teledermatology appointment between March 1, 2020, and June 30, 2020. The primary outcomes were participation in a live-interactive video visit versus a telephone visit and participation in any teledermatology visit with photographs versus one without photographs. Multivariable logistic regression was performed to evaluate the associations between patient characteristics and the primary outcomes. RESULTS In total, 5717 unique patients completed at least 1 teledermatology visit during the study period; 68.25% (n=3902) of patients participated in a video visit, and 31.75% (n=1815) participated in a telephone visit. A minority of patients (n=1815, 31.75%) submitted photographs for their video or telephone appointment. Patients who submitted photographs for their teledermatology visit were more likely to be White, have commercial insurance, and live in areas with higher income, better education, and greater access to a computer and high-speed internet (P<.001 for all). In adjusted analysis, older age (age group >75 years: odds ratio [OR] 0.60, 95% CI 0.44-0.82), male sex (OR 0.85, 95% CI 0.75-0.97), Black race (OR 0.79, 95% CI 0.65-0.96), and Medicaid insurance (OR 0.81, 95% CI 0.66-0.99) were each associated with lower odds of a patient submitting photographs for their video or telephone visit. Older age (age group >75 years: OR 0.37, 95% CI 0.27-0.50) and Black race (OR 0.82, 95% CI 0.68-0.98) were also associated with lower odds of a patient participating in a video visit versus telephone visit. CONCLUSIONS Patients who were older, male, or Black, or who had Medicaid insurance were less likely to participate in teledermatology visits with photographs and may be particularly vulnerable to disparities in teledermatology care. Further research is necessary to identify the barriers to patients providing photographs for remote dermatology visits and to develop targeted interventions to facilitate equitable participation in teledermatology care.
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Affiliation(s)
- Jordan E Lamb
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Anjana Sevagamoorthy
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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TIZEK L, WECKER H, SCHNEIDER S, JOHANSSON EK, GIRMAY Y, ZINK A. Eczema-related Web Search Data in Sweden: Investigating Search Patterns and the Influence of Weather. Acta Derm Venereol 2022; 102:adv00810. [PMID: 36065747 PMCID: PMC9811297 DOI: 10.2340/actadv.v102.2937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As atopic eczema is triggered by environmental factors, such as temperature, differences in disease burden between and within countries are possible. One method to study this phenomenon is to perform web-search analysis, since the internet is commonly used to retrieve health-related information. This study, investigating the Google search volume regarding eczema in Swedish counties between April 2017 and March 2021, revealed a continuous increase in number of searches and that the search volume was higher in Northern than Southern Sweden. Gotland had the most searches per 100,000 inhabitants. In general, there was a negative correlation between search volume and temperature (r=-0.315, p < 0.001) and hours of sunshine (r=-0.213, p < 0.001), whereas there was a positive association between search volume and wind (r=0.229, p < 0.001). Search engine analysis is a rapid and cost-effective method of examining search behaviour regarding disease among the general population within a country and, thus, can enable the identification of regions with specific interests and needs.
