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Proesmans K, Van Vaerenbergh F, Lahousse L. The role of community pharmacists in primary and secondary prevention of skin cancer: an evaluation of a Flemish skin cancer prevention campaign. BMC Public Health 2023; 23:2490. [PMID: 38087215 PMCID: PMC10717840 DOI: 10.1186/s12889-023-17429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Skin cancer is a leading form of cancer in Belgium. Prevention of skin cancer by community pharmacists can play a role in increasing awareness and promoting sun protection. However, which persons could be reached by community pharmacists for skin cancer awareness in Belgium and whether this increased awareness is associated with increased sun protection and early detection remains unclear. METHODS Demographics of approached persons in Flemish community pharmacies during the months of May-June 2022 and the content of the skin cancer counseling were retrieved from the pharmacy database. Sunscreen purchases and dermatologist visits were evaluated up to 180 days after the skin cancer counseling. RESULTS Community pharmacists provided skin cancer counseling to a broad population of visitors (n = 822, 69% females, median age of 59 years Q1-Q3: 44-71 years). During the campaign, 822 visitors received a leaflet with skin cancer prevalence and sunscreen importance. On top of that, 335 visitors (41%) received additional counseling: skin type sensitivity was checked for 198 visitors (24%), typical characteristics of melanoma were discussed with 100 visitors (12%) and 37 visitors (5%) were referred to a physician for further information or concerns regarding a skin spot. Overall, one out of three visitors purchased sunscreen on the day of the counseling (33%, increasing up to 38% after 180 days). Among people under 20 years, this was even higher (51%). Additional counseling increased the likelihood of a dermatologist visit within 180 days (OR = 1.80; 95%CI: 1.12-2.88). CONCLUSIONS By providing skin cancer counseling in Belgian community pharmacies, a broad range of citizens was reached and triggered to purchase sunscreen, often on the same day as the counseling. Notably, young people were likely to purchase sunscreen. Citizens receiving additional counseling were more likely to visit a dermatologist within 180 days.
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Affiliation(s)
- Kristiaan Proesmans
- Faculty of Pharmaceutical Sciences, Department of Bio-analysis, Pharmaceutical Care Unit, Ghent University, Ottergemsesteenweg 460, Ghent, 9000, Belgium
| | - Frauke Van Vaerenbergh
- Faculty of Pharmaceutical Sciences, Department of Bio-analysis, Pharmaceutical Care Unit, Ghent University, Ottergemsesteenweg 460, Ghent, 9000, Belgium
| | - Lies Lahousse
- Faculty of Pharmaceutical Sciences, Department of Bio-analysis, Pharmaceutical Care Unit, Ghent University, Ottergemsesteenweg 460, Ghent, 9000, Belgium.
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2
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Uygun A, Caliskan ND, Tezcan S. Community Pharmacists' Knowledge on Cancer and Screening Methods. J Oncol Pharm Pract 2023; 29:386-392. [PMID: 35018843 DOI: 10.1177/10781552211073822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of the study is to evaluate the knowledge of community pharmacists on cancer and screening methods. SETTING AND METHOD This study was a descriptive cross-sectional study and was conducted between January-June 2020 in Istanbul/Turkey. a structured questionnaire was applied to pharmacists as online. The questionnaire was prepared by the researchers and consisted of 49 questions; basic information about cancer (15 items), signs and symptoms (11 items), causes and risk factors (14 items), cancer screening methods (9 items). RESULTS It was determined that the majority (>90%) of the pharmacists did not receive any education on cancer and/or cancer screening methods after graduation. The sufficient knowledge level of the pharmacists about cancer basics, signs and symptoms, and risk factors were found to be as 80%, 77%, and 67%, respectively. The internal consistency level of the questionnaire was calculated (Cronbach's alpha = 0.814). The item "Every woman should perform breast self-examination and notify a health professional when there is a change in breast appearance or feeling," was answered correctly by 98% of the pharmacists. It was determined that 71% of the pharmacists gave the correct answer to the item "Women aged 21-30 years should have a PAP smear every 3 years". CONCLUSION According to the results of the study, while the rate of sufficient knowledge level on cancer was found to be low, knowledge on cancer screening was found to be sufficient. We think that pharmacists should receive training on cancer and screening methods and to follow the guidelines closely.
