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Beames C, Adelson P, Sharplin G, Eckert M. Primary care nurse's role and educational preparedness in skin cancer screening and early detection: A scoping review. J Adv Nurs 2024; 80:2228-2251. [PMID: 38037496 DOI: 10.1111/jan.15993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/15/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023]
Abstract
AIM To identify the available evidence regarding nursing roles in skin cancer screening and early detection and the reported education and training undertaken to do so. DESIGN Scoping review, reported in accordance with PRISMA-ScR. DATA SOURCES A database search of Medline, CINAHL, Scopus, Embase, Emcare and JBI was conducted in November 2021. A grey literature search was conducted in February 2022. Searches were updated in August 2023. REVIEW METHODS The data were extracted and synthesized into themes related to nursing roles and education. RESULTS Of the 2285 identified studies, 54 were included in the review. Nursing roles included screening and early detection, prevention and patient education or counselling. Except for specialized nurse practitioners, nurses working in primary clinical care mostly engage in skin cancer supportive/administrative roles rather than leading collaborators in screening and early detection. The education and training for nurses were identified around themes of didactic education, clinical experience, training in dermoscopy, performance and knowledge assessment and self-efficacy. CONCLUSION The roles and responsibilities of nurses working in skin cancer screening and early detection are highly variable, as are the reported training and education programmes. Little research has been conducted to explore this nursing role or the educational requirements needed for proficiency. With appropriate best practice education, it is within most primary care nurses' scope of practice to obtain competence in delivering opportunistic skin cancer screening. IMPACT While most nurse specialists in dermatology will be proficient in dermoscopy and skin cancer screening, nurses who work in general practice are often underutilized due to a lack of opportunity and a clear pathway to becoming proficient in dermoscopic skin cancer screening. Most nurses involved in skin cancer screening are employed in advanced roles, and only a few studies investigating educational interventions utilized dermoscopy among advanced nurses. With specific training, nurses can work within their full scope of practice and increase access to skin cancer screening and early detection. REPORTING METHOD Adhered to JBI Guidance for Conducting Systematic Scoping Reviews. PROTOCOL REGISTRATION Open Science Framework, https://doi.org/10.17605/OSF.IO/XUNE6 PATIENT OR PUBLIC CONTRIBUTION: N/A; a literature review.
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Affiliation(s)
- Chelsea Beames
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Pamela Adelson
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Wiley K, Johnson J, Coleman C, Olson C, Chuo J, McSwain D. Translating Value Across Telehealth Stakeholders: A Rapid Review of Telehealth Measurement Evidence and a New Policy Framework to Guide Telehealth Researchers. Telemed J E Health 2024. [PMID: 38563764 DOI: 10.1089/tmj.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Introduction: The surge in virtual care during the pandemic was accompanied by an increase in telehealth data of interest to policy stakeholders and other health care decision makers. However, these data often require substantial preprocessing and targeted analyses to be usable. By deliberately evaluating telehealth services with stakeholder perspectives in mind, telehealth researchers can more effectively inform clinical and policy decision making. Objective: To examine existing literature on telehealth measurement and evaluation and develop a new policy-oriented framework to guide telehealth researchers. Materials and Methods: A systematic rapid review of literature on telehealth measurement and evaluation was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The findings were analyzed and applied to the Supporting Pediatric Research on Outcomes and Utilization of Telehealth Evaluation and Measurement (STEM) Framework through the lens of key health care delivery decision makers to create a STEM Policy Framework Results: An initial search yielded 2,324 peer-reviewed articles and gray literatyre from 2012 to 2022, of which 56 met inclusion criteria. These measured and evaluated telehealth access (41.5%), quality (32.1%), cost (15.1%), experience (5.7%), and utilization (5.7%), consistent with the STEM Framework domains, but there was no universal approach. The STEM Policy Framework focuses this literature by describing data measures for each domain from the perspectives of five stakeholders. Conclusions: Literature describing measurement and evaluation approaches for telehealth is limited and not standardized, with few considering policy stakeholder perspectives. With this proposed STEM Policy Framework, we aim to improve this body of literature and support researchers seeking to inform telehealth policy through their work.