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Affiliation(s)
- Linda TIZEK
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Hannah WECKER
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Simon SCHNEIDER
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Emma K. JOHANSSON
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Yodit GIRMAY
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Alexander ZINK
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
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Hewitt RM, Ploszajski M, Purcell C, Pattinson R, Jones B, Wren GH, Hughes O, Ridd MJ, Thompson AR, Bundy C. A mixed methods systematic review of digital interventions to support the psychological health and well-being of people living with dermatological conditions. Front Med (Lausanne) 2022; 9:1024879. [PMID: 36405626 PMCID: PMC9669071 DOI: 10.3389/fmed.2022.1024879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background Dermatological conditions can have a substantial impact on psychological as well as physical health yet dedicated face-to-face psychological support for patients is lacking. Thus, individuals may require additional support to self-manage dermatological conditions effectively. Digital technology can contribute to long-term condition management, but knowledge of the effectiveness of digital interventions addressing psychological (cognitive, emotional, and behavioural) aspects of dermatological conditions is limited. Objectives To identify, determine the effectiveness, and explore people’s views and experiences of digital interventions supporting the psychological health of people with dermatological conditions. Methods A mixed methods systematic review informed by JBI methodology. The protocol was registered on PROSPERO. Eight electronic databases were searched for papers written between January 2002 and October 2021. Data screening and extraction were conducted in Covidence. The methodological quality of studies were scrutinised against JBI critical appraisal tools. Intervention characteristics were captured using the Template for Intervention Description and Replication checklist and guide. Data were synthesised using a convergent segregated approach. The results were reported in a narrative summary. Results Twenty-three papers were identified from 4,883 references, including 15 randomised controlled trials. Nineteen interventions were condition-specific, 13 were delivered online, 16 involved an educational component, and 7 endorsed established, evidence-based therapeutic approaches. Improvements in knowledge, mood, quality of life, the therapeutic relationship, and reduced disease severity in the short to medium term, were reported, although there was substantial heterogeneity within the literature. Thirteen studies captured feedback from users, who considered various digital interventions as convenient and helpful for improving knowledge, emotion regulation, and personal control, but technical and individual barriers to use were reported. Use of established qualitative methodologies was limited and, in some cases, poorly reported. Conclusion Some web-based digital psychological interventions seem to be acceptable to people living with mainly psoriasis and eczema. Whilst some digital interventions benefitted cognitive and emotional factors, heterogeneity and inconsistencies in the literature meant definitive statements about their effectiveness could not be drawn. Interdisciplinary and patient-centred approaches to research are needed to develop and test quality digital interventions supporting the psychological health of adults living with common and rare dermatological conditions. Systematic review registration [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=285435], identifier [CRD42021285435].
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Affiliation(s)
- Rachael M. Hewitt
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- Wales Centre for Evidence Based Care–A JBI Centre of Excellence, Cardiff, United Kingdom
- *Correspondence: Rachael M. Hewitt,
| | | | - Catherine Purcell
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Rachael Pattinson
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Bethan Jones
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
| | - Georgina H. Wren
- School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Olivia Hughes
- School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Matthew J. Ridd
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Andrew R. Thompson
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- South Wales Clinical Psychology Training Programme, Cardiff and Vale University Health Board – School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Chris Bundy
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
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Ma T, Zhang S, Zhu S, Ni J, Wu Q, Liu M. The new role of nursing in digital inclusion: Reflections on smartphone use and willingness to increase digital skills among Chinese older adults. Geriatr Nurs 2022; 48:118-126. [PMID: 36155310 DOI: 10.1016/j.gerinurse.2022.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study explores the willingness of older adults to use smartphones and improve their digital skills and encourages nursing to actively participate in bridging the digital divide. METHODS Subject analysis was used to conduct qualitative research, and 23 older adults were interviewed. RESULTS We identified four themes: (1) the current situation of smartphone use; (2) the digital dilemma of smartphone use; (3) social support for digital skills; and (4) the willingness to learn digital skills. Older adults in China are willing to accept and use smartphones for simple operations, and peer learning may be an effective way to improve their digital skills. CONCLUSION Community support is necessary to develop the digital skills of older adults with smartphones and reduce the digital divide to the greatest extent possible. Nursing may play a role in promoting digital inclusion for older adults.
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Affiliation(s)
- Tianjiao Ma
- School of Nursing, Jilin University, No. 965, Xinjiang Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China
| | - Siyu Zhang
- School of Journalism and Communication, Jilin University, No.2699, Qianjin Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China
| | - Siying Zhu
- School of Journalism and Communication, Jilin University, No.2699, Qianjin Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China
| | - Jingqi Ni
- School of Journalism and Communication, Jilin University, No.2699, Qianjin Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China
| | - Qiqi Wu
- School of Journalism and Communication, Jilin University, No.2699, Qianjin Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China
| | - Mingzheng Liu
- School of Journalism and Communication, Jilin University, No.2699, Qianjin Street, Chaoyang District, Changchun, Jilin 130012, People's Republic of China.