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Affiliation(s)
- Aysen Uygun
- Marmara University Institute of Health Sciences, Istanbul, Turkey
| | | | - Songul Tezcan
- Marmara University Faculty of Pharmacy52982, Clinical Pharmacy Department, Istanbul, Turkey
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El-Den S, Lee YLE, Gide DN, O'Reilly CL. Stakeholders' Acceptability of Pharmacist-Led Screening in Community Pharmacies: A Systematic Review. Am J Prev Med 2022; 63:636-646. [PMID: 35688723 DOI: 10.1016/j.amepre.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Community pharmacists are among the most accessible healthcare providers. Community pharmacist-led screening may facilitate the early detection of illnesses/medical risk factors, optimizing health outcomes. However, it is important to assess the acceptability of screening services to ensure uptake by key stakeholders. The aim of this review was to explore the acceptability of community pharmacist-led screening by all stakeholders (i.e., patients, pharmacists, and other healthcare professionals) and identify the methods used to evaluate the acceptability of screening. METHODS A systematic search was conducted in Embase, MEDLINE, International Pharmaceutical Abstracts, and Scopus in April 2020 since inception. Studies that explored the acceptability of pharmacist-led screening for any risk factor/medical condition(s) within community pharmacies were included. RESULTS A total of 44 studies met the inclusion criteria. A total of 17 studies identified community pharmacies as appropriate screening locations. Seven studies reported that patients were comfortable with participating in pharmacist-led screening. Eight studies explored acceptability from the perspective of medical practitioners and other healthcare professionals, with 6 reporting high recommendation acceptance rates and/or acceptability of pharmacist-led screening. Barriers to pharmacist-led screening included time and privacy constraints, whereas adequate remuneration was considered an important enabler. DISCUSSION Community pharmacist-led screening appears to be acceptable to patients, pharmacists, and other healthcare professionals. However, no uniform psychometrically sound measure of acceptability was used consistently across studies, rendering comparisons difficult and showing the need for future research exploring the psychometric properties of acceptability measures. Findings, including barriers and enablers to pharmacist-led screening, are important to consider when providing screening services in community pharmacies.
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Affiliation(s)
- Sarira El-Den
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Yee Lam Elim Lee
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Duha N Gide
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Claire L O'Reilly
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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A group randomized trial of SCAN! (Skin Cancer Awareness Now!) in Appalachian community pharmacies. Res Social Adm Pharm 2021; 18:3058-3063. [PMID: 34429251 DOI: 10.1016/j.sapharm.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
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Kirkdale CL, Archer Z, Thornley T, Wright D, Valeur M, Gourlay N, Ayerst K. Accessing Mole-Scanning through Community Pharmacy: A Pilot Service in Collaboration with Dermatology Specialists. PHARMACY 2020; 8:pharmacy8040231. [PMID: 33287210 PMCID: PMC7768496 DOI: 10.3390/pharmacy8040231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 11/16/2022] Open
Abstract
Early identification and treatment of malignant melanoma is crucial to prevent mortality. The aim of this work was to describe the uptake, profile of users and service outcomes of a mole scanning service in the community pharmacy setting in the UK. In addition, health care costs saved from the perspective of general practice were estimated. The service allowed patients to have concerning skin lesions scanned with a dermatoscopy device which were analyzed remotely by clinical dermatology specialists in order to provide recommendations for the patient. Patients were followed up to ascertain the clinical outcome. Data were analyzed for 6355 patients and 9881 scans across 50 community pharmacies. The majority of the scans required no further follow-up (n = 8763, 88.7%). Diagnosis was confirmed for 70.4% (n = 757/1118) of scans where patients were recommended to seek further medical attention. Of these, 44.3% were ultimately defined as normal (n = 335) and 6.2% as malignant melanoma (n = 47/757). An estimated 0.7% of scans taken as part of the service led to a confirmed diagnosis of malignant melanoma. This service evaluation has shown that a mole scanning service available within community pharmacies is effective at triaging patients and ultimately playing a part in identifying diagnoses of malignant melanoma.