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Affiliation(s)
- Kevin Wiley
- Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jada Johnson
- Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christina Coleman
- Department of Pediatrics, UNC School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christina Olson
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - John Chuo
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David McSwain
- Department of Pediatrics, UNC School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Charlly N, Swedlund M. Can You Hear Me Now? Patient Perceptions of Telehealth in a Rural Primary Care Population. Telemed J E Health 2024. [PMID: 38452338 DOI: 10.1089/tmj.2023.0554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background: The COVID-19 pandemic significantly increased telehealth adoption. Rural communities experience challenges relating to telehealth, including a shortage of clinicians, low health literacy, mistrust of medicine, and limited technology access, yet rural perceptions have not been a subject of robust study. The setting of this study was a rural Midwestern family medicine clinic within an academic health system. Methods: Surveys were given to all patients of age 18 or older visiting the clinic over a one-week period. Those who expressed interest were contacted for a semistructured interview. Descriptive statistics and chi-square testing were used to analyze survey results for significant relationships, while interview transcripts were analyzed for themes. Results: Of respondents, 27% indicated prior telehealth use and were more likely to prefer telehealth visits (p = 0.03). Perceptions of telehealth were sorted into themes, including scope of care, convenience, and technology. Telehealth was preferred for discussing test results or mental health. Barriers such as travel time and transportation access favored telehealth. Although more convenient, telehealth was found to be less effective for relationship building. The absence of physical examination during phone visits was a concern. Phone visits were more prevalent due to failure of video-based technology. Conclusions: Despite the potential to address these unique challenges in rural communities, telehealth acceptance is poor. Barriers such as accessibility of technology can be improved through governmental and health systemwide measures. Future work can help develop interventions that counter negative perceptions of telehealth while increasing interest and uptake in rural communities.
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Affiliation(s)
- Nithin Charlly
- Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew Swedlund
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Mehri Z, Nahidi Y, Ramezani B, Torabi S. Evaluation of the Status of Patients with Autoimmune Bullous Diseases (Pemphigus and Bullous Pemphigoids) in Dermatology Clinics of Mashhad University of Medical Sciences During the COVID-19 Pandemic Using Telemedicine. Telemed J E Health 2024. [PMID: 38416427 DOI: 10.1089/tmj.2023.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Background: The COVID-19 pandemic impacted the growth of telemedicine. The challenge was in the way of dermatologists, who needed a comprehensive examination of the lesions. Here, we tried a tele-management of patients with autoimmune bullous diseases. Methods: This cross-sectional study was conducted on confirmed bullous disorder cases. Demographic data and the status of COVID-19 infection were assessed in the patients. Some of the cases were provided online, and some with office visits. Drug and treatment plan changes were compared between these two groups. All statistical analysis was conducted using SPSS version 20. Result: Totally, 100 patients, including 46 males (46.0%) and 54 females (54.0%), 48.15 ± 11.11 years old, were studied. Among them, 73 were pemphigus vulgaris (73.0%), 11 were bullous pemphigoid (11.0%), 10 were pemphigus foliaceus (10.0%), and the other 6 (6.0%) were categorized as other autoimmune bullous diseases. During the pandemic, 38 cases (38.0%) had COVID-19 infection. 72 patients had office and 28 had online visits. Treatment plans after visits during the pandemic (p = 0.588) and drug dose change (p = 0.297) showed no significant difference between office and online visits. Conclusion: Our patients tended to plan office visits more than online; however, we found no differences regarding the plan or treatment changes. Online visit has good efficacy, but further investigation in case of provision of a suitable platform and getting the attention of the patients is needed.
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Affiliation(s)
- Zohreh Mehri
- Cutaneous Leishmaniasis Research Center, Department of Dermatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yalda Nahidi
- Cutaneous Leishmaniasis Research Center, Department of Dermatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behrokh Ramezani
- Student Research Committee, Department of Dermatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shatila Torabi
- Cutaneous Leishmaniasis Research Center, Department of Dermatology, Mashhad University of Medical Sciences, Mashhad, Iran
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Lee CJ, Boyce A, Chequer de Souza J, Evans R. Store-and-forward (asynchronous) doctor-to-dermatologist non-skin cancer specific teledermatology services in Australia: A scoping review. Australas J Dermatol 2024; 65:37-48. [PMID: 37929627 DOI: 10.1111/ajd.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/06/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
Store-and-forward teledermatology (SAFT) has become increasingly popular as a means to increase access to specialist care and address healthcare disparities such as those experienced by rural communities. A contemporary systematic overview of the Australian SAFT services and outcomes for all dermatological conditions is missing. This scoping review provides an overview of Australian SAFT models. Twelve studies were identified through web databases, grey literature sites and reference lists of eligible articles. Eligibility criteria included studies evaluating doctor-to-dermatologist Australian SAFT services provided to Australians for all skin conditions but excluded the studies that solely focused on skin cancers. Data on study design, setting, population, SAFT model, referral characteristics, patient, and general practitioner perspectives, diagnostic concordance, and measured outcomes such as follow up, investigation and waiting time were extracted. Quality of the included studies was assessed using CASP tools. Synthesis reveals that SAFT can be used for patients with any dermatological condition, provides more accurate diagnostics compared to cases without dermatologist input, may reduce waiting times for dermatological expertise, and users generally had positive experiences with SAFT. Although results are positive, this review reveals the heterogenous nature of the literature on SAFT in Australia and a need to establish a uniform approach to assessing the outcomes and impacts of such services.