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Virtual Access to Subspecialty Care. Prim Care 2022; 49:557-573. [PMCID: PMC9581700 DOI: 10.1016/j.pop.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hooper J, Shao K, Feng H. Racial/ethnic health disparities in dermatology in the United States, part 1: Overview of contributing factors and management strategies. J Am Acad Dermatol 2022; 87:723-730. [PMID: 35143914 DOI: 10.1016/j.jaad.2021.12.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/02/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
Racial or ethnic disparities are prevalent in the field of dermatology. Part 1 of this continuing medical education series aims to elucidate contributors to racial and ethnic disparities within dermatology and highlight potential actionable steps to combat these disparities. We review access to care, workforce diversity, cultural competency, implicit bias, dermatologic education material, patient education, and clinical research. Part 2 of the continuing medical education series will address disease-specific inequities that influence the clinical practice of dermatology.
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Affiliation(s)
- Jette Hooper
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Kimberly Shao
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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Sud E, Anjankar A. Applications of Telemedicine in Dermatology. Cureus 2022; 14:e27740. [PMID: 36106261 PMCID: PMC9445412 DOI: 10.7759/cureus.27740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022] Open
Abstract
Telemedicine is a technological tool that enhances well-being all around the globe. Practicing medicine or performing a clinical examination from a distance was a mere thought until this decade's pandemic hit the world. Telemedicine is practicing medicine sitting on one side of a globe and diagnosing and treating a different individual from the opposite part of the world. There is a long way to go for medical practitioners to execute an entire clinical examination analogous to an accurate clinical examination. Telemedicine is a supplement to a patient's total care, not a replacement for in-person doctor visits. Family doctors can easily access specialists using telemedicine, which enables them to monitor their patients closely. Numerous telemedicine systems, including store and forward, real-time and remote, or self-monitoring, are used worldwide for education, healthcare delivery and control, sickness screening, and disaster management. Even if telemedicine cannot solve every issue, it can significantly lessen the strain on the healthcare system. Nevertheless, investigations performed via telemedicine have started incorporating various medical instruments called telemedicine peripherals, including electronic stethoscopes, teleophthalmoscopes, and video-otoscopes. The prevailing disease around the globe of coronavirus has remarkably debilitated the medical infrastructure in providing diagnosis, treatment, monitoring, and follow-ups. As a result, there is a significant change in the way of practicing medicine and managing patients. Telemedicine provides timely patient care and reduces the risk of exposure to various communicable diseases offered to medical practitioners. The development of imaging technologies has significantly impacted dermatology, a specialty that relies on visual signals. Reviewing dermatology's existing situation and potential digital future, in brief, is the goal of this study. This study provides brief information on telemedicine, its application and scope in dermatology, and how it can alter the healthcare system.
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Abstract
PURPOSE OF REVIEW To identify factors that impact accessibility to pediatric dermatology and review healthcare delivery models that improve access and address these barriers. RECENT FINDINGS Up to one-third of pediatric primary care visits include a skin-related problem, yet pediatric dermatology subspecialist services are highly inaccessible. Workforce shortages and geographic, sociocultural, and economic barriers perpetuate inaccessibility. Teledermatology expands care, particularly to underserved or geographically remote communities, and reduces healthcare-related costs. Federal legislation to support telehealth services with adequate reimbursement for providers with parity between live, video, and phone visits will dictate the continued feasibility of virtual visits. Innovative care delivery models, such as language-based clinics, multidisciplinary teleconferencing, or embedded dermatology services within primary care are other promising alternatives. SUMMARY Despite efforts to expand access, dermatology still ranks among the most underserved pediatric subspecialties. Improving access requires a multipronged approach. Efforts to expand exposure and mentorship within pediatric dermatology, diversify the workforce and clinical curriculum, recruit and retain clinicians in geographically underserved areas, and collaborate with policymakers to ensure adequate reimbursement for teledermatology services are necessary.