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Affiliation(s)
| | - Zoe Archer
- ScreenCancer UK Ltd., Innovation Centre, Maidstone Road, Chatham, Kent ME5 9FD, UK; (Z.A.); (M.V.); (K.A.)
| | - Tracey Thornley
- Boots UK, Thane Road, Nottingham NG90 1BS, UK; (T.T.); (N.G.)
- School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Mette Valeur
- ScreenCancer UK Ltd., Innovation Centre, Maidstone Road, Chatham, Kent ME5 9FD, UK; (Z.A.); (M.V.); (K.A.)
| | - Nicola Gourlay
- Boots UK, Thane Road, Nottingham NG90 1BS, UK; (T.T.); (N.G.)
| | - Kurt Ayerst
- ScreenCancer UK Ltd., Innovation Centre, Maidstone Road, Chatham, Kent ME5 9FD, UK; (Z.A.); (M.V.); (K.A.)
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Kelly KM, Dhumal T, Scott VG, Mbous YPV, Chotiner M, Powers R, Whetsel T, Safarudin F, Cornelius P, Garofoli G. SCAN! A pharmacy-based, sun safety feasibility study. J Am Pharm Assoc (2003) 2020; 61:e69-e79. [PMID: 33132105 DOI: 10.1016/j.japh.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/21/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Skin cancer is the most common form of cancer, and individuals from the medically underserved Appalachian region are at elevated risks for cancer morbidity and mortality. Skin cancer can be prevented by decreasing ultraviolet light exposure (sunscreen sun protection factor 30, shade, clothing, sunglasses, hats) and can be caught at an early treatable stage through a routine skin examination. The Skin Cancer Awareness Now! (SCAN!) pilot project promoted skin cancer prevention and screening in community pharmacies, using a dynamic communication model. The objectives of the study were to understand (1) the feasibility of the SCAN! and (2) the preliminary impact of the SCAN! METHODS We conducted pre- and postintervention surveys of the SCAN!, a student pharmacist-led or pharmacy resident-led intervention in community pharmacies (n = 3). RESULTS Participants (n = 90) had a mean age of 43.8 (SD= 18.4) years, were predominantly white (92.1%), without a college degree (65.6%), and had an average family income in the range of $25,000-$49,999, with approximately 16% falling below the poverty level. To begin, the SCAN! scored highly in attention (mean = 5.8), liking (mean = 6.1), comprehension (mean = 6.7), and intentions to be sun safe (mean = 6.0). Most improved in their knowledge of the amount of sunscreen needed per application for sun safety (66%, P < 0.01) and of melanoma features from pre- and postintervention (39%, P < 0.01). A multivariate analysis of variance indicated that knowledge and intentions improved (all P's < 0.01). Interaction effects indicated that improvements in knowledge were greater for those in the rural pharmacy (P = 0.03), and improvements in perceived importance were greater for those in urban pharmacies (P = 0.01). CONCLUSION The SCAN! intervention was well received by the population. Our study provides evidence that community pharmacy is a novel venue for skin cancer prevention interventions, particularly for rural, medically underserved populations.