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Affiliation(s)
- Celine Jessica Lee
- College of Medicine and Dentistry, James Cook University, Queensland, Townsville, Australia
| | - Aaron Boyce
- Department of Dermatology, Townsville University Hospital, Douglas, Queensland, Australia
| | - Julia Chequer de Souza
- College of Medicine and Dentistry, James Cook University, Queensland, Townsville, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Queensland, Townsville, Australia
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Echarri A, Pradera C, Molina G, Gonzalez Moure C, De las Heras C, Fraga Iriso R, Ollero V, Echevarria C, Muñiz J. Implementation of a Teledermatology Electronic Consultation Program to Improve the Care of Patients with Inflammatory Bowel Disease. TELEMEDICINE REPORTS 2024; 5:12-17. [PMID: 38469167 PMCID: PMC10927239 DOI: 10.1089/tmr.2023.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 03/13/2024]
Abstract
Introduction Skin lesions are a common extraintestinal manifestation associated with inflammatory bowel disease (IBD), although they may also appear as a complication of IBD treatment. Prompt referral to the dermatologist can be very helpful in practice. Teledermatology complements the traditional in-person health care modality, improving access to dermatological care. Objective To evaluate the impact of a store-and-forward teledermatology electronic consultation (e-consult) program on the care of IBD patients. Methods A retrospective study assessing the outcomes of our teledermatology program over its first 2 years of implementation. Results A total of 39 consultations involving 33 patients (69.2% women, mean age 39.6 years [12-63]) were conducted. The mean number of teleconsultations was 2.8 per month in the initial implementation stage: 33 consultations were carried out in patients with Crohn's disease and 6 in ulcerative colitis. Only 18% of the patients had an active flare-up. The most frequent reason for the e-consult was paradoxical psoriasiform lesions (n = 13, 33.3%), commonly related with anti-tumor necrosis factor agents (70% of the patients) and hidradenitis suppurativa (n = 4, 10.3%). Resolution was achieved in 87% of patients, with a mean waiting time of 4.7 days (0-14). Almost all patients (97%) were satisfied with our program, and considered the referral through the program to be appropriate (92%). Best valued features were the reduced waiting time and the coordinated approach between the two departments involved. Conclusions Dermatology e-consult is an efficient and useful means of optimizing IBD patient care.
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Affiliation(s)
- Ana Echarri
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Carmen Pradera
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Gema Molina
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Cristina De las Heras
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Rebeca Fraga Iriso
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Virginia Ollero
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Cristina Echevarria
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Javier Muñiz
- Departamento de Ciencias de la Salud e INIBIC, Universidad de A Coruña, CIBERCV, A Coruña, Spain
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Asokan N. Community Dermatology: Current Status and the Way Forward. Indian Dermatol Online J 2023; 14:762-768. [PMID: 38099039 PMCID: PMC10718120 DOI: 10.4103/idoj.idoj_497_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/17/2023] Open
Abstract
Community health interventions in dermatology have the potential to deliver healthcare to large populations. Such interventions can bridge the gap between increasing demands from vast populations and limited availability and asymmetric geographical distribution of specialist doctors. This narrative review aims to delineate various areas in which community dermatology initiatives are useful, the different approaches used, and the factors which could determine their effectiveness. We did a PubMed search using the search terms, "Community Health Services"[Mesh]) AND "Dermatology"[Mesh]. A further literature search was performed by cross-referencing these articles. In addition to its primary purpose of increasing access, community involvement can augment medical education, foster research, and help to develop more patient-centered clinical guidelines, understand disease trends and influences of the environment on various diseases, and formulate population-centered health policy. Task shifting, development of culture-sensitive and gender-sensitive community healthcare teams, disease-specific patient support groups, and use of advances in technology such as telemedicine are some of the important methods used in community dermatology. Task shifting may be performed at different levels - general practitioners, pharmacists, nurses, and community health workers. Community interventions harness volunteerism among health professionals as well as various stakeholders in the community. Partnering with non-governmental organizations, involving members of the community, and being a part of a long-term public health program help to sustain community interventions. The interventions should adapt to the ethical and cultural norms of the community. Continuity of care, fidelity, and evidence support are crucial for the success of community interventions in dermatology.
