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Kothari K, Damoi JO, Zeizafoun N, Asiimwe P, Glerum K, Bakaleke M, Giibwa A, Umphlett M, Marin M, Zhang LP. Increasing access to pathology services in low- and middle-income countries through innovative use of telepathology. Surg Endosc 2023; 37:7206-7211. [PMID: 37365395 DOI: 10.1007/s00464-023-10220-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION In low- and middle-income countries (LMICs), surgical care can be limited by access to pathology services. In Uganda, the pathologist-to-population ratio is less than 1 to 1 million people. The Kyabirwa Surgical Center in Jinja, Uganda, created a telepathology service in collaboration with an academic institution in New York City. This study demonstrated the feasibility and considerations of implementing a telepathology model to supplement the critical pathology needs of a low-income country. METHODS This was a retrospective, single-center study of an ambulatory surgery center with pathology capability using virtual microscopy. The remote pathologist (also known as a telepathologist) controlled the microscope and reviewed histology images transmitted across the network in real time. In addition, this study collected demographics, clinical histories, the surgeon's preliminary diagnoses, and the pathology reports from the center's electronic medical record. RESULTS Nikon's NIS Element Software was used as a dynamic, robotic microscopy model with a video conferencing platform for communication. An underground fiber optic cable established Internet connectivity. After a two-hour tutorial session, the lab technician and pathologist were able to proficiently use the software. The remote pathologist read (1) pathology slides with inconclusive reports from external pathology labs, and (2) tissues labeled by the surgeon as suspicious for malignancy, which belonged to patients who lacked financial means for pathology services. Between April 2021 and July 2022, tissue samples of 110 patients were examined by a telepathologist. The most common malignancies on histology were squamous cell carcinoma of the esophagus, ductal carcinoma of the breast, and colorectal adenocarcinoma. CONCLUSION With the increasing availability of video conference platforms and network connections, telepathology is an emerging field that can be used by surgeons in LMICs to improve access to pathology services, confirming histological diagnosis of malignancies to ensure appropriate treatment.
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Affiliation(s)
- Krsna Kothari
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA.
| | | | - Nebras Zeizafoun
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | | | - Katie Glerum
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | | | | | - Melissa Umphlett
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Michael Marin
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Linda P Zhang
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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Razzano D, Puranam K, Tomoka T, Fedoriw Y. The role of telepathology in improving cancer diagnostic and research capacity in sub-Saharan Africa. Front Med (Lausanne) 2022; 9:978245. [PMID: 36325383 PMCID: PMC9618672 DOI: 10.3389/fmed.2022.978245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Non-communicable disease (NCD), including cancer, disproportionately affect Low- and Middle-Income Countries (LMICs). This inequity is in part due to limitations of pathology services, both human and infrastructural. While significant improvements have been made to address these gaps, creative approaches that are mindful of regional priorities, cultural differences, and unique local challenges are needed. In this perspective, we will describe the implementation of telepathology services in sub-Saharan Africa (SSA) that serve as cornerstones for direct patient care, multi-disciplinary care coordination, research programs, and building human capacity through training. Models and challenges of system implementation, sustainability, and pathologist engagement will be discussed. Using disease and site-specific examples, we will suggest metrics for quality control and improvement initiatives that are critical for providing high-quality cancer registry data and necessary for future implementation of therapeutic and interventional clinical trials.
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Affiliation(s)
- Dana Razzano
- Department of Pathology, Stanford University, Stanford, CA, United States
| | - Kaushik Puranam
- School of Medicine, Georgetown University, Washington, DC, United States
| | - Tamiwe Tomoka
- Department of Pathology, UNC Project Malawi Cancer Program, Lilongwe, Malawi
| | - Yuri Fedoriw
- Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Yuri Fedoriw
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Kabukye JK, Kakungulu E, Keizer ND, Cornet R. Digital health in oncology in Africa: A scoping review and cross-sectional survey. Int J Med Inform 2021; 158:104659. [PMID: 34929545 DOI: 10.1016/j.ijmedinf.2021.104659] [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: 06/30/2021] [Revised: 11/09/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Low- and middle-income countries, especially in Africa, face a growing cancer burden. Adoption of digital health solutions has the potential to improve cancer care delivery and research in these countries. However, the extent of implementation and the impact of digital health interventions across the cancer continuum in Africa have not been studied. AIMS To describe the current landscape of digital health interventions in oncology in Africa. METHODS We conducted a scoping literature review and supplemented this with a survey. Following the PRISMA for Scoping Reviews guidelines, we searched literature in PubMed and Embase for keywords and synonyms for cancer, digital health, and African countries, and abstracted data using a structured form. For the survey, participants were delegates of the 2019 conference of the African Organization for Research and Training in Cancer. RESULTS The literature review identified 57 articles describing 40 digital health interventions or solutions from 17 African countries, while the survey included 111 respondents from 18 African countries, and these reported 25 different digital health systems. Six articles (10.5%) reported randomized controlled trials. The other 51 articles (89.5%) were descriptive or quasi-experimental studies. The interventions mostly targeted cancer prevention (28 articles, 49.1%) or diagnosis and treatment (23 articles, 40.4%). Four articles (7.0%) targeted survivorship and end of life, and the rest were cross-cutting. Cervical cancer was the most targeted cancer (25 articles, 43.9%). Regarding WHO classification of digital interventions, most were for providers (35 articles, 61.4%) or clients (13, 22.8%), while the others were for data services or cut across these categories. The interventions were mostly isolated pilots using basic technologies such as SMS and telephone calls for notifying patients of their appointments or results, or for cancer awareness; image capture apps for cervical cancer screening, and tele-conferencing for tele-pathology and mentorship. Generally positive results were reported, but evaluation focused on structure and process measures such as ease of use, infrastructure requirements, and acceptability of intervention; or general benefits e.g. supporting training and mentorship of providers, communication among providers and clients, and improving data collection and management. No studies evaluated individualized clinical outcomes, and there were no interventions in literature for health system managers although the systems identified in the survey had such functionality, e.g. inventory management. The survey also indicated that none of the digital health systems had all the functionalities for a comprehensive EHR, and major barriers for digital health were initial and ongoing costs, resistance from clinical staff, and lack of fit between the EHR and the clinical workflows. CONCLUSION Digital health interventions in oncology in Africa are at early maturity stages but promising. Barriers such as funding, fit between digital health tools and clinical workflows, and inertia towards technology, shall need to be addressed to allow for advancement of digital health solutions to support all parts of the cancer continuum. Future research should investigate the impact of digital health solutions on long-term cancer outcomes such as cancer mortality, morbidity and quality of life.