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Forsea AM. Melanoma Epidemiology and Early Detection in Europe: Diversity and Disparities. Dermatol Pract Concept 2020; 10:e2020033. [PMID: 32642304 DOI: 10.5826/dpc.1003a33] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Melanoma claims annually more than 20,000 lives in Europe and is an important public health burden through its continuously increasing incidence and with its high mortality, costs, and complexity of care in advanced stages. Epidemiological surveillance is indispensable for the research into its causes, new prognostic markers, and innovative therapies, as well as for the building of efficient cancer control plans. However, important differences in the sources and availability of accurate epidemiological data exist among European countries and regions, contributing to a heterogeneous picture with 20-fold differences in the reported national melanoma incidence rates, divergent mortality trends, and solid disparities in survival across the Continent. Countries in the eastern half of Europe report the lowest incidence rates, but high case fatality, persisting and increasing mortality, a higher proportion of thicker tumors and late diagnosis, and lower survival rates. They are the least well equipped with quality cancer registration and reporting, and they lag behind in efficient cancer control plans implementation. This review highlights the main differences in melanoma epidemiology across Europe, together with an insight into their underlying causes in the areas of melanoma registration, early diagnosis, and prevention. These differences should be acknowledged and understood by physicians, researchers, and all stakeholders involved in improving melanoma care and outcomes, as no one-size-fits-all solution can tackle the melanoma problem in Europe. Instead, there is a need for nuanced strategies, adapted to the heterogeneous national and regional contexts, that would build on European diversity to eliminate the outcome disparities.
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Affiliation(s)
- Ana-Maria Forsea
- Oncologic Dermatology Department, Elias University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Mir JF, Estrada-Campmany M, Heredia A, Rodríguez-Caba C, Alcalde M, Espinosa N, Monnier J, Pérez-Anker J, Yélamos O, Puig S, Bosch N, Malvehy J. Role of community pharmacists in skin cancer screening: A descriptive study of skin cancer risk factors prevalence and photoprotection habits in Barcelona, Catalonia, Spain. Pharm Pract (Granada) 2019; 17:1455. [PMID: 31592287 PMCID: PMC6763307 DOI: 10.18549/pharmpract.2019.3.1455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/28/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Skin cancer incidence is increasing alarmingly, despite current efforts
trying to improve its early detection. Community pharmacists have proven
success in implementing screening protocols for a number of diseases because
of their skills and easy access. Objective: To evaluate the prevalence of skin cancer risk factors and the
photoprotection habits with a questionnaire in community pharmacy users. Methods: A research group consisting of pharmacists and dermatologists conducted a
descriptive cross-sectional study to assess photoprotection habits and skin
cancer risk factors by using a validated questionnaire in 218 community
pharmacies in Barcelona from May 23rd to June 13th
2016. All participants received health education on photoprotection and skin
cancer prevention. Patients with ≥1 skin cancer risk factor were
referred to their physician, as they needed further screening of skin
cancer. Results: A total of 5,530 participants were evaluated. Of those, only 20.2%
participants had received a total body skin examination for skin cancer
screening in the past by a physician and 57.1% reported using a SPF
50+ sunscreen. 53.9% participants presented ≥1 skin cancer
risk factor: 11.8% participants reported having skin cancer familial
history and 6.2% reported skin cancer personal history; pharmacists
found ≥10 melanocytic nevi in 43.8% participants and
chronically sun-damaged skin in 21.4%. Lesions suspicious for
melanoma were reported in 10.9% of the participants and urgent
dermatological evaluation was recommended. Conclusions: Pharmacists can detect people with skin cancer risk factors amongst their
users. This intervention can be considered in multidisciplinary strategies
of skin cancer screening.
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Affiliation(s)
- Joan F Mir
- Consultant Pharmacist in Research and Projects Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Maria Estrada-Campmany
- Consultant Pharmacist in Research and Projects Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Anna Heredia
- Professional Relations Manager. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Cristina Rodríguez-Caba
- Head of Department of Continuous Professional Development. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Marta Alcalde
- Community Pharmacist. Dermopharmacy and Medical Devices Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Natalia Espinosa
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Jilliana Monnier
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Javiera Pérez-Anker
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Oriol Yélamos
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Susana Puig
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona; & Biomedical Research Networking Centers Consortium, Institute of Health Carlos III (CIBER-ISCIII). Barcelona (Spain).
| | - Núria Bosch
- Community Pharmacist. Dermopharmacy and Medical Devices Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Josep Malvehy
- Dermatologist. Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS).Centro de Investigación Biomédica en Red (CIBER), Instituto Carlos III, Barcelona (Spain).