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Affiliation(s)
- Neelakandhan Asokan
- Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
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8
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Lamkin RP, Peracca SB, Jackson GL, Hines AC, Gifford AL, Lachica O, Li D, Morris IJ, Paiva M, Weinstock MA, Oh DH. Using the RE-AIM framework to assess national teledermatology expansion. FRONTIERS IN HEALTH SERVICES 2023; 3:1217829. [PMID: 37936881 PMCID: PMC10627029 DOI: 10.3389/frhs.2023.1217829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/02/2023] [Indexed: 11/09/2023]
Abstract
Background Teledermatology has been utilized in the United States Department of Veterans Affairs (VA) for decades but continues to have incomplete penetration. VA has funded an initiative to enhance access to dermatology services since 2017 to support asynchronous teledermatology for Veterans living in rural areas. As part of an ongoing evaluation of this program, we assessed the teledermatology activity between the fiscal years 2020 and 2022. We focused on the second cohort of the initiative, comprising six VA facilities and their 54 referral clinics. Methods We studied teledermatology programs at cohort facilities using the reach, effectiveness, adoption, implementation, and maintenance framework. We used a mixed-methods design including annual online reports completed by participating facilities and VA administrative data. When possible, we compared the data from the 3 years of teledermatology funding with the baseline year prior to the start of funding. Findings Reach: Compared with the baseline year, there was a 100% increase in encounters and a 62% increase in patients seen at the funded facilities. Over 500 clinicians and support staff members were trained. Effectiveness: In FY 2022, primary or specialty care clinics affiliated with the funded facilities had more dermatology programs than primary or specialty care clinics across the VA (83% vs. 71% of sites). Adoption: By the end of the funding period, teledermatology constituted 16% of dermatology encounters at the funded facilities compared with 12% nationally. This reflected an increase from 9.2% at the funded facilities and 10.3% nationally prior to the funding period. Implementation: The continued funding for staff and equipment facilitated the expansion to rural areas. Maintenance: By the end of the funding period, all facilities indicated that they had fully implemented their program for patients of targeted primary care providers. The Program Sustainability Index scores generally increased during the funding period. Conclusions Targeted funding to support asynchronous teledermatology implementation for rural Veterans increased its reach, adoption, and implementation, ultimately improving access. Providing program guidance with staffing and training resources can increase the impact of these programs. Ongoing efforts to maintain and increase communication between primary care and dermatology will be needed to sustain success.
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Affiliation(s)
- Rebecca P. Lamkin
- Center for Healthcare Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
| | - Sara B. Peracca
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA, United States
| | - George L. Jackson
- Center of Innovation to Accelerate Discovery & Practice Transformation (ADAPT), Durham VA Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Durham, NC, United States
- Peter O'Donnell, Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Aliya C. Hines
- Department of Medicine, Division of Dermatology, John D. Dingell VA Medical Center, United States Department of Veterans Affairs, Detroit, MI, United States
- Department of Dermatology, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Allen L. Gifford
- Center for Healthcare Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
- Department of Health, Law, Policy and Management, School of Public Health, Boston University, Boston, MA, United States
| | - Olevie Lachica
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA, United States
| | - Donglin Li
- Center for Healthcare Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
| | - Isis J. Morris
- Center of Innovation to Accelerate Discovery & Practice Transformation (ADAPT), Durham VA Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Durham, NC, United States
| | - Marcelo Paiva
- Center for Dermatology, Providence VA Medical Center, United States Department of Veterans Affairs, Providence, RI, United States
| | - Martin A. Weinstock
- Center for Dermatology, Providence VA Medical Center, United States Department of Veterans Affairs, Providence, RI, United States
- Department of Dermatology and Epidemiology, Brown University, Providence, RI, United States
- Office of Connected Care, Department of Veterans Affairs, Washington, DC, United States
| | - Dennis H. Oh
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA, United States
- Office of Connected Care, Department of Veterans Affairs, Washington, DC, United States
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, United States
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Omiye JA, Gui H, Daneshjou R, Cai ZR, Muralidharan V. Principles, applications, and future of artificial intelligence in dermatology. Front Med (Lausanne) 2023; 10:1278232. [PMID: 37901399 PMCID: PMC10602645 DOI: 10.3389/fmed.2023.1278232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
This paper provides an overview of artificial-intelligence (AI), as applied to dermatology. We focus our discussion on methodology, AI applications for various skin diseases, limitations, and future opportunities. We review how the current image-based models are being implemented in dermatology across disease subsets, and highlight the challenges facing widespread adoption. Additionally, we discuss how the future of AI in dermatology might evolve and the emerging paradigm of large language, and multi-modal models to emphasize the importance of developing responsible, fair, and equitable models in dermatology.