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Affiliation(s)
- Johnblack K Kabukye
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands; Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda.
| | - Edward Kakungulu
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
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He X, Wang L, Wang L, Gao J, Cui F, Ma Q, Zhang W, Wang L, Zhai Y, Zhao J. Effectiveness of a Cloud-Based Telepathology System in China: Large-Sample Observational Study. J Med Internet Res 2021; 23:e23799. [PMID: 34326037 PMCID: PMC8367172 DOI: 10.2196/23799] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/18/2020] [Accepted: 05/24/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Whole-slide imaging allows the entire slide to be viewed in a manner that simulates microscopy; therefore, it is widely used in telepathology. However, managing the large digital files needed for whole-slide imaging is difficult. To solve this problem, we set up the Chinese National Cloud-Based Telepathology System (CNCTPS). CNCTPS has been running for more than 4 years and has accumulated a large amount of data. OBJECTIVE The main purpose of this study was to comprehensively evaluate the effectiveness of the CNCTPS based on a large sample. The evaluation indicators included service volume, turnaround time, diagnosis accuracy, and economic benefits. METHODS Details of 23,167 cases submitted to the CNCTPS from January 2016 to December 2019 were collected to analyze the service volume, turnaround time, and economic benefits. A total of 564 patients who visited the First Affiliated Hospital of Zhengzhou University and obtained final diagnoses were followed up to analyze the diagnostic accuracy of the CNCTPS. RESULTS From 2016 to 2019, the service volume of the CNCTPS increased from 2335 to 9240, and the number of participating hospitals increased from 60 to 74. Consultation requests from county-level hospitals accounted for 86.57% (20,287/23,167). A total of 17,495 of 23,167 cases (75.52%) were confirmed, including 12,088 benign lesions, 5217 malignant lesions, and 190 borderline lesions. Of the cases, 3.85% (893/23,167) failed to be diagnosed for reasons such as poor slice quality and incomplete sampling. The median turnaround time was 16.93 hours and was shortened yearly (between 2018 and 2019: adjusted P=.01; other groups: adjusted P<.001); 82.88% cases were diagnosed in 48 hours. There was a discrepancy between the diagnosis and final diagnosis for 11 cases, including 4 false-positive cases and 7 false-negative cases. The sensitivity and specificity were 97.66% and 98.49%, respectively. The diagnostic accuracy of the system was 98.05%, with no statistical difference from the final diagnosis in the hospital (P=.55). By using this system, a total of US $300,000 was saved for patients every year. CONCLUSIONS The novel cloud-based telepathology system has the potential to relieve the shortage of pathologists in primary hospitals. It can also simultaneously reduce medical costs for patients in China. It should, therefore, be further promoted to enhance the efficiency, quantity, and quality of telepathology diagnoses.
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Affiliation(s)
- Xianying He
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linlin Wang
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Wang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinghong Gao
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China
| | - Fangfang Cui
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qianqian Ma
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjie Zhang
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China
| | - Lin Wang
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yunkai Zhai
- School of Management Engineering, Zhengzhou University, Zhengzhou, China
| | - Jie Zhao
- National Telemedicine Center of China, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, China
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Zerd F, Moore BE, Malango AE, Hosokawa PW, Lillehei KO, Mchome LL, Ormond DR. Photomicrograph-Based Neuropathology Consultation in Tanzania. Am J Clin Pathol 2020; 154:656-670. [PMID: 32715312 DOI: 10.1093/ajcp/aqaa084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Since neuropathologic diagnosis in the developing world is hampered by limitations in technical infrastructure, trained laboratory personnel, and subspecialty-trained pathologists, the use of telepathology for diagnostic support, second-opinion consultations, and ongoing training holds promise as a means of addressing these challenges. This study aims to assess the utility of static teleneuropathology in improving neuropathologic diagnoses in low- and middle-income countries. METHODS Consecutive neurosurgical biopsy and resection specimens obtained at Muhimbili National Hospital in Tanzania between July 1, 2018, and June 30, 2019, were selected for retrospective, blinded static-image neuropathologic review followed by on-site review by an expert neuropathologist. RESULTS A total of 75 neuropathologic cases were reviewed. The agreement of static images and on-site glass diagnosis was 71% with strict criteria and 88% with less stringent criteria. This represents an overall improvement in diagnostic accuracy from 36% by general pathologists to 71% by a neuropathologist using static telepathology (or from 76% to 88% with less stringent criteria). CONCLUSIONS Telepathology offers a promising means of providing diagnostic support, second-opinion consultations, and ongoing training to pathologists practicing in resource-limited countries. Moreover, static digital teleneuropathology is an uncomplicated, cost-effective, and reliable way to achieve these goals.