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Del Castillo AM, Castro MDM, Cossio A, García Luna JA, Rincón D, Castillo RM, Prieto MD, Rebellón-Sánchez DE, Navarro A, Alexander N. Sensitivity and Specificity of the Remote Evaluation of Therapeutic Response in Cutaneous Leishmaniasis Using Photographs from a Mobile Application. Am J Trop Med Hyg 2022; 107:tpmd220164. [PMID: 35895332 PMCID: PMC9490675 DOI: 10.4269/ajtmh.22-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 11/07/2022] Open
Abstract
Cutaneous leishmaniasis (CL) primarily affects people in remote settings with limited access to health services. mHealth tools offer an opportunity to overcome knowledge gaps about clinical response to treatment. We evaluated the validity of the Guaral+ST mobile application for the remote assessment of therapeutic response in patients with CL, through photographs of lesions captured with the app by community health volunteers. Patients with confirmed CL were followed at weeks 13 and 26 after completion of treatment to assess therapeutic response in two clinical settings in southwest Colombia. Direct evaluation of lesions performed by an experienced physician was considered the reference standard. Photographs of lesions taken by CHV or nurse assistants with the mobile app, were independently evaluated by three physicians to define clinical response. A summary measure of clinical outcome defined by the three physicians was considered the index test. Sensitivity, specificity, and positive and negative predictive values were estimated. Interrater reliability (kappa) was calculated. Among 53 participants with CL who had at least one follow-up visit, the sensitivity of therapeutic response evaluation through photographs taken with the Guaral+ST app, compared with direct evaluation by an expert physician, had high validity with sensitivity of 100% (95% confidence interval: 80.5-100%) and specificity of 97.2% (95% confidence interval: 85.5-99.9%). The chance-adjusted agreement (κ) was > 0.8, which is conventionally characterized as almost perfect. The high accuracy of the remote evaluation of photographs for the assessment of therapeutic response supports the use of mHealth tools for improving access to treatment follow-up for CL.
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Affiliation(s)
| | - Maria del Mar Castro
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Alexandra Cossio
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Jonny Alejandro García Luna
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Domiciano Rincón
- Universidad Icesi, Cali, Colombia
- Grupo i2t, Universidad Icesi, Cali, Colombia
| | - Ruth Mabel Castillo
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Miguel Darío Prieto
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | | | - Andrés Navarro
- Universidad Icesi, Cali, Colombia
- Grupo i2t, Universidad Icesi, Cali, Colombia
| | - Neal Alexander
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
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Olteanu C, Motamedi M, Hersthammer J, Azer B, Rao J. Implementation of Teledermatology in Alberta, Canada: A Report of One Thousand Cases. J Cutan Med Surg 2022; 26:477-484. [PMID: 35801350 PMCID: PMC9476229 DOI: 10.1177/12034754221108990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Teledermatology utilizes photoimaging and background information to allow dermatologists to remotely provide a diagnosis to practitioners. ConsultDerm is an asynchronous, web-based teledermatology software that allows practitioners to submit their electronic referrals for assessment by board-certified dermatologists. Objective Our study aimed to retrospectively analyze teledermatology’s utilization in Canada by using the teledermatology platform ConsultDerm. Methods After implementing inclusion criteria, 1000 patients were selected, and relevant demographic and clinical information were extracted for data analysis. In addition, an online survey with pre-formulated questions was distributed to 7 dermatologists currently using the ConsultDerm platform to determine their experience in utilizing teledermatology. Results Of the 1000 patients, 66.5% had not received treatment prior to their teledermatology referral, and on average, patients experienced symptoms for 489.5 days prior to their referral. Diagnoses made were categorized by conditions, most common being dermatitis (37.1%), followed by acneiform conditions (10.6%), benign lesions/neoplasms (12.1%), infections (9.4%), and dyspigmentation (3.1%). Most consults originated from small population centers, and the referring practitioners were predominantly family physicians. Dermatologists utilizing the platform expressed ease of use, however, areas of improvement were identified such as increasing the quality of imaging and more detailed patient history. Conclusion Through our analysis of 1000 cases, we identified how a teledermatology consultation could be used to assess a wide variety of cutaneous conditions, improving access for patients who may face barriers to seeing a dermatologist.