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Affiliation(s)
| | - Haiwen Gui
- Department of Dermatology, Stanford University, Stanford, CA, United States
| | - Roxana Daneshjou
- Department of Dermatology, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Zhuo Ran Cai
- Department of Dermatology, Stanford University, Stanford, CA, United States
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Dwivedi N, Barsoum R, Rathbone E, Browne I. Analysis of patient demographics and attendance at a Far North Queensland public dermatology outpatient clinic. Australas J Dermatol 2023; 64:339-345. [PMID: 37403891 DOI: 10.1111/ajd.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/27/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND/OBJECTIVES There is limited literature focussing on the demographics of patients presenting to public dermatology outpatient clinics, with an even smaller amount focussing on clinics in regional Australia. This study presents the first patient demographic analysis for the Cairns Hospital's Dermatology Outpatient Department and analyses the cohort of patients who did not attend their appointments. In doing so, it recommends potential strategies that should be considered to address the issues of patient absenteeism and wait times in a regional setting, while also suggesting future data points that should be collected for analysis. METHODS A 4-year retrospective cohort study using demographic data from all referrals with medical officers (N = 10,333) from 1 January 2018 to 31 December 2021 at the Cairns Hospital Dermatology Outpatient Department. The hospital is the only facility with a dermatology service within the Cairns and Hinterland Hospital and Health Service. Data were extracted from the Cairns Hinterland Analytical Intelligence (CHAI) system. RESULTS Data pertaining to patient demographics, attendance of appointments, triage categories and wait times were collected and reviewed for patients referred during the study period. CONCLUSION The Dermatology Outpatient Department services an ever-growing and diverse patient cohort. Barriers to access and long wait times exist for patients referred to the Department. Strategies to combat these issues, such as an increase in funding and resourcing, should be considered to better optimise patient care and the utilisation of health resources.
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Affiliation(s)
- Nikhil Dwivedi
- Princess Alexandra Hospital - Metro South HHS, Woolloongabba, Queensland, Australia
| | - Ramez Barsoum
- Department of Dermatology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Evelyne Rathbone
- Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Ilsphi Browne
- Department of Dermatology, Cairns Hospital, Cairns, Queensland, Australia
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Young JN, Griffith‐Bauer K, Hill E, Latour E, Samatham R, Leachman S. The benefit of early-stage diagnosis: A registry-based survey evaluating the quality of life in patients with melanoma. SKIN HEALTH AND DISEASE 2023; 3:e237. [PMID: 37538330 PMCID: PMC10395626 DOI: 10.1002/ski2.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 08/05/2023]
Abstract
Background The morbidity associated with advanced stage melanoma is an important consideration in the dialog surrounding early detection and overdiagnosis. Few studies have stratified melanoma patient quality of life (QoL) by stage at diagnosis. Objective We sought to investigate if melanoma stage is independently associated with changes in QoL within a large, community-based melanoma registry. Secondarily, we investigated whether demographic factors such as age, geographic location or level of education are associated with changes in QoL in the same population. Methods 1108 melanoma patients were surveyed over a three-month period using the QoL in Adult Cancer Survivors Survey, consisting of 47 items on a 7-point frequency scale. Data were analysed using both descriptive statistical models and adjusted multivariate logistic regression. Results There were 677 respondents generating a 61% response rate. Overall, higher stage at diagnosis correlated with the largest decreases in QoL as it pertained to both general (p = 0.001) and Cancer-Specific stressors (p < 0.001). Education level (p = 0.020), age (p < 0.001), rural area code designation (p = 0.020) and family history of melanoma (p = 0.017) were also independently associated with changes in QoL. Conclusion Earlier stage at melanoma diagnosis is associated with better QoL and thus represents a crucial intervention in patient care. Given our findings and the growing body of evidence surrounding morbidity in late-stage melanoma, it is essential that QoL be included in assessing the benefits of early detection.