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Affiliation(s)
- Francis Zerd
- Department of Pathology, Muhimbili National Hospital, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Brian E Moore
- Division of Neuropathology, Department of Pathology, Aurora
| | - Atuganile E Malango
- Department of Pathology, Muhimbili National Hospital, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Patrick W Hosokawa
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora
| | - Kevin O Lillehei
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora
| | | | - D Ryan Ormond
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora
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“Teledermatopathology: A Review”. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Saleh M, Naik G, Mwirigi A, Shaikh AJ, Sayani S, Ghesani M, Asaria S, Sohani AR, Sayed S, Moloo Z, Budhwani KI, Talib Z. Bridging the Gap in Training and Clinical Practice in Sub-Saharan Africa. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Voelker HU, Stauch G, Strehl A, Azima Y, Mueller-Hermelink HK. Diagnostic validity of static telepathology supporting hospitals without local pathologists in low-income countries. J Telemed Telecare 2018; 26:261-270. [PMID: 30595076 DOI: 10.1177/1357633x18818745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Static telepathology (TP) was used to support a hospital in Tanzania that cannot employ a resident pathologist but has a basic laboratory. Histological slides were prepared by the local technical staff and digital images were uploaded into an Internet-based system; consultant pathologists in Germany could give their opinion. The aim of the study was to examine the diagnostic validity of this project without local pathologists. METHODS The set-up period for special training of local technical assistants was 10 weeks. Diagnoses of the first 545 cases that were processed via TP were compared with the results of a second opinion on the basis of routine slides created from the corresponding paraffin blocks, which were sent to Germany. RESULTS Of all cases, 384 (70%) TP diagnoses were completely confirmed by the second opinion. Minor deviations (e.g. divergent subtypes of tumours or other aetiology of non-specific reactive processes) were documented in 76 cases (14%), so that overall, 84% of diagnoses were useful in the setting of the available therapeutic possibilities. The results were better in some subgroups of diseases (90-100% useful diagnoses) and suboptimal (minimum 63%) in a few subgroups with rare diseases. Thirty (5%) malignant diseases were primarily misinterpreted as being benign and 12 (2%) benign diseases as malignant. Forty-three (8%) cases were insufficient for diagnosis using TP and could not be provided with a primary assessment. DISCUSSION Static TP can help support medical services in low-income countries in the absence of local pathologists with a potentially high diagnostic validity, especially for selected groups of diseases. The procedure can significantly improve the diagnostic procedures before commencement of therapy - a substantial contribution within a globalised world.
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Affiliation(s)
- Hans-Ullrich Voelker
- Institute for Pathology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Gerhard Stauch
- Retired Pathologist, Consultant in Telepathology, Aurich, Germany
| | - Annette Strehl
- Institute for Pathology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Yasmin Azima
- Institute for Pathology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
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Montgomery ND, Tomoka T, Krysiak R, Powers E, Mulenga M, Kampani C, Chimzimu F, Owino MK, Dhungel BM, Gopal S, Fedoriw Y. Practical Successes in Telepathology Experiences in Africa. Clin Lab Med 2018; 38:141-150. [PMID: 29412878 PMCID: PMC5996143 DOI: 10.1016/j.cll.2017.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Across much of Africa, there is a critical shortage of pathology services necessary for clinical care. Even in settings where specialty-level clinical care, such as medical oncology, is available, access to anatomic pathology services has often lagged behind. Pathology laboratories in the region are challenging to establish and maintain. This article describes the successful implementation of telepathology services in Malawi and reviews other successful programs developed to support diagnostic pathology in resource-limited settings.
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Affiliation(s)
- Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA
| | - Tamiwe Tomoka
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Robert Krysiak
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Eric Powers
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA
| | - Maurice Mulenga
- Kamuzu Central Hospital, Tidziwe Centre, PO Box 149, Lilongwe, Malawi
| | - Coxcilly Kampani
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Fred Chimzimu
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Michael K Owino
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | | | - Satish Gopal
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi; Lineberger Comprehensive Cancer Center, CB 7295, Chapel Hill, NC 27599-7295, USA
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA; Lineberger Comprehensive Cancer Center, CB 7295, Chapel Hill, NC 27599-7295, USA.
