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Anwar ET, Gupta N, Porwal O, Sharma A, Malviya R, Singh A, Fuloria NK. Skin Diseases and their Treatment Strategies in Sub-Saharan African Regions. Infect Disord Drug Targets 2021; 22:e270921196808. [PMID: 34579638 DOI: 10.2174/1871526521666210927120334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the rural areas of sub-Saharan African regions, skin diseases are so common. Due to which the population of the sub-Saharan region suffers from different types of skin disorders. In these regions, many treatment options are not available for the treatment of skin disease. AIM The current study aims to discuss various skin diseases and their treatment strategies specifically in sub-Saharan African regions. METHOD Extensive literature survey was carried out by using scopus, science direct, elsevier, google scholar and bentham science databases. RESULT AND DISCUSSION It was demonstrated from the literature surveys that different effective techniques are used in the management of skin disease. In the result, it was shown that the condition of the disease is at a dangerous level which must be controlled. CONCLUSION It is concluded from the manuscript that the skin disorder in the sub-Saharan region is at a very dangerous level. The research must be done to develop a better understanding of the disease and its treatment.
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Affiliation(s)
- Esra Tariq Anwar
- Department of Pharmacy, Tishk International University, Erbil-Kurdistan. Iraq
| | - Nandan Gupta
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Gautam Buddha Nagar, Uttar Pradesh. India
| | - Omji Porwal
- Department of Pharmacy, Tishk International University, Erbil-Kurdistan. Iraq
| | - Akanksha Sharma
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Gautam Buddha Nagar, Uttar Pradesh. India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Gautam Buddha Nagar, Uttar Pradesh. India
| | - Amit Singh
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Gautam Buddha Nagar, Uttar Pradesh. India
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Teledermatology Addressing Disparities in Health Care Access: a Review. CURRENT DERMATOLOGY REPORTS 2021; 10:40-47. [PMID: 33747638 PMCID: PMC7953516 DOI: 10.1007/s13671-021-00329-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
Purpose of Review Dermatologists have been at the forefront of researching telemedicine to expand access to care. The current COVID-19 pandemic has prompted even greater expansion and implementation of teledermatology. This review discusses the research examining the potential impact of teledermatology addressing disparities in care. Recent Findings Teledermatology appears to increase access to dermatology given expanded means to deliver care. Specifically, recent studies have found increased access among Medicaid-insured, resource-poor urban and rural, and elderly populations. Teledermatology implementation also facilitates education among providers at different levels of training. Still, as some patients have inconsistent access to the required technology, increased reliance on telemedicine may also potentially increase disparities for some populations. Summary Teledermatology may serve to reduce disparities in health care access in many underserved and marginalized communities. Future research should continue to study implementation, especially given the expansion during the COVID-19 pandemic. Ultimately, teledermatology may play an important role in ensuring equitable care access for all.
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Coustasse A, Sarkar R, Abodunde B, Metzger BJ, Slater CM. Use of Teledermatology to Improve Dermatological Access in Rural Areas. Telemed J E Health 2019; 25:1022-1032. [PMID: 30741608 DOI: 10.1089/tmj.2018.0130] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Alberto Coustasse
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
| | - Raghav Sarkar
- Health Informatics Program, Marshall University, Huntington, West Virginia
| | - Bukola Abodunde
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
| | - Brandon J. Metzger
- Health Informatics Program, Marshall University, Huntington, West Virginia
| | - Chelsea M. Slater
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
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Theodorakopoulou E, Goutos I, Mason K, Ghanem AM, Myers S. London calling Gaza: The role of international collaborations in the globalisation of postgraduate burn care education. Scars Burn Heal 2019; 5:2059513119830519. [PMID: 30815281 PMCID: PMC6381431 DOI: 10.1177/2059513119830519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Burn injuries represent a significant epidemiological problem, with the vast majority occurring in low- to middle-income countries. These regions also represent areas where lack of socioeconomic growth and geopolitical instability pose additional barriers not only to healthcare provision but also to the acquisition of continuing professional development. Long-distance, web-based learning programmes ('tele-education') have been identified as a successful and powerful means of propagating up-to-date medical education and training in poor-resource, isolated or conflict-ridden regions. This report evaluates the role of tele-education in delivering a distance-learning Master's degree in Burn Care to a group of 11 healthcare professionals working in the occupied Palestinian territories (OPT), which was funded as part of a collaboration between Queen Mary University of London and IMET-Pal (International Medical Education Trust - Palestine). We present our experience in delivering the programme in a conflict-ridden part of the world, which includes the specific adaptations to tailor the programme to regional needs as well the unique challenges faced by students and faculty in enhancing the educational value of this unique initiative. The academic achievements of this group of healthcare professionals were found to be comparable to historical student cohorts from privileged socioeconomic backgrounds and the majority of students felt that participation in the programme contributed to a direct improvement to their daily burn care practices. The successful outcomes achieved by our students support the constantly emerging evidence that targeted, well-delivered, long-distance learning programmes can become powerful tools in combating inequalities in global healthcare and health education.