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Affiliation(s)
- Jade N. Young
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
| | - Kelly Griffith‐Bauer
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
- The PolyclinicSeattleWashingtonUSA
| | - Emma Hill
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
| | - Emile Latour
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
- Biostatistics Shared ResourceKnight Cancer InstituteOregon Health and Science UniversityPortlandOregonUSA
| | - Ravikant Samatham
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
| | - Sancy Leachman
- Department of DermatologyOregon Health and Science UniversityPortlandOregonUSA
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Gill C, Fischer AK, Dicke K, Teigelake B, Brans R, Skudlik C, John SM, Symanzik C. Teledermatological Follow-Up Consultations in Individual Prevention of Occupational Dermatoses: A Monocentric Feasibility Study on Quality and Satisfaction by Patients and Physicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6127. [PMID: 37372714 DOI: 10.3390/ijerph20126127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Teledermatology has become very popular, and not only due to the SARS-CoV-2 pandemic. Patients with occupational skin diseases (OSDs) could also benefit from teledermatology services as part of their follow-up care, but the opportunities and challenges for patients and dermatologists, especially regarding quality and satisfaction, need exploration. In this single-center feasibility study, 215 patients taking part in a tertiary prevention program for OSD were invited to participate. After obtaining consent, a follow-up video consultation appointment with the center's dermatologists was made. Quality and satisfaction with the consultations were evaluated by fully standardized online questionnaires filled in by the patients and dermatologists. A total of 68 teledermatological follow-up consultations were conducted by 10 dermatologists on 42 patients. Half of the dermatologists (50.0%) and 87.6% of the patients were satisfied with the video consultations. However, the lack of physical examination seems to be a problem, especially from the physicians' point of view (75.8%). A total of 66.1% of the dermatologists and 87.5% of the patients saw video consultations as useful supplements to face-to-face consultations. The results of our feasibility study indicate general satisfaction of patients and physicians with teledermatological sessions in occupational dermatology, especially as a useful supplement to face-to-face consultation.
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Affiliation(s)
- Carina Gill
- Department of Dermatology, Institute for Health Research and Education, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
| | - Ann-Kristin Fischer
- Department of Dermatology, Institute for Health Research and Education, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
| | - Katja Dicke
- Department of Dermatology, Institute for Health Research and Education, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
| | - Björn Teigelake
- Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), Gesundheitscampus-Süd 29, 44801 Bochum, Germany
| | - Richard Brans
- Department of Dermatology, Institute for Health Research and Education, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Lower Saxony Institute of Occupational Dermatology at the University of Osnabrück, 49076 Osnabrück, Germany
| | - Christoph Skudlik
- Department of Dermatology, Institute for Health Research and Education, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Lower Saxony Institute of Occupational Dermatology at the University of Osnabrück, 49076 Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Institute for Health Research and Education, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Lower Saxony Institute of Occupational Dermatology at the University of Osnabrück, 49076 Osnabrück, Germany
| | - Cara Symanzik
- Department of Dermatology, Institute for Health Research and Education, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076 Osnabrück, Germany
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Maita KC, Palmieri-Serrano L, Avila FR, Torres-Guzman RA, Garcia JP, S. Eldaly A, Haider CR, Felton CL, Paulson MR, Maniaci MJ, Forte AJ. Imaging evaluated remotely through telemedicine as a reliable alternative for accurate diagnosis: a systematic review. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-023-00745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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14
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Peracca SB, Fonseca AS, Lachica O, Jackson GL, Morris IJ, King HA, Misitzis A, Whited JD, Mohr DC, Lamkin RP, Gifford AL, Weinstock MA, Oh DH. Organizational Readiness for Patient-Facing Mobile Teledermatology to Care for Established Veteran Patients in the United States. Telemed J E Health 2023; 29:72-80. [PMID: 35612465 DOI: 10.1089/tmj.2022.0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose: To improve patient access to skin care, the Department of Veterans Affairs (VA) developed a patient-facing asynchronous mobile teledermatology application (app), which allows patients to follow up remotely with dermatologists. To understand how the app would be received in VA, we examined Organizational Readiness for Change (ORC), an important prelude to effective implementation, which includes the shared resolve and collective ability of organizational members to implement a change. Methods: We used a mixed-methods multiple case study approach to assess ORC at three VA facilities. Data derived from a site process call, surveys, and semistructured telephone interviews of VA staff, field notes, and administrative data. Results: Participants at all three facilities supported the intervention and recognized the value of using the app to increase patients' access to dermatologists, but expressed concerns largely related to disruption of the pre-existing clinical workflow. Participants at the facility most actively using the app had the highest overall ORC score and reported the most facilitators. Facility leadership support when guided by a clinical champion minimized barriers by recognizing the complexities of health care provision at specialty clinics. Discussion: While provider buy-in remained a barrier, leadership, guided by the clinical champion, played a critical role instituting implementation strategies. The strong association between the ORC survey score and the presence of facilitators and barriers suggests that the ORC survey may be a rapid, convenient, and effective tool for health care systems to identify favorable sites for wider implementation of mobile telehealth care. Clinical Trials Identifier: NCT03241589.