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Royall J, Isyagi MM, Iliyasu Y, Lukande R, Vuhahula E. From Access to Collaboration: Four African Pathologists Profile Their Use of the Internet and Social Media. Clin Lab Med 2018; 38:53-66. [PMID: 29412885 DOI: 10.1016/j.cll.2017.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The shared practice of pathology via the Internet holds great potential for pathologists in sub-Saharan Africa (SSA) and their global partners. Application of the Internet is constrained by issues of bandwidth, cost, and power. The penetration of mobile telephony and the arrival of smartphones have changed the use of Internet and social media in Africa and therefore the work of the 4 African pathologists featured in this article. As pathology in SSA struggles for visibility and usefulness, the Internet and its electronic applications provide a critical infrastructure as well as a podium for pathologists across the continent.
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Affiliation(s)
- Julia Royall
- Office of International Programs, US National Library of Medicine, National Institutes of Health, 6361 Highway 26, Dubois, WY 82513, USA.
| | | | - Yawale Iliyasu
- Department of Pathology, Faculty of Medicine, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Robert Lukande
- Department of Pathology, College of Health Sciences, Makerere University, Mulago Hill Road, Room B24 Pathology Building, Kampala, Uganda
| | - Edda Vuhahula
- Department of Pathology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Utility of international store-and-forward teledermatopathology among a cohort of mostly female patients at a tertiary referral center in Afghanistan. Int J Womens Dermatol 2017; 4:83-86. [PMID: 29872681 PMCID: PMC5986254 DOI: 10.1016/j.ijwd.2017.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 11/24/2022] Open
Abstract
Background The variety and complexity of dermatologic diseases in Afghanistan and the associated diagnostic resource constraints have not been previously studied. Moreover, the utility of store-and-forward teledermatopathology in this resource-limited setting has not been investigated. Methods A retrospective analysis was conducted of 150 store-and-forward teledermatopathology cases that were composed of a clinical history, clinical images, and histologic images that were sent from an academic teaching hospital in Kabul to a dermatology-trained dermatopathologist at Emory University in the United States between November 2013 and June 2017. For each case, the histologic impression of the Emory dermatopathologist was compared with that of the Kabul-based general pathologist and the clinical differential diagnosis and histologic impression of the Kabul-based dermatologist. Results Eighty-one of the cases that were analyzed were from female patients. The diagnosis after telepathology consultation differed from the first entity in the clinical differential diagnosis in 34.7% of cases. The telepathology consultation refined the Afghan general pathologist’s histologic impression 45.5% of the time and the Kabul-based dermatologist’s histologic impression 24.3% of the time. A clinically significant difference in care was made in 19.3% of cases for which an analysis could take place between the histologic impressions of the Emory dermatopathologist and U.S.-trained dermatologist. The most common resource constraints that limited a definitive diagnosis were the inability to perform infectious stains and cultures to identify specific pathogens (19.3% of cases) and immunofluorescence studies to confirm autoimmune bullous disease (6.7% of cases). Conclusions These results highlight the important diagnostic role that teledermatopathology can serve in resource-limited settings such as in Afghanistan.
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Adeloye D, Adigun T, Misra S, Omoregbe N. Assessing the Coverage of E-Health Services in Sub-Saharan Africa. A Systematic Review and Analysis. Methods Inf Med 2017; 56:189-199. [PMID: 28244548 DOI: 10.3414/me16-05-0012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/07/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND E-Health has attracted growing interests globally. The relative lack of facilities, skills, funds and information on existing e-Health initiatives has affected progress on e-Health in Africa. OBJECTIVES To review publicly available literature on e-Health in sub-Saharan Africa (sSA) towards providing information on existing and ongoing e-Health initiatives in the region. METHODS Searches of relevant literature were conducted on Medline, EMBASE and Global Health, with search dates set from 1990 to 2016. We included studies on e-Health initiatives (prototypes, designs, or completed projects) targeting population groups in sSA. RESULTS Our search returned 2322 hits, with 26 studies retained. Included studies were conducted in 14 countries across the four sub-regions in sSA (Central, East, South and West) and spreading over a 12-year period, 2002-2014. Six types of e-Health interventions were reported, with 17 studies (65 %) based on telemedicine, followed by mHealth with 5 studies (19 %). Other e-Health types include expert system, electronic medical records, e-mails, and online health module. Specific medical specialties covered include dermatology (19 %), pathology (12 %) and radiology (8 %). Successes were 'widely reported' (representing 50 % overall acceptance or positive feedbacks in a study) in 10 studies (38 %). The prominent challenges reported were technical problems, poor internet and connectivity, participants' selection biases, contextual issues, and lack of funds. CONCLUSION E-Health is evolving in sSA, but with poorly published evidence. While we call for more quality research in the region, it is also important that population-wide policies and on-going e-Health initiatives are contextually feasible, acceptable, and sustainable.