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Affiliation(s)
- Evgenia Theodorakopoulou
- Health Education East of England, Colchester, UK
- The Blizard Institute, Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ioannis Goutos
- The Blizard Institute, Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Katrina Mason
- The Blizard Institute, Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ali M Ghanem
- The Blizard Institute, Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Simon Myers
- The Blizard Institute, Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Armstrong AW, Chambers CJ, Maverakis E, Cheng MY, Dunnick CA, Chren MM, Gelfand JM, Wong DJ, Gibbons BM, Gibbons CM, Torres J, Steel AC, Wang EA, Clark CM, Singh S, Kornmehl HA, Wilken R, Florek AG, Ford AR, Ma C, Ehsani-Chimeh N, Boddu S, Fujita M, Young PM, Rivas-Sanchez C, Cornejo BI, Serna LC, Carlson ER, Lane CJ. Effectiveness of Online vs In-Person Care for Adults With Psoriasis: A Randomized Clinical Trial. JAMA Netw Open 2018; 1:e183062. [PMID: 30646223 PMCID: PMC6324453 DOI: 10.1001/jamanetworkopen.2018.3062] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Innovative, online models of specialty-care delivery are critical to improving patient access and outcomes. OBJECTIVE To determine whether an online, collaborative connected-health model results in equivalent clinical improvements in psoriasis compared with in-person care. DESIGN, SETTING, AND PARTICIPANTS The Patient-Centered Outcomes Research Institute Psoriasis Teledermatology Trial is a 12-month, pragmatic, randomized clinical equivalency trial to evaluate the effect of an online model for psoriasis compared with in-person care. Participant recruitment and study visits took place at multicenter ambulatory clinics from February 2, 2015, to August 18, 2017. Participants were adults with psoriasis in Northern California, Southern California, and Colorado. The eligibility criteria were an age of 18 years or older, having physician-diagnosed psoriasis, access to the internet and a digital camera or mobile phone with a camera, and having a primary care physician. Analyses were on an intention-to-treat basis. INTERVENTIONS Participants were randomized 1:1 to receive online or in-person care (148 randomized to online care and 148 randomized to in-person care). The online model enabled patients and primary care physicians to access dermatologists online asynchronously. The dermatologists provided assessments, recommendations, education, and prescriptions online. The in-person group sought care in person. The frequency of online or in-person visits was determined by medical necessity. All participants were exposed to their respective interventions for 12 months. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was the difference in improvement in the self-administered Psoriasis Area and Severity Index (PASI) score between the online and in-person groups. Prespecified secondary outcomes included body surface area (BSA) affected by psoriasis and the patient global assessment score. RESULTS Of the 296 randomized participants, 147 were women, 149 were men, 187 were white, and the mean (SD) age was 49 (14) years. The adjusted difference between the online and in-person groups in the mean change in the self-administered PASI score during the 12-month study period was -0.27 (95% CI, -0.85 to 0.31). The difference in the mean change in BSA affected by psoriasis between the 2 groups was -0.05% (95% CI, -1.58% to 1.48%). Between-group differences in the PASI score and BSA were within prespecified equivalence margins, which demonstrated equivalence between the 2 interventions. The difference in the mean change in the patient global assessment score between the 2 groups was -0.11 (95% CI, -0.32 to 0.10), which exceeded the equivalence margin, with the online group displaying greater improvement. CONCLUSIONS AND RELEVANCE The online, collaborative connected-health model was as effective as in-person management in improving clinical outcomes among patients with psoriasis. Innovative telehealth delivery models that emphasize collaboration, quality, and efficiency can be transformative to improving patient-centered outcomes in chronic diseases. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02358135.