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Affiliation(s)
- Sara B Peracca
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - Allene S Fonseca
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Olevie Lachica
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Population Health Science, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Isis J Morris
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Population Health Science, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Angelica Misitzis
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - John D Whited
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Rebecca P Lamkin
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts, USA.,Department of Medicine, Section of General Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Martin A Weinstock
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Dennis H Oh
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA.,Department of Dermatology, University of California at San Francisco, San Francisco, California, USA
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15
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Vasavda C, Tang O, Kwatra SG, Ho BK, Grossberg AL. Asymmetric patterns of patient access to in-person and teledermatologic health care during the COVID-19 pandemic. J Am Acad Dermatol 2023; 88:167-169. [PMID: 34933041 PMCID: PMC9726204 DOI: 10.1016/j.jaad.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Chirag Vasavda
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olive Tang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Byron K. Ho
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anna L. Grossberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland,Reprint requests: Anna L. Grossberg, MD, Department of Dermatology, Johns Hopkins University School of Medicine, 200 N Wolfe St, Rubenstein 2107, Baltimore, MD 21287
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16
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Lamb JE, Fitzsimmons R, Sevagamoorthy A, Kovarik CL, Shin DB, Takeshita J. Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis. JMIR DERMATOLOGY 2022; 5:e38694. [PMID: 37632882 DOI: 10.2196/38694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/10/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated the widespread adoption of teledermatology, and this continues to account for a significant proportion of dermatology visits after clinics have reopened for in-person care. Delivery of high-quality teledermatology care requires adequate visualization of the patient's skin, with photographs being preferred over live video for remote skin examination. It remains unknown which patients face the greatest barriers to participating in a teledermatology visit with photographs. OBJECTIVE The aim of this study was to identify patient characteristics associated with type of telemedicine visit and the factors associated with participating in teledermatology visits with digital photographs versus those without photographs. METHODS We performed a cross-sectional analysis of the University of Pennsylvania Health System electronic health record data for adult patients who participated in at least 1 teledermatology appointment between March 1, 2020, and June 30, 2020. The primary outcomes were participation in a live-interactive video visit versus a telephone visit and participation in any teledermatology visit with photographs versus one without photographs. Multivariable logistic regression was performed to evaluate the associations between patient characteristics and the primary outcomes. RESULTS In total, 5717 unique patients completed at least 1 teledermatology visit during the study period; 68.25% (n=3902) of patients participated in a video visit, and 31.75% (n=1815) participated in a telephone visit. A minority of patients (n=1815, 31.75%) submitted photographs for their video or telephone appointment. Patients who submitted photographs for their teledermatology visit were more likely to be White, have commercial insurance, and live in areas with higher income, better education, and greater access to a computer and high-speed internet (P<.001 for all). In adjusted analysis, older age (age group >75 years: odds ratio [OR] 0.60, 95% CI 0.44-0.82), male sex (OR 0.85, 95% CI 0.75-0.97), Black race (OR 0.79, 95% CI 0.65-0.96), and Medicaid insurance (OR 0.81, 95% CI 0.66-0.99) were each associated with lower odds of a patient submitting photographs for their video or telephone visit. Older age (age group >75 years: OR 0.37, 95% CI 0.27-0.50) and Black race (OR 0.82, 95% CI 0.68-0.98) were also associated with lower odds of a patient participating in a video visit versus telephone visit. CONCLUSIONS Patients who were older, male, or Black, or who had Medicaid insurance were less likely to participate in teledermatology visits with photographs and may be particularly vulnerable to disparities in teledermatology care. Further research is necessary to identify the barriers to patients providing photographs for remote dermatology visits and to develop targeted interventions to facilitate equitable participation in teledermatology care.