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Affiliation(s)
- Cristina Olteanu
- 3158 Division of Dermatology, University of Alberta, Edmonton, Canada
| | - Melika Motamedi
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | | | - Brandon Azer
- Faculty of Sciences, University of Alberta, Edmonton, Canada
| | - Jaggi Rao
- 3158 Division of Dermatology, University of Alberta, Edmonton, Canada
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Pendlebury GA, Oro P, Haynes W, Merideth D, Bartling S, Bongiorno MA. The Impact of COVID-19 Pandemic on Dermatological Conditions: A Novel, Comprehensive Review. Dermatopathology (Basel) 2022; 9:212-243. [PMID: 35892480 PMCID: PMC9326733 DOI: 10.3390/dermatopathology9030027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background: The earliest cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019. Since the declaration as a pandemic on 11 March 2020, further dermatological conditions continue to be documented. We herein present a novel literature review of dermatological manifestations associated with the Coronavirus Disease 2019 (COVID-19) pandemic. To date, this literature review is the first broad-spectrum examination that analyzes a range of dermatological manifestations related to the COVID-19 pandemic: infection, vaccinations, personal protective equipment (PPE), and psychosocial factors. Methods: A detailed literature search was conducted using key terms for cutaneous manifestations associated with the scope of this review. The search retrieved 2199 articles. Results: The COVID-19 pandemic has triggered a significant range of dermatologic sequela. Etiologies of lesions continue to be investigated. Proposed mechanisms include inflammatory response to spike protein, vitamin D deficiency, ACE2 receptor activation, androgen levels, and increased psychological stress. One prominent mechanism describes viral spike protein invasion into the dermis by binding to the angiotensin-converting enzyme 2 (ACE-2) receptors in keratinocytes, with a secondary immunological response. Conclusions: Dermatologists play an integral role in the proper diagnosis and treatment of COVID-related lesions. Early treatment regimens and timely prophylaxis have been shown to safely reduce infection-related dermatological sequelae. Additional investigations and data collection can reduce disease burden and improve overall prognosis.
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Affiliation(s)
- Gehan A. Pendlebury
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Peter Oro
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - William Haynes
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Drew Merideth
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Samantha Bartling
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
| | - Michelle A. Bongiorno
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
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A Pilot Study to Assess the Reliability of Digital Image-Based PASI Scores Across Patient Skin Tones and Provider Training Levels. Dermatol Ther (Heidelb) 2022; 12:1685-1695. [PMID: 35727498 PMCID: PMC9276898 DOI: 10.1007/s13555-022-00750-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The ability to perform psoriasis skin assessments remotely through digital image-based psoriasis area and severity index (DIB-PASI) would be a valuable tool for psoriasis clinical trials. An ideal teledermatological assessment would be robust across patients of diverse skin tones as well as across assessors of varying experience levels. In this pilot study, we evaluated the reliability of face-to-face (FTF) versus DIB-PASI scores determined by trained clinical assessors with a spectrum of experience and with patients of different skin tones. Methods Fourteen subjects of varying skin tones with moderate-to-severe plaque psoriasis were treated with adalimumab. In-person PASI assessments and digital photography were performed in the clinic at weeks 0, 12, and 24. Photographs were reviewed by four independent assessors to derive a digital image-based PASI score. The concordance of face-to-face PASI (FTF-PASI) and DIB-PASI were analyzed across patient and assessor factors. Results Overall concordance between FTF-PASI and DIB-PASI was high (ICC 0.82, p < 0.0001), with good agreement across individual assessors. When analyzed by PASI score component or body region, digital assessors also demonstrated good agreement with the FTF assessor. Similarly, DIB-PASI showed high concordance with FTF-PASI for patients with light skin tones and patients with medium-to-dark skin tones, and across clinical training levels. Conclusion Overall, PASI scores derived from digital images showed good agreement with those determined in person. Importantly, these remote assessments were reliable for both light and medium-to-dark skin tones, and robust to training level of the assessor. The findings from this pilot study lay the foundation for expanding teledermatology-based clinical trials for patients with psoriasis and enabling accurate, remote monitoring of disease severity and therapy response. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00750-w.