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Affiliation(s)
- April W. Armstrong
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Cindy J. Chambers
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Michelle Y. Cheng
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Cory A. Dunnick
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joel M. Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David J. Wong
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Brittany M. Gibbons
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Caitlin M. Gibbons
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Josefina Torres
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Andrea C. Steel
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Elizabeth A. Wang
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Caitlin M. Clark
- University of Hawaii–Manoa John A. Burns School of Medicine, Honolulu
| | - Sanminder Singh
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | | | - Reason Wilken
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Aleksandra G. Florek
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Adam R. Ford
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Chelsea Ma
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Nazanin Ehsani-Chimeh
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Sucharita Boddu
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Mayumi Fujita
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Paulina M. Young
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Cesar Rivas-Sanchez
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Brenda I. Cornejo
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Laura C. Serna
- Clinical and Translational Science Institute, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Eric R. Carlson
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado
| | - Christianne J. Lane
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles
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Ismail A, Stoff BK, McMichael JR. Store-and-forward teledermatology service for primary care providers in Afghanistan. Int J Dermatol 2018; 57:e145-e147. [PMID: 30070355 DOI: 10.1111/ijd.14165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/17/2018] [Accepted: 07/04/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Aimen Ismail
- Department of Dermatology, Emory University, Atlanta, GA, USA
| | - Benjamin K Stoff
- Department of Dermatology, Department of Pathology and Laboratory Medicine, Emory Center for Ethics, Emory University, Atlanta, GA, USA
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Yotsu RR, Kouadio K, Vagamon B, N’guessan K, Akpa AJ, Yao A, Aké J, Abbet Abbet R, Tchamba Agbor Agbor B, Bedimo R, Ishii N, Fuller LC, Hay R, Mitjà O, Drechsler H, Asiedu K. Skin disease prevalence study in schoolchildren in rural Côte d'Ivoire: Implications for integration of neglected skin diseases (skin NTDs). PLoS Negl Trop Dis 2018; 12:e0006489. [PMID: 29771976 PMCID: PMC5976208 DOI: 10.1371/journal.pntd.0006489] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/30/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022] Open
Abstract
Background Early detection of several skin-related neglected tropical diseases (skin NTDs)–including leprosy, Buruli ulcer, yaws, and scabies- may be achieved through school surveys, but such an approach has seldom been tested systematically on a large scale in endemic countries. Additionally, a better understanding of the spectrum of skin diseases and the at-risk populations to be encountered during such surveys is necessary to facilitate the process. Methods We performed a school skin survey for selected NTDs and the spectrum of skin diseases, among primary schoolchildren aged 5 to 15 in Côte d’Ivoire, West Africa. This 2-phase survey took place in 49 schools from 16 villages in the Adzopé health district from November 2015 to January 2016. The first phase involved a rapid visual examination of the skin by local community healthcare workers (village nurses) to identify any skin abnormality. In a second phase, a specialized medical team including dermatologists performed a total skin examination of all screened students with any skin lesion and provided treatment where necessary. Results Of a total of 13,019 children, 3,504 screened positive for skin lesions and were listed for the next stage examination. The medical team examined 1,138 of these children. The overall prevalence of skin diseases was 25.6% (95% CI: 24.3–26.9%). The predominant diagnoses were fungal infections (n = 858, prevalence: 22.3%), followed by inflammatory skin diseases (n = 265, prevalence: 6.9%). Skin diseases were more common in boys and in children living along the main road with heavy traffic. One case of multi-bacillary type leprosy was detected early, along with 36 cases of scabies. Our survey was met with very good community acceptance. Conclusion We carried out the first large-scale integrated, two-phase pediatric multi-skin NTD survey in rural Côte d’Ivoire, effectively reaching a large population. We found a high prevalence of skin diseases in children, but only limited number of skin NTDs. With the lessons learned, we plan to expand the project to a wider area to further explore its potential to better integrate skin NTD screening in the public health agenda. Integration of neglected tropical diseases (NTDs) into the public health agenda has been a priority in global health for the last decade. A common feature shared by several NTDs is skin involvement. Conditions within this group of NTDs have now been classified as skin NTDs to promote wider NTD integration. Several skin NTDs including leprosy, Buruli ulcer, yaws, and scabies are co-endemic in Côte d’Ivoire, West Africa. As children are vulnerable to these diseases, we carried out the first large-scale integrated, multi-skin NTD school survey in a rural district of this country. Our strategy of involving community healthcare workers and dermatologists effectively reached a large population. However, the detection of skin NTDs may have been limited because of the low schooling and attendance rate. We found a high prevalence of skin diseases among schoolchildren (26%), possibly due to poor socio-economic status and air pollution, which requires more attention. This high prevalence of skin diseases posed a challenge for our project as the need for medications and those with dermatological skills exceeded our capacity to reach our initial target population. Our study provides important lessons that will aid the framing of future school skin surveys in sub-Saharan Africa.