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Chuchu N, Dinnes J, Takwoingi Y, Matin RN, Bayliss SE, Davenport C, Moreau JF, Bassett O, Godfrey K, O'Sullivan C, Walter FM, Motley R, Deeks JJ, Williams HC. Teledermatology for diagnosing skin cancer in adults. Cochrane Database Syst Rev 2018; 12:CD013193. [PMID: 30521686 PMCID: PMC6517019 DOI: 10.1002/14651858.cd013193] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Teledermatology provides a way for generalist clinicians to access the opinion of a specialist dermatologist for skin lesions that they consider to be suspicious without referring the patients through the normal referral pathway. Teledermatology consultations can be 'store-and-forward' with electronic digital images of a lesion sent to a dermatologist for review at a later time, or can be live and interactive consultations using videoconferencing to connect the patient, referrer and dermatologist in real time. OBJECTIVES To determine the diagnostic accuracy of teledermatology for the detection of any skin cancer (melanoma, BCC or cutaneous squamous cell carcinoma (cSCC)) in adults, and to compare its accuracy with that of in-person diagnosis. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, CPCI, Zetoc, Science Citation Index, US National Institutes of Health Ongoing Trials Register, NIHR Clinical Research Network Portfolio Database and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA Studies evaluating skin cancer diagnosis for teledermatology alone, or in comparison with face-to-face diagnosis by a specialist clinician, compared with a reference standard of histological confirmation or clinical follow-up and expert opinion. We also included studies evaluating the referral accuracy of teledermatology compared with a reference standard of face-to-face diagnosis by a specialist clinician. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where there were information related to the target condition of any skin cancer missing. Data permitting, we estimated summary sensitivities and specificities using the bivariate hierarchical model. Due to the scarcity of data, we undertook no covariate investigations for this review. For illustrative purposes, we plotted estimates of sensitivity and specificity on coupled forest plots for diagnostic threshold and target condition under consideration. MAIN RESULTS The review included 22 studies reporting diagnostic accuracy data for 4057 lesions and 879 malignant cases (16 studies) and referral accuracy data for reported data for 1449 lesions and 270 'positive' cases as determined by the reference standard face-to-face decision (six studies). Methodological quality was variable with poor reporting hindering assessment. The overall risk of bias was high or unclear for participant selection, reference standard, and participant flow and timing in at least half of all studies; the majority were at low risk of bias for the index test. The applicability of study findings were of high or unclear concern for most studies in all domains assessed due to the recruitment of participants from secondary care settings or specialist clinics rather than from primary or community-based settings in which teledermatology is more likely to be used and due to the acquisition of lesion images by dermatologists or in specialist imaging units rather than by primary care clinicians.Seven studies provided data for the primary target condition of any skin cancer (1588 lesions and 638 malignancies). For the correct diagnosis of lesions as malignant using photographic images, summary sensitivity was 94.9% (95% confidence interval (CI) 90.1% to 97.4%) and summary specificity was 84.3% (95% CI 48.5% to 96.8%) (from four studies). Individual study estimates using dermoscopic images or a combination of photographic and dermoscopic images generally suggested similarly high sensitivities with highly variable specificities. Limited comparative data suggested similar diagnostic accuracy between teledermatology assessment and in-person diagnosis by a dermatologist; however, data were too scarce to draw firm conclusions. For the detection of invasive melanoma or atypical intraepidermal melanocytic variants both sensitivities and specificities were more variable. Sensitivities ranged from 59% (95% CI 42% to 74%) to 100% (95% CI 48% to 100%) and specificities from 30% (95% CI 22% to 40%) to 100% (95% CI 93% to 100%), with reported diagnostic thresholds including the correct diagnosis of melanoma, classification of lesions as 'atypical' or 'typical, and the decision to refer or to excise a lesion.Referral accuracy data comparing