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Affiliation(s)
- Davies Adeloye
- Dr. Davies Adeloye, Demography and Social Statistics, and the e-Health Research Cluster, Covenant University, Ota, Nigeria, E-mail:
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Bashshur RL, Krupinski EA, Weinstein RS, Dunn MR, Bashshur N. The Empirical Foundations of Telepathology: Evidence of Feasibility and Intermediate Effects. Telemed J E Health 2017; 23:155-191. [PMID: 28170313 DOI: 10.1089/tmj.2016.0278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Telepathology evolved from video microscopy (i.e., "television microscopy") research in the early 1950s to video microscopy used in basic research in the biological sciences to a basic diagnostic tool in telemedicine clinical applications. Its genesis can be traced to pioneering feasibility studies regarding the importance of color and other image-based parameters for rendering diagnoses and a series of studies assessing concordance of virtual slide and light microscopy diagnoses. This article documents the empirical foundations of telepathology. METHODS A selective review of the research literature during the past decade (2005-2016) was conducted using robust research design and adequate sample size as criteria for inclusion. CONCLUSIONS The evidence regarding feasibility/acceptance of telepathology and related information technology applications has been well documented for several decades. The majority of evidentiary studies focused on intermediate outcomes, as indicated by comparability between telepathology and conventional light microscopy. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include use of telepathology and whole slide imaging for teaching, research, and outreach to resource-limited countries. Challenges still exist, however, in terms of use of telepathology as an effective diagnostic modality in clinical practice.
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Affiliation(s)
- Rashid L Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | | | | | - Matthew R Dunn
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | - Noura Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
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Shah KK, Lehman JS, Gibson LE, Lohse CM, Comfere NI, Wieland CN. Validation of diagnostic accuracy with whole-slide imaging compared with glass slide review in dermatopathology. J Am Acad Dermatol 2016; 75:1229-1237. [PMID: 27742174 DOI: 10.1016/j.jaad.2016.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/03/2016] [Accepted: 08/11/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Teledermatopathology has evolved from static images to whole slide imaging (WSI), which allows for remote viewing and manipulation of tissue sections. Previous studies of WSI in teledermatopathology predated College of American Pathologists (CAP) telepathology validation guidelines. OBJECTIVE We conducted a comprehensive retrospective WSI validation study of routine dermatopathology cases, adhering to CAP guidelines. METHOD In all, 181 consecutive cases arranged into 3 categories (inflammatory, melanocytic, nonmelanocytic proliferations) were reviewed by 3 board-certified dermatopathologists via traditional microscopy (TM) and WSI. Intraobserver (TM vs WSI), TM intraobserver and interobserver (TM vs TM), and WSI interobserver (WSI vs WSI) concordance was interpreted using a 3-tier system. RESULTS TM versus WSI intraobserver concordance (86.9%; 95% confidence interval [CI] 83.7-89.6) did not differ from TM versus TM intraobserver concordance (90.3%; 95% CI 86.7-93.1) or interobserver concordance (WSI: 89.9%; 95% CI 87.0-92.2, and TM: 89.5%; 95% CI 86.5-91.9). Melanocytic proliferations had the lowest TM versus WSI intraobserver concordance (75.6%; 95% CI 68.5-81.5), whereas inflammatory lesions had the highest TM versus WSI intraobserver concordance (96.1%; 95% CI 91.8-98.3). Nonmelanocytic proliferations had an intraobserver concordance of 89.1% (95% CI 83.4-93.0). LIMITATIONS Efficiency and other logistical WSI parameters were not evaluated. CONCLUSION Intraobserver and interobserver diagnostic concordance between WSI and TM was equivalent. Therefore, WSI appears to be a reliable diagnostic modality for dermatopathology.
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Affiliation(s)
- Kabeer K Shah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Lawrence E Gibson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Nneka I Comfere
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Carilyn N Wieland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Dermatopathology and Cutaneous Immunopathology, Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
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Mpunga T, Hedt-Gauthier BL, Tapela N, Nshimiyimana I, Muvugabigwi G, Pritchett N, Greenberg L, Benewe O, Shulman DS, Pepoon JR, Shulman LN, Milner DA. Implementation and Validation of Telepathology Triage at Cancer Referral Center in Rural Rwanda. J Glob Oncol 2016; 2:76-82. [PMID: 28717686 PMCID: PMC5495446 DOI: 10.1200/jgo.2015.002162] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Connecting a cancer patient to the appropriate treatment requires the correct diagnosis provided in a timely manner. In resource-limited settings, the anatomic pathology bridge to efficient, accurate, and timely cancer care is often challenging. In this study, we present the first phase of an anatomic telepathology triage system, which was implemented and validated at the Butaro District Hospital in northern rural Rwanda. Methods Select cases over a 9-month period in three segments were evaluated by static image telepathology and were independently evaluated by standard glass slide histology. Each case via telepathology was classified as malignant, benign, infectious/inflammatory, or nondiagnostic and was given an exact histologic diagnosis. Results For cases triaged as appropriate for telepathology, correlation with classification and exact diagnosis demonstrated greater than 95% agreement over the study. Cases in which there was disagreement were analyzed for cause, and the triage process was adjusted to avoid future problems. Conclusion Challenges to obtaining a correct and complete diagnosis with telepathology alone included the need for immunohistochemistry, assessment of the quality of images, and the lack of images representing an entire sample. The next phase of the system will assess the effect of telepathology triage on turnaround time and the value of on-site immunohistochemistry in reducing that metric and the need for evaluation outside of telepathology.