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Affiliation(s)
- Rie Roselyne Yotsu
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Dermatology, National Suruga Sanatorium, Shizuoka, Japan
- * E-mail: ,
| | - Kouamé Kouadio
- Eco Epidemiology Unit, Pasteur Institute Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Bamba Vagamon
- Raoul Follereau Institute Côte d’Ivoire, Adzopé, Côte d’Ivoire
| | | | | | - Aubin Yao
- MAP International West Africa, Abidjan, Côte d’Ivoire
| | - Julien Aké
- MAP International West Africa, Abidjan, Côte d’Ivoire
| | - Rigobert Abbet Abbet
- National Program for Leprosy Control (PNEL), Ministry of Health and Public Hygiene, Abidjan, Côte d’Ivoire
| | | | - Roger Bedimo
- Department of Medicine, VA North Texas Healthcare System, Dallas, Texas, United States of America
- Division of Infectious Diseases, University of Texas Dallas Southwestern, Dallas, Texas, United States of America
| | - Norihisa Ishii
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - L. Claire Fuller
- International Foundation for Dermatology
- Dermatology Department, Chelsea and Westminster Hospital, London, United Kingdom
| | | | - Oriol Mitjà
- Skin NTD Program, Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Henning Drechsler
- Department of Medicine, VA North Texas Healthcare System, Dallas, Texas, United States of America
- Division of Infectious Diseases, University of Texas Dallas Southwestern, Dallas, Texas, United States of America
| | - Kingsley Asiedu
- Global Buruli Ulcer Initiative, World Health Organization, Geneva, Switzerland
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Mitjà O, Marks M, Bertran L, Kollie K, Argaw D, Fahal AH, Fitzpatrick C, Fuller LC, Garcia Izquierdo B, Hay R, Ishii N, Johnson C, Lazarus JV, Meka A, Murdoch M, Ohene SA, Small P, Steer A, Tabah EN, Tiendrebeogo A, Waller L, Yotsu R, Walker SL, Asiedu K. Integrated Control and Management of Neglected Tropical Skin Diseases. PLoS Negl Trop Dis 2017; 11:e0005136. [PMID: 28103250 PMCID: PMC5245794 DOI: 10.1371/journal.pntd.0005136] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Oriol Mitjà
- Skin NTDs Program, Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
| | - Laia Bertran
- Skin NTDs Program, Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Karsor Kollie
- Neglected Tropical and Non Communicable Diseases Program, Ministry of Health, Government of Liberia, Liberia
| | - Daniel Argaw
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Ahmed H. Fahal
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | - Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - L. Claire Fuller
- International Foundation for Dermatology, London, United Kingdom
| | | | - Roderick Hay
- International Foundation for Dermatology, London, United Kingdom
| | - Norihisa Ishii
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Jeffrey V. Lazarus
- Skin NTDs Program, Barcelona Institute for Global Health, Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Anthony Meka
- Medical Department, German Leprosy and TB Relief Association, Enugu, Nigeria
| | - Michele Murdoch
- Department of Dermatology, Watford General Hospital, Watford, United Kingdom
| | | | - Pam Small
- Department of Microbiology, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Andrew Steer
- Group A Streptococcal Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Earnest N. Tabah
- National Yaws, Leishmaniasis, Leprosy and Buruli ulcer Control Programme, Ministry of Public Health, Yaoundé, Cameroon
| | | | - Lance Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Rie Yotsu
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Stephen L. Walker
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Bashshur RL, Shannon GW, Tejasvi T, Kvedar JC, Gates M. The Empirical Foundations of Teledermatology: A Review of the Research Evidence. Telemed J E Health 2015; 21:953-79. [PMID: 26394022 PMCID: PMC4776540 DOI: 10.1089/tmj.2015.0146] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This article presents the scientific evidence for the merit of telemedicine interventions in the diagnosis and management of skin disorders (teledermatology) in the published literature. The impetus for this work derives from the high prevalence of skin disorders, the high cost, the limited availability of dermatologists in certain areas, and the promise of teledermatology to address unmet needs in this area. MATERIALS AND METHODS The findings are based on a targeted review of scientific studies published from January 2005 through April 2015. The initial search yielded some 5,020 articles in Google Scholar and 428 in PubMed. A review of the abstracts yielded 71 publications that met the inclusion criteria for this analysis. Evidence is organized according to the following: feasibility and acceptance; intermediate outcomes (use of service, compliance, and diagnostic and treatment concordance and accuracy); outcomes (health improvement and problem resolution); and cost savings. A special section is devoted to studies conducted at the Veterans Health Administration. RESULTS Definitions of teledermatology varied across a wide spectrum of skin disorders, technologies, diagnostic tools, provider types, settings, and patient populations. Outcome measures included diagnostic concordance, treatment plans, and health. CONCLUSIONS Despite these complexities, sufficient evidence was observed consistently supporting the effectiveness of teledermatology in improving accessibility to specialty care, diagnostic and treatment concordance, and skin care provided by primary care physicians, while also reducing cost. One study reported suboptimal clinical results from teledermatology for patients with pigmented skin lesions. On the other hand, confocal microscopy and advanced dermoscopy improved diagnostic accuracy, especially when rendered by experienced teledermatologists.