teledermatology against a face-to-face reference standard suggested good agreement for lesions considered to require some positive action by face-to-face assessment (sensitivities of over 90%). For lesions considered of less concern when assessed face-to-face (e.g. for lesions not recommended for excision or referral), agreement was more variable with teledermatology specificities ranging from 57% (95% CI 39% to 73%) to 100% (95% CI 86% to 100%), suggesting that remote assessment is more likely recommend excision, referral or follow-up compared to in-person decisions. AUTHORS' CONCLUSIONS Studies were generally small and heterogeneous and methodological quality was difficult to judge due to poor reporting. Bearing in mind concerns regarding the applicability of study participants and of lesion image acquisition in specialist settings, our results suggest that teledermatology can correctly identify the majority of malignant lesions. Using a more widely defined threshold to identify 'possibly' malignant cases or lesions that should be considered for excision is likely to appropriately triage those lesions requiring face-to-face assessment by a specialist. Despite the increasing use of teledermatology on an international level, the evidence base to support its ability to accurately diagnose lesions and to triage lesions from primary to secondary care is lacking and further prospective and pragmatic evaluation is needed.
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Affiliation(s)
- Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Jacqueline F Moreau
- University of Pittsburgh Medical CenterInternal MedicineDepartment of Medicine, Office of EducationUPMC Montefiore Hospital, N715PittsburghUSAPA, 15213
| | - Oliver Bassett
- Addenbrooke's HospitalPlastic SurgeryHills RoadCambridgeUKCB2 0QQ
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | | | - Fiona M Walter
- University of CambridgePublic Health & Primary CareStrangeways Research Laboratory, Worts CausewayCambridgeUKCB1 8RN
| | - Richard Motley
- University Hospital of WalesWelsh Institute of DermatologyHeath ParkCardiffUKCF14 4XW
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Chuchu N, Takwoingi Y, Dinnes J, Matin RN, Bassett O, Moreau JF, Bayliss SE, Davenport C, Godfrey K, O'Connell S, Jain A, Walter FM, Deeks JJ, Williams HC. Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma. Cochrane Database Syst Rev 2018; 12:CD013192. [PMID: 30521685 PMCID: PMC6517294 DOI: 10.1002/14651858.cd013192] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Melanoma accounts for a small proportion of all skin cancer cases but is responsible for most skin cancer-related deaths. Early detection and treatment can improve survival. Smartphone applications are readily accessible and potentially offer an instant risk assessment of the likelihood of malignancy so that the right people seek further medical attention from a clinician for more detailed assessment of the lesion. There is, however, a risk that melanomas will be missed and treatment delayed if the application reassures the user that their lesion is low risk. OBJECTIVES To assess the diagnostic accuracy of smartphone applications to rule out cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults with concerns about suspicious skin lesions. SEARCH METHODS We undertook a comprehensive search of the following databases from inception to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA Studies of any design evaluating smartphone applications intended for use by individuals in a community setting who have lesions that might be suspicious for melanoma or atypical intraepidermal melanocytic variants versus a reference standard of histological confirmation or clinical follow-up and expert opinion. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). Due to scarcity of data and poor quality of studies, we did not perform a meta-analysis for this review. For illustrative purposes, we plotted estimates of sensitivity and specificity on coupled forest plots for each application under consideration. MAIN RESULTS This review reports on two cohorts of lesions published in two studies. Both studies were at high risk of bias from selective participant recruitment and high rates of non-evaluable images. Concerns about applicability of findings were high due to inclusion only of lesions already selected for excision in a dermatology clinic setting, and image acquisition by clinicians rather than by smartphone app users.We report data for five mobile phone applications and 332 suspicious skin lesions with 86 melanomas across the two studies. Across the four artificial