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Affiliation(s)
- Tharcisse Mpunga
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Bethany L Hedt-Gauthier
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Neo Tapela
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Irenee Nshimiyimana
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Gaspard Muvugabigwi
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Natalie Pritchett
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lauren Greenberg
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Origene Benewe
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - David S Shulman
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - James R Pepoon
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lawrence N Shulman
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Danny A Milner
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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16
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Kiprono S, Muchunu J, Beltraminelli H. The use of special stains at two dermatopathology laboratories in East Africa. J Cutan Pathol 2015; 43:242-5. [PMID: 26460160 DOI: 10.1111/cup.12641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Histopathology is often essential to establish an accurate diagnosis. Pathology laboratories are scarce in most Sub-Saharan Africa where dermatopathology is a developing field. In resource-poor countries, most specimens are analyzed only after hematoxylin and eosin staining. The availability of special stains is very limited and restricted to only few centers. The aim of this study is to analyze the extent of dermatopathological cases which can be adequately diagnosed after hematoxylin and eosin alone. Secondly, to investigate which cases required further special stains. METHODS All skin specimens submitted to two University Hospitals (Tanzania and Kenya) were included in this study. All specimens were first analyzed with hematoxylin and eosin and a diagnosis established when possible. All cases in which an accurate diagnosis after hematoxylin and eosin only was not possible, were registered and evaluated after further special stains. RESULTS A total of 386 specimens were examined. A proper histopathologic diagnosis with hematoxylin and eosin alone was possible in 344 (89.1%) samples. In 45 (11.6%) cases, mostly skin infections, further special stains were necessary. CONCLUSION A proper histopathologic diagnosis was possible after hematoxylin and eosin alone in almost 90% of the specimens submitted to the two laboratories in Sub-Saharan Africa.
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Affiliation(s)
- S Kiprono
- Department of Medicine, College of Health Science, Moi University, Eldoret, Kenya
| | - J Muchunu
- Regional Dermatology Training Center (RDTC), Kilimanjaro Christian Medical University College (KCM-CU), Moshi, Tanzania
| | - H Beltraminelli
- Department of Dermatology, Inselspital Bern University Hospital, Bern, Switzerland
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17
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[Importance of dermatopathology in the diagnosis of tropical and travel-associated skin diseases]. Hautarzt 2015; 65:895-9. [PMID: 25209758 DOI: 10.1007/s00105-014-3500-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Skin diseases are frequent in tropical countries and cause a significant burden for their health systems. Tropical dermatoses are frequently of infectious nature. DIAGNOSTICS Dermatopathology plays an important role in the diagnosis of many tropical skin diseases. This refers specially to leishmaniasis, tropical helminthic diseases, tuberculosis, leprosy, and deep fungal infections. In addition, dermatopathology is important for the differential diagnosis of non-infectious inflammatory diseases in pigmented skin; their identification may be more challenging than when seen in Caucasian skin. CONCLUSION While it is usually not problematic to perform a dermatopathologic workup in travelers and expatriates returning from the tropics into Western industrialized countries, dermatopathologic services are frequently non-existent or severely limited in many tropical countries. Therefore, in improving health systems, not only should a dermatologic workforce be developed, but also training of dermatopathologists and the establishment of dermatopathology laboratories should be considered.
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18
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Adambounou K, Adjenou V, Salam AP, Farin F, N'Dakena KG, Gbeassor M, Arbeille P. A low-cost tele-imaging platform for developing countries. Front Public Health 2014; 2:135. [PMID: 25250306 PMCID: PMC4155785 DOI: 10.3389/fpubh.2014.00135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/20/2014] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To design a "low-cost" tele-imaging method allowing real-time tele-ultrasound expertise, delayed tele-ultrasound diagnosis, and tele-radiology between remote peripherals hospitals and clinics (patient centers) and university hospital centers (expert center). MATERIALS AND METHODS A system of communication via internet (IP camera and remote access software) enabling transfer of ultrasound videos and images between two centers allows a real-time tele-radiology expertise in the presence of a junior sonographer or radiologist at the patient center. In the absence of a sonographer or radiologist at the patient center, a 3D reconstruction program allows a delayed tele-ultrasound diagnosis with images acquired by a lay operator (e.g., midwife, nurse, technician). The system was tested both with high and low bandwidth. The system can further accommodate non-ultrasound tele-radiology (conventional radiography, mammography, and computer tomography for example). The system was tested on 50 patients between CHR Tsevie in Togo (40 km from Lomé-Togo and 4500 km from Tours-France) and CHU Campus at Lomé and CHU Trousseau in Tours. RESULTS A real-time tele-expertise was successfully performed with a delay of approximately 1.5 s with an internet bandwidth of around 1 Mbps (IP Camera) and 512 kbps (remote access software). A delayed tele-ultrasound diagnosis was also performed with satisfactory results. The transmission of radiological images from the patient center to the expert center was of adequate quality. Delayed tele-ultrasound and tele-radiology was possible even in the presence of a low-bandwidth internet connection. CONCLUSION This tele-imaging method, requiring nothing by readily available and inexpensive technology and equipment, offers a major opportunity for telemedicine in developing countries.