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Affiliation(s)
- Rashid L. Bashshur
- eHealth Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Gary W. Shannon
- Department of Geography, University of Kentucky, Lexington, Kentucky
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Joseph C. Kvedar
- Center for Connected Health, Partners HealthCare, Boston, Massachusetts
| | - Michael Gates
- eHealth Center, University of Michigan Health System, Ann Arbor, Michigan
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Czekierda Ł, Malawski F, Wyszkowski P. Holistic approach to design and implementation of a medical teleconsultation workspace. J Biomed Inform 2015; 57:225-44. [PMID: 26277117 DOI: 10.1016/j.jbi.2015.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 07/31/2015] [Accepted: 08/06/2015] [Indexed: 11/17/2022]
Abstract
While there are many state-of-the-art approaches to introducing telemedical services in the area of medical imaging, it is hard to point to studies which would address all relevant aspects in a complete and comprehensive manner. In this paper we describe our approach to design and implementation of a universal platform for imaging medicine which is based on our longstanding experience in this area. We claim it is holistic, because, contrary to most of the available studies it addresses all aspects related to creation and utilization of a medical teleconsultation workspace. We present an extensive analysis of requirements, including possible usage scenarios, user needs, organizational and security issues and infrastructure components. We enumerate and analyze multiple usage scenarios related to medical imaging data in treatment, research and educational applications - with typical teleconsultations treated as just one of many possible options. Certain phases common to all these scenarios have been identified, with the resulting classification distinguishing several modes of operation (local vs. remote, collaborative vs. non-interactive etc.). On this basis we propose a system architecture which addresses all of the identified requirements, applying two key concepts: Service Oriented Architecture (SOA) and Virtual Organizations (VO). The SOA paradigm allows us to decompose the functionality of the system into several distinct building blocks, ensuring flexibility and reliability. The VO paradigm defines the cooperation model for all participating healthcare institutions. Our approach is validated by an ICT platform called TeleDICOM II which implements the proposed architecture. All of its main elements are described in detail and cross-checked against the listed requirements. A case study presents the role and usage of the platform in a specific scenario. Finally, our platform is compared with similar systems described into-date studies and available on the market.
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Affiliation(s)
- Łukasz Czekierda
- Department of Computer Science, AGH University of Science and Technology, ul. Kawiory 21, 30-055 Kraków, Poland.
| | - Filip Malawski
- Department of Computer Science, AGH University of Science and Technology, ul. Kawiory 21, 30-055 Kraków, Poland.
| | - Przemysław Wyszkowski
- Department of Computer Science, AGH University of Science and Technology, ul. Kawiory 21, 30-055 Kraków, Poland.
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Greisman L, Nguyen TM, Mann RE, Baganizi M, Jacobson M, Paccione GA, Friedman AJ, Lipoff JB. Feasibility and cost of a medical student proxy-based mobile teledermatology consult service with Kisoro, Uganda, and Lake Atitlán, Guatemala. Int J Dermatol 2014; 54:685-92. [PMID: 25558031 DOI: 10.1111/ijd.12708] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/20/2014] [Accepted: 03/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The expansion of mobile technology and coverage has unveiled new means for delivering medical care to isolated and resource-poor communities. Teledermatology, or dermatology consultation from a distance using technology, is gaining greater acceptance among physicians and patients. OBJECTIVES To evaluate feasibility and cost of a smartphone-based teledermatology consult service utilizing a designated medical student proxy to facilitate all consults on site, and to evaluate the service's effect upon diagnosis and management. METHODS An IRB-approved smartphone-based teledermatology consult service was established to serve two rural communities in the developing world: Kisoro, Uganda, and Lake Atitlán, Guatemala. Fourth-year medical students were recruited as proxies for each site, responding to consults by local doctors and transmitting photographs and clinical information via a smartphone application to a dermatology resident and attending in the USA over an encrypted website. At the Ugandan site, when indicated, the medical student performed skin biopsies under supervision, and rotating Montefiore residents transported specimens back to the USA. RESULTS From October 2011 to August 2012, 93 cases were evaluated by the consult service (57 from Uganda and 36 from Guatemala). Initial diagnoses changed completely in 55.9% (52 of 93) of cases, and management changes were recommended in 89.2% (83 of 93) of cases. The estimated total cost of supplies and technology was 42.01 USD per consult and 64.24 USD per biopsy (including processing). Given fixed upfront costs, the cost per consult decreased with each additional case. CONCLUSION Smartphone-based systems for teledermatology consultation using a medical student proxy are feasible for delivery of care in the developing world at relatively little cost. Optimization and sustainability of this system requires and deserves further investigation in larger studies.