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Faucon C, Gribi D, Courvoisier D, Senet P, Itani O, Barbaud A, Magnier AM, Frances C, Chastang J, Chasset F. Performance accuracy, advantages and limitations of a store-and-forward teledermatology platform developed for general practitioners: A retrospective study of 298 cases. Ann Dermatol Venereol 2022; 149:245-250. [DOI: 10.1016/j.annder.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/04/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
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Jones K, Lennon E, McCathie K, Millar A, Isles C, McFadyen A, Shearer H. Teledermatology to reduce face-to-face appointments in general practice during the COVID-19 pandemic: a quality improvement project. BMJ Open Qual 2022; 11:bmjoq-2021-001789. [PMID: 35618315 PMCID: PMC9136693 DOI: 10.1136/bmjoq-2021-001789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
Teledermatology is an important subspecialty of telemedicine that continues to evolve with advances in telecommunication and mobile phone technology. A 19-week primary care quality improvement project collected baseline data and tested three change ideas, using the Model for Improvement method, with primary and secondary aims: to increase the weekly percentage of remote dermatological consultations with supporting images that were successfully concluded remotely to greater than 80% and to reduce the weekly percentage of dermatological face-to-face consultations to less than 50%. We hypothesised that by improving the quality of patient images and the confidence of reception staff in triaging skin complaints, there would be a decrease in the weekly number of face-to-face dermatological appointments, thereby decreasing the risk of COVID-19 transmission within the practice and community. Two change ideas focused on supporting patients to improve image quality by introducing ‘4 Key Instructions’ and a patient information leaflet (PIL). The third focused on increasing reception staff confidence in triaging skin complaints by introducing a triage pathway guidance tool. A total of 253 dermatological consultations were analysed: 170 of these were telephone consultations with 308 supporting images. Process measures showed clear improvements in the quality of images provided by patients which likely contributed to an increase in completed remote consultation. Our primary outcome measure was achieved. Our secondary outcome measure suggested that in the absence of high-quality images, it might not be possible to reduce dermatological face-to-face consultations much below 50% in primary care. Process measures showed clear improvements in the quality of images provided by patients which likely contributed to the increase in remote consultation. The implications of these findings for the theory of change are discussed.
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Affiliation(s)
- Keira Jones
- School of Medicine, University of Dundee, College of Medicine Dentistry and Nursing, Dundee, UK
| | - Emer Lennon
- Cairnsmore Medical Practice, Dumfries and Galloway, UK
| | | | - Angela Millar
- School of Medicine, University of Dundee, College of Medicine Dentistry and Nursing, Dundee, UK
| | - Chris Isles
- Department of Medicine, Dumfries and Galloway Acute Hospitals, Dumfries, UK
| | | | - Heather Shearer
- School of Medicine, University of St Andrews, St Andrews, UK
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Kling SMR, Saliba-Gustafsson EA, Winget M, Aleshin MA, Garvert DW, Amano A, Brown-Johnson CG, Kwong BY, Calugar A, El-Banna G, Shaw JG, Asch SM, Ko JM. Teledermatology to Facilitate Patient Care Transitions from Inpatient to Outpatient Dermatology: a Mixed Methods Evaluation (Preprint). J Med Internet Res 2022; 24:e38792. [PMID: 35921146 PMCID: PMC9386584 DOI: 10.2196/38792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 01/26/2023] Open
Abstract
Background Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination–dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap. Objective Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care. Methods Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients. Results More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic’s capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19–related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient’s own. Conclusions Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers’ preferences.
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Affiliation(s)
- Samantha M R Kling
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Erika A Saliba-Gustafsson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marcy Winget
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Maria A Aleshin
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Donn W Garvert
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Alexis Amano
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Cati G Brown-Johnson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ana Calugar
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ghida El-Banna
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Steven M Asch
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Heath Care System, Menlo Park, CA, United States
| | - Justin M Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
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