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Affiliation(s)
- Kokou Adambounou
- Unité de Télémédecine du Centre Hospitalier Universitaire Campus, Université de Lomé , Lomé , Togo ; Unité de Médecine et Physiologie Spatiales (UMPS-CERCOM), Centre Hospitalier Universitaire Trousseau de Tours , Tours , France
| | - Victor Adjenou
- Unité de Télémédecine du Centre Hospitalier Universitaire Campus, Université de Lomé , Lomé , Togo
| | | | - Fabien Farin
- Unité de Médecine et Physiologie Spatiales (UMPS-CERCOM), Centre Hospitalier Universitaire Trousseau de Tours , Tours , France
| | - Koffi Gilbert N'Dakena
- Unité de Télémédecine du Centre Hospitalier Universitaire Campus, Université de Lomé , Lomé , Togo
| | - Messanvi Gbeassor
- Unité de Télémédecine du Centre Hospitalier Universitaire Campus, Université de Lomé , Lomé , Togo
| | - Philippe Arbeille
- Unité de Médecine et Physiologie Spatiales (UMPS-CERCOM), Centre Hospitalier Universitaire Trousseau de Tours , Tours , France
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19
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Wootton R, Wu WI, Bonnardot L. Nucleating the development of telemedicine to support healthcare workers in resource-limited settings: a new approach. J Telemed Telecare 2014; 19:411-7. [PMID: 24218356 DOI: 10.1177/1357633x13506511] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Collegium Telemedicus (CT) offers a new approach to the problem of starting a store-and-forward telemedicine network for use in low resource settings. The CT organization provides a no-cost template to allow groups to start a network without delay, together with a peer-support environment for those operating the networks. A new group needs only to supply a Guarantor (who accepts responsibility for the work of the network) and a Coordinator (who operates the telemedicine network, allocating cases and ensuring that they are responded to). Communication takes place via secure messaging, which has several advantages over plain email, e.g. all the data are stored centrally, which means that they can be read from a hand-held device such as a smart phone, but do not need to be stored on that device. Users can access the system with a standard web browser. In the first three months, seven networks were established on the CT system by university groups in the US, the UK, Australia and New Zealand, and by a large, multinational humanitarian organisation. In the most active network, there were 86 telemedicine cases in the first three months, i.e. an average submission rate of 7 cases/week. The CT system appears to fulfil its aim of assisting doctors who wish to help colleagues in other countries by improving their access to specialist opinions, while allowing them to maintain control over the new network's use and development. The long term aim of the CT organization is to provide a means of improving the quality of health care at the point of delivery in low resource settings.
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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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20
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Micheletti RG, Steele KT, Kovarik CL. Robotic teledermatopathology from an African dermatology clinic. J Am Acad Dermatol 2014; 70:952-4. [PMID: 24742843 DOI: 10.1016/j.jaad.2014.01.861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/01/2014] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Robert G Micheletti
- Departments of Dermatology and Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
| | - Katherine T Steele
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carrie L Kovarik
- Departments of Dermatology and Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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21
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Obstacles hindering the mainstream practice of teledermatopathology. J Am Acad Dermatol 2014; 71:772-80. [PMID: 24906611 DOI: 10.1016/j.jaad.2014.04.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 04/11/2014] [Accepted: 04/16/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Teledermatopathology has the potential to link underserved areas to experts across the country and assist in making quick diagnoses, which may improve health care costs and delivery. Despite these potential benefits, teledermatopathology is not used routinely for primary diagnosis in the United States. OBJECTIVE To assess the current status of and address the potential for improving health care by the use of teledermatolopathology for primary diagnosis. METHODS Current available literature and online resources were reviewed to address 3 major variables that hinder the widespread use of teledermatopathology: diagnostic accuracy, licensure requirements, and reimbursement. RESULTS Recent studies show similar diagnostic accuracy for this technology compared to conventional microscopy. State-to-state variation and ambiguity in laws serve as the biggest hurdles to the widespread use of teledermatopathology. More states are recognizing the importance of the implementation of specific laws regarding telemedicine. More studies are required to evaluate the systems that offer specific telemedicine licenses, in addition to those that pay for telemedicine services specifically. LIMITATIONS This study reviewed current legislation concerning teledermatopathology; these laws are subject to revision. CONCLUSION Improving diagnostic accuracy and limiting variations in policy and reimbursement may encourage more pathologists to use teledermatopathology technology.
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22
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Carey P, Fudzulani R, Scholfield D, Chagaluka G, Tomoka T, Liombe G, Banda K, Wadehra V, Samarasinghe S, Molyneux EM, Bailey S. Remote and rapid pathological diagnosis in a resource challenged unit. J Clin Pathol 2014; 67:540-3. [PMID: 24561316 DOI: 10.1136/jclinpath-2013-202099] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Malawi is one of the world's poorest countries, but despite this, has a dedicated paediatric oncology service. The service has been hampered by the inability to make a timely cytological diagnosis in the majority of patients. A telemedicine programme was commenced to help overcome this problem, and the results for the first 197 consecutive patients are described. The results are compared with the local reports where available. Most samples were fine needle aspirates (104/197-53%), but others included bone marrow aspirates, peripheral blood films and other fluid collections. A diagnosis was arrived at in 52% of the samples; there were 46 discordant results, 38 were when one or other of the local or distant teams were unable to make a diagnosis, and only 8 where the diagnoses of the 2 teams differed. Diagnoses were made and reports were compiled by the 'distant' team within 24 h and sent to the centre in Malawi. This simple telepathology initiative has had a positive impact on clinical management, and could be used in other less resourced centres twinned with better resourced ones.