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Affiliation(s)
- Laura Greisman
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tan M Nguyen
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ranon E Mann
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mark Jacobson
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gerald A Paccione
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adam J Friedman
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jules B Lipoff
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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Delaigue S, Morand JJ, Olson D, Wootton R, Bonnardot L. Teledermatology in Low-Resource Settings: The MSF Experience with a Multilingual Tele-Expertise Platform. Front Public Health 2014; 2:233. [PMID: 25453029 PMCID: PMC4231841 DOI: 10.3389/fpubh.2014.00233] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/27/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction: In 2010, Médecins Sans Frontières (MSF) launched a tele-expertise system to improve the access to specialized clinical support for its field health workers. Among medical specialties, dermatology is the second most commonly requested type of tele-expertise. The aim of the present study was to review all MSF teledermatology cases in the first 4 years of operation. Our hypothesis was that the review would enable the identification of key areas for improvement in the current MSF teledermatology system. Methods: We carried out a retrospective analysis of all dermatology cases referred by MSF field doctors through the MSF platform from April 2010 until February 2014. We conducted a quantitative and qualitative analysis based on a survey sent to all referrers and specialists involved in these cases. Results: A total of 65 clinical cases were recorded by the system and 26 experts were involved in case management. The median delay in providing the first specialist response was 10.2 h (IQR 3.7–21.1). The median delay in allocating a new case was 0.96 h (IQR 0.26–3.05). The three main countries of case origin were South Sudan (29%), Ethiopia (12%), and Democratic Republic of Congo (10%). The most common topics treated were infectious diseases (46%), inflammatory diseases (25%), and genetic diseases (14%). One-third of users completed the survey. The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers. Discussion: The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period. Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography.
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Affiliation(s)
| | | | - David Olson
- Médecins Sans Frontières , New York, NY , USA
| | - Richard Wootton
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway , Tromsø , Norway ; Faculty of Health Sciences, University of Tromsø , Tromsø , Norway
| | - Laurent Bonnardot
- Fondation Médecins Sans Frontières , Paris , France ; Department of Medical Ethics and Legal Medicine (EA 4569), Paris Descartes University , Paris , France
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Wootton R, Geissbuhler A, Jethwani K, Kovarik C, Person DA, Vladzymyrskyy A, Zanaboni P, Zolfo M. Comparative performance of seven long-running telemedicine networks delivering humanitarian services. J Telemed Telecare 2012; 18:305-11. [DOI: 10.1258/jtt.2012.120315] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Seven long-running telemedicine networks were surveyed. The networks provided humanitarian services (clinical and educational) in developing countries, and had been in operation for periods of 5–15 years. The number of experts serving each network ranged from 15 to 513. The smallest network had a total of 10 requesters and the largest one had more than 500 requesters. The networks operated in nearly 60 countries. The seven networks managed a total of 1857 cases in 2011, i.e. an average of 265 cases per year per network. There was a significant growth in total activity, amounting to 100.3 cases per year during the 15 year study period. In 2011, network activity was 50–700 teleconsultations per network. There were clear differences in the patterns of activity, with some networks managing an increasing caseload, and others managing a slowly reducing caseload. The seven networks had published a total of 44 papers listed in Medline which summarized the evidence resulting from the delivery of services by telemedicine. There was a dearth of information about clinical and cost-effectiveness. Nevertheless, the services were widely appreciated by referring doctors, considered to be clinically useful, and there were indications that clinical outcomes for telemedicine patients were often improved. Despite a lack of formal evidence, the present study suggests that telemedicine can provide clinically useful services in developing countries.