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Affiliation(s)
- Jordan E Lamb
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Anjana Sevagamoorthy
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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17
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A Call to Action: Evidence for the Military Integration of Teledermoscopy in a Pandemic Era. Dermatopathology (Basel) 2022; 9:327-342. [PMID: 36278540 PMCID: PMC9590112 DOI: 10.3390/dermatopathology9040039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Skin disease remains a common complaint among deployed service members. To mitigate the limited supply of dermatologists in the U.S. Military Health System, teledermatology has been harnessed as a specialist extender platform, allowing for online consultations in remote deployed settings. Operational teledermatology has played a critical role in reductions of medical evacuations with significant cost-savings. When direct in-person lesion visualization is unattainable, teledermoscopy can be harnessed as an effective diagnostic tool to distinguish suspicious skin lesions. Teledermoscopy has the versatile capacity for streamlined incorporation into the existing asynchronous telemedicine platforms utilized worldwide among deployed U.S. military healthcare providers. In terms of clinical utility, teledermoscopy offers a unique and timely opportunity to improve diagnostic accuracy, early detection rates, and prognostic courses for dermatological conditions. Such improvements will further reduce medical evacuations and separations, thereby improving mission readiness and combat effectiveness. As mission goals are safeguarded, associated operational budget costs are also preserved. This innovative, cost-effective technology merits integration into the U.S. Military Health System (MHS).
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18
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Daneshjou R, Vodrahalli K, Novoa RA, Jenkins M, Liang W, Rotemberg V, Ko J, Swetter SM, Bailey EE, Gevaert O, Mukherjee P, Phung M, Yekrang K, Fong B, Sahasrabudhe R, Allerup JAC, Okata-Karigane U, Zou J, Chiou AS. Disparities in dermatology AI performance on a diverse, curated clinical image set. SCIENCE ADVANCES 2022; 8:eabq6147. [PMID: 35960806 PMCID: PMC9374341 DOI: 10.1126/sciadv.abq6147] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/30/2022] [Indexed: 06/10/2023]
Abstract
An estimated 3 billion people lack access to dermatological care globally. Artificial intelligence (AI) may aid in triaging skin diseases and identifying malignancies. However, most AI models have not been assessed on images of diverse skin tones or uncommon diseases. Thus, we created the Diverse Dermatology Images (DDI) dataset-the first publicly available, expertly curated, and pathologically confirmed image dataset with diverse skin tones. We show that state-of-the-art dermatology AI models exhibit substantial limitations on the DDI dataset, particularly on dark skin tones and uncommon diseases. We find that dermatologists, who often label AI datasets, also perform worse on images of dark skin tones and uncommon diseases. Fine-tuning AI models on the DDI images closes the performance gap between light and dark skin tones. These findings identify important weaknesses and biases in dermatology AI that should be addressed for reliable application to diverse patients and diseases.
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Affiliation(s)
- Roxana Daneshjou
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, CA, USA
| | - Kailas Vodrahalli
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Roberto A. Novoa
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
- Department of Pathology, Stanford School of Medicine, Stanford, CA, USA
| | - Melissa Jenkins
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Weixin Liang
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Veronica Rotemberg
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin Ko
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Susan M. Swetter
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Elizabeth E. Bailey
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Olivier Gevaert
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, CA, USA
| | - Pritam Mukherjee
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, CA, USA
| | - Michelle Phung
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Kiana Yekrang
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Bradley Fong
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Rachna Sahasrabudhe
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Johan A. C. Allerup
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | | | - James Zou
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
- Department of Computer Science, Stanford University, Stanford, CA, USA
- Chan-Zuckerberg Biohub, San Francisco, CA, USA
| | - Albert S. Chiou
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
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Jiang SW, Flynn MS, Kwock JT, Nicholas MW. Store-and-Forward Images in Teledermatology: Narrative Literature Review. JMIR DERMATOLOGY 2022