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Affiliation(s)
- P Carey
- Department of Haematology, Great North Childrens Hospital, Newcastle upon Tyne, UK
| | - R Fudzulani
- Department of Paediatrics, Queen Elizabeth Hospital, Blantyre, Malawi
| | - D Scholfield
- Medical School, University of Birmingham, Birmingham, UK
| | - G Chagaluka
- Department of Paediatrics, Queen Elizabeth Hospital, Blantyre, Malawi
| | - T Tomoka
- Department of Pathology, Queen Elizabeth Hospital, Blantyre, Malawi
| | - G Liombe
- Department of Pathology, Queen Elizabeth Hospital, Blantyre, Malawi
| | - K Banda
- Department of Paediatrics, Queen Elizabeth Hospital, Blantyre, Malawi
| | - V Wadehra
- Department of Pathology, Great North Childrens Hospital, Newcastle upon Tyne, UK
| | - S Samarasinghe
- Department of Haematology, Great North Childrens Hospital, Newcastle upon Tyne, UK
| | - E M Molyneux
- Department of Paediatrics, Queen Elizabeth Hospital, Blantyre, Malawi
| | - S Bailey
- Department of Child Health, Great North Childrens Hospital, Newcastle upon Tyne, UK
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Kadaba V, Ly T, Noor S, Chhut SV, Hinsch N, Stauch G, Gollogly J. A hybrid approach to telepathology in Cambodia. J Telemed Telecare 2013; 19:475-8. [DOI: 10.1177/1357633x13512071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We established a hybrid telepathology network at the Children’s Surgical Centre (CSC) in Cambodia, based on store-and-forward communication using iPATH and videoconferencing using Skype. We retrospectively analysed all data from the CSC stored on the iPATH server and reviewed the patient notes over an 8-month period. Of 115 patients for histopathology diagnosis during the study period, 38 cases were uploaded onto iPATH for further telemedicine discussion. The median number of days it took a specialist, other than the local one, to comment on the case on iPATH was 5 days (range 0–15). In three cases (8%) there was no reply from a specialist on iPATH. During the study period, seven clinical conferences were held, with an average of 6 cases (range 4–7) discussed at each conference. All 38 cases discussed had a final agreed diagnosis and firm management plans were made. Of the 24 cases where proactive management was advised, 17 patients followed through with the recommendations. Although the combination of video consultations and store-and-forward communication has not been used much before in the developing world, it has benefited patient care and outcomes at the CSC.
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Affiliation(s)
| | - Tho Ly
- Children’s Surgical Centre, Phnom Penh, Cambodia
| | - Saqib Noor
- Children’s Surgical Centre, Phnom Penh, Cambodia
| | - Serey V Chhut
- Phnom Penh Institute of Pathology, Phnom Penh, Cambodia
| | - Nora Hinsch
- Department of Pathology, MVZ Lukaskrankenhaus Neuss GmbH, Neuss, Germany
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Adambounou K, Farin F, Adjenou V, N’dakena K, Gbeassor M, Tossou A, Akohin L, Decker K, Arbeille P. Plateforme de télémédecine moindre coût pour les pays en développement. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.eurtel.2013.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Nakayama I, Matsumura T, Kamataki A, Uzuki M, Saito K, Hobbs J, Akasaka T, Sawai T. Development of a teledermatopathology consultation system using virtual slides. Diagn Pathol 2012; 7:177. [PMID: 23237667 PMCID: PMC3557204 DOI: 10.1186/1746-1596-7-177] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 12/06/2012] [Indexed: 11/10/2022] Open
Abstract
Background An online consultation system using virtual slides (whole slide images; WSI) has been developed for pathological diagnosis, and could help compensate for the shortage of pathologists, especially in the field of dermatopathology and in other fields dealing with difficult cases. This study focused on the performance and future potential of the system. Method In our system, histological specimens on slide glasses are digitalized by a virtual slide instrument, converted into web data, and up-loaded to an open server. Using our own purpose-built online system, we then input patient details such as age, gender, affected region, clinical data, past history and other related items. We next select up to ten consultants. Finally we send an e-mail to all consultants simultaneously through a single command. The consultant receives an e-mail containing an ID and password which is used to access the open server and inspect the images and other data associated with the case. The consultant makes a diagnosis, which is sent to us along with comments. Because this was a pilot study, we also conducted several questionnaires with consultants concerning the quality of images, operability, usability, and other issues. Results We solicited consultations for 36 cases, including cases of tumor, and involving one to eight consultants in the field of dermatopathology. No problems were noted concerning the images or the functioning of the system on the sender or receiver sides. The quickest diagnosis was received only 18 minutes after sending our data. This is much faster than in conventional consultation using glass slides. There were no major problems relating to the diagnosis, although there were some minor differences of opinion between consultants. The results of questionnaires answered by many consultants confirmed the usability of this system for pathological consultation. (16 out of 23 consultants.) Conclusion We have developed a novel teledermatopathological consultation system using virtual slides, and investigated the usefulness of the system. The results demonstrate that our system can be a useful tool for international medical work, and we anticipate its wider application in the future. Virtual slides The virtual slides for this article can be found here:
http://www.diagnosticpathology.diagnomx.eu/vs/1902376044831574
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Affiliation(s)
- Ikunori Nakayama
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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