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Affiliation(s)
- Richard Wootton
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
- Faculty of Health Sciences, University of Tromsø, Norway
| | - Antoine Geissbuhler
- Department of Radiology and Medical Informatics, Geneva University, Switzerland
| | | | - Carrie Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
| | - Donald A Person
- Pacific Island Health Care Project, Tripler Army Medical Center, Hawaii, USA
| | | | - Paolo Zanaboni
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Maria Zolfo
- Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium
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Lasierra N, Alesanco A, Gilaberte Y, Magallón R, García J. Lessons learned after a three-year store and forward teledermatology experience using internet: Strengths and limitations. Int J Med Inform 2012; 81:332-43. [DOI: 10.1016/j.ijmedinf.2012.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 02/16/2012] [Accepted: 02/20/2012] [Indexed: 11/24/2022]
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Wootton R, Geissbuhler A, Jethwani K, Kovarik C, Person DA, Vladzymyrskyy A, Zanaboni P, Zolfo M. Long-running telemedicine networks delivering humanitarian services: experience, performance and scientific output. Bull World Health Organ 2012; 90:341-347D. [PMID: 22589567 PMCID: PMC3341689 DOI: 10.2471/blt.11.099143] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To summarize the experience, performance and scientific output of long-running telemedicine networks delivering humanitarian services. METHODS Nine long-running networks--those operating for five years or more--were identified and seven provided detailed information about their activities, including performance and scientific output. Information was extracted from peer-reviewed papers describing the networks' study design, effectiveness, quality, economics, provision of access to care and sustainability. The strength of the evidence was scored as none, poor, average or good. FINDINGS The seven networks had been operating for a median of 11 years (range: 5-15). All networks provided clinical tele-consultations for humanitarian purposes using store-and-forward methods and five were also involved in some form of education. The smallest network had 15 experts and the largest had more than 500. The clinical caseload was 50 to 500 cases a year. A total of 59 papers had been published by the networks, and 44 were listed in Medline. Based on study design, the strength of the evidence was generally poor by conventional standards (e.g. 29 papers described non-controlled clinical series). Over half of the papers provided evidence of sustainability and improved access to care. Uncertain funding was a common risk factor. CONCLUSION Improved collaboration between networks could help attenuate the lack of resources reported by some networks and improve sustainability. Although the evidence base is weak, the networks appear to offer sustainable and clinically useful services. These findings may interest decision-makers in developing countries considering starting, supporting or joining similar telemedicine networks.
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Affiliation(s)
- Richard Wootton
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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Hay R, Estrada R, Grossmann H. Managing skin disease in resource-poor environments - the role of community-oriented training and control programs. Int J Dermatol 2011; 50:558-63. [PMID: 21506972 DOI: 10.1111/j.1365-4632.2011.04954.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Programs that have been devised to improve the lot of patients with skin disease, or disease presenting with skin signs and symptoms, in resource-poor regions have focused mainly on education and training or community-oriented control measures. However, both have in common an objective of managing disease at population level. Training has been delivered in different ways both by direct teaching for varying periods of time or by web-based and electronic communication; control measures have been less in evidence and there is a great need for more support from funding agencies. Despite this, there is now a growing number of successful initiatives in health improvement for skin conditions that cover many parts of the world. This report describes many of these schemes as an example of what can be done to help patients.
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Affiliation(s)
- Roderick Hay
- International Foundation of Dermatology, London, UK.
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Mougiakakou SG, Kyriacou E, Perakis K, Papadopoulos H, Androulidakis A, Konnis G, Tranfaglia R, Pecchia L, Bracale U, Pattichis C, Koutsouris D. A feasibility study for the provision of electronic healthcare tools and services in areas of Greece, Cyprus and Italy. Biomed Eng Online 2011; 10:49. [PMID: 21649924 PMCID: PMC3127994 DOI: 10.1186/1475-925x-10-49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 06/07/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of the southeast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. METHODS The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i) Telecollaboration and teleconsultation services between remotely located healthcare providers, ii) telemedicine services in emergencies, iii) home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv) eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc) and persons supporting "at risk" citizens.These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G), and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. RESULTS The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances, homes of "at-risk" citizens, and a ferry. CONCLUSIONS The results proved the functionality and utilization of the platform in various rural places in Greece, Cyprus and Italy. However, further actions are needed to enable the local healthcare systems and the different population groups to be familiarized with, and use in their everyday lives, mature technological solutions for the provision of healthcare services.