intelligence-based applications that classified lesion images (photographs) as melanomas (one application) or as high risk or 'problematic' lesions (three applications) using a pre-programmed algorithm, sensitivities ranged from 7% (95% CI 2% to 16%) to 73% (95% CI 52% to 88%) and specificities from 37% (95% CI 29% to 46%) to 94% (95% CI 87% to 97%). The single application using store-and-forward review of lesion images by a dermatologist had a sensitivity of 98% (95% CI 90% to 100%) and specificity of 30% (95% CI 22% to 40%).The number of test failures (lesion images analysed by the applications but classed as 'unevaluable' and excluded by the study authors) ranged from 3 to 31 (or 2% to 18% of lesions analysed). The store-and-forward application had one of the highest rates of test failure (15%). At least one melanoma was classed as unevaluable in three of the four application evaluations. AUTHORS' CONCLUSIONS Smartphone applications using artificial intelligence-based analysis have not yet demonstrated sufficient promise in terms of accuracy, and they are associated with a high likelihood of missing melanomas. Applications based on store-and-forward images could have a potential role in the timely presentation of people with potentially malignant lesions by facilitating active self-management health practices and early engagement of those with suspicious skin lesions; however, they may incur a significant increase in resource and workload. Given the paucity of evidence and low methodological quality of existing studies, it is not possible to draw any implications for practice. Nevertheless, this is a rapidly advancing field, and new and better applications with robust reporting of studies could change these conclusions substantially.
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Affiliation(s)
- Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Oliver Bassett
- Addenbrooke's HospitalPlastic SurgeryHills RoadCambridgeUKCB2 0QQ
| | - Jacqueline F Moreau
- University of Pittsburgh Medical CenterInternal MedicineDepartment of Medicine, Office of EducationUPMC Montefiore Hospital, N715PittsburghUSAPA, 15213
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | - Susan O'Connell
- Cardiff and Vale University Health BoardCEDAR Healthcare Technology Research CentreCardiff Medicentre, University Hospital of Wales, Heath Park CampusCardiffWalesUKCF144UJ
| | - Abhilash Jain
- Imperial College Healthcare NHS trust, St Mary’s HospitalDepartment of Plastic and Reconstructive SurgeryLondonUKW2 1NY
| | - Fiona M Walter
- University of CambridgePublic Health & Primary CareStrangeways Research Laboratory, Worts CausewayCambridgeUKCB1 8RN
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Alhaddad MS. Youth Experience With Community Pharmacy Services and Their Perceptions Toward Implementation of Medication Therapy Management Services by Community Pharmacists in the Western Region of Saudi Arabia. Ther Innov Regul Sci 2018; 53:95-99. [PMID: 29714597 DOI: 10.1177/2168479018769299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Pharmacists are the part of the health care team who can counsel patients on the most appropriate use of medications. This study aims to measure patients' experience with services provided by community pharmacists and their perceptions toward providing medication therapy management (MTM) services by community pharmacists in the Western Region of Saudi Arabia. In addition, this study aims to measure patients' willingness to pay (WTP) for participating in the MTM program led by community pharmacists. METHODS Using a cross-sectional research design, a prevalidated questionnaire was developed and posted to respondents through either face-to-face interviews or online social media. All data were analyzed using SPSS, version 22.0, and all alpha values less than 0.05 were considered significant. RESULTS A total of 953 responses were obtained in this study. Overall, 47.6% of the respondents always buy their medications from different community pharmacies, and 46.1% of respondents said that community pharmacists always respond to all of their questions. In addition, 96% of respondents perceived the MTM program to be beneficial for patient care. Moreover, 70.3% of respondents were willing to register in the MTM program if implemented at community pharmacies. CONCLUSION Residents in the Western Region of Saudi Arabia highly appreciate the additional values of the MTM program if implemented by community pharmacists. Decisions makers should encourage community pharmacists to plan for MTM services.
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