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Affiliation(s)
- Stavroula G Mougiakakou
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital - Inselspital - University of Bern, Bern, Switzerland
| | - Efthyvoulos Kyriacou
- Department of Computer Science, University of Cyprus, Cyprus
- Department of Computer Science and Engineering, Frederick University, Lemesos, Cyprus
| | - Kostas Perakis
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
| | | | - Aggelos Androulidakis
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
| | - Georgios Konnis
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
| | - Riccardo Tranfaglia
- Department of Biomedical, Electronic and Telecommunication Engineering, University of Naples Federico II, Naples, Italy
| | - Leandro Pecchia
- Department of Biomedical, Electronic and Telecommunication Engineering, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Department of General, Vascular and Thoracic Surgery, University of Naples Federico II, Naples, Italy
| | | | - Dimitrios Koutsouris
- Institute of Communication and Computer Systems, National Technical University of Athens, Athens, Greece
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18
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Tsang MW, Kovarik CL. The role of dermatopathology in conjunction with teledermatology in resource-limited settings: lessons from the African Teledermatology Project. Int J Dermatol 2011; 50:150-6. [PMID: 21244377 DOI: 10.1111/j.1365-4632.2010.04790.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Access to dermatology and dermatopathology services is scarce in sub-Saharan Africa. Teledermatology provides consultations for healthcare providers in resource-limited settings where specialty medical services are difficult to obtain, and the African Teledermatology Project has helped to bridge the gap in dermatological care in Africa. This program also allows for biopsy specimens to be sent to the USA for processing in cases where the clinical diagnosis is difficult and definitive diagnosis has implications for patient management. This study characterizes conditions diagnosed through clinicopathological correlation in conjunction with photos and tissue submitted to the African Teledermatology Project. MATERIALS AND METHODS Retrospective case review of tissue specimens submitted over three years. RESULTS Fifty-five biopsy specimens met inclusion criteria and represent cases of malignancy (35%), infection (7%), suspected infection (15%), lichenoid tissue reaction (5%), dermatitis (15%), and other various conditions (18%). Three biopsy specimens were non-diagnostic (5%). Clinicopathological concordance between submitting clinician and biopsy results occurred in 32 out of 55 cases (58%). Clinical and pathological diagnoses differed in 21 out of 55 cases (38%). Kaposi sarcoma (KS) represents the clinical diagnosis most often suspected in the evaluated biopsy specimens (42%) and was correctly recognized clinically in 13 out of 23 cases (57%). CONCLUSION Clinical images may not provide sufficient information to definitively diagnose certain infectious and malignant dermatological conditions submitted through telemedicine consultation. Microscopic examination of skin biopsy specimens is an important adjunct for accurate diagnosis of disease and determination of appropriate treatment strategies.
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Affiliation(s)
- Matthew W Tsang
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
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Tran K, Ayad M, Weinberg J, Cherng A, Chowdhury M, Monir S, El Hariri M, Kovarik C. Mobile teledermatology in the developing world: implications of a feasibility study on 30 Egyptian patients with common skin diseases. J Am Acad Dermatol 2010; 64:302-9. [PMID: 21094560 DOI: 10.1016/j.jaad.2010.01.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 01/01/2010] [Accepted: 01/05/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND The expansion of store-and-forward teledermatology into underserved regions of the world has long been hampered by the requirement for computers with Internet connectivity. To our knowledge, this study is one of the first to demonstrate the feasibility of teledermatology using newer-generation mobile telephones with specialized software and wireless connectivity to overcome this requirement in a developing country. OBJECTIVE We sought to demonstrate that mobile telephones may be used on the African continent to submit both patient history and clinical photographs wirelessly to remote expert dermatologists, and to assess whether these data are diagnostically reliable. METHODS Thirty patients with common skin diseases in Cairo, Egypt, were given a diagnosis by face-to-face consultation. They were then given a diagnosis independently by local senior dermatologists using teleconsultation with a software-enabled mobile telephone containing a 5-megapixel camera. Diagnostic concordance rates between face-to-face and teleconsultation were tabulated. RESULTS Diagnostic agreement between face-to-face consultation and the two local senior dermatologists performing independent evaluation by teleconsultation was achieved in 23 of 30 (77%) and in 22 of 30 (73%) cases, respectively, with a global mean of 75%. LIMITATIONS Limited sample size and interobserver variability are limitations. CONCLUSION Mobile teledermatology is a technically feasible and diagnostically reliable method of amplifying access to dermatologic expertise in poorer regions of the globe where access to computers with Internet connectivity is unreliable or insufficient.
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Affiliation(s)
- Kathleen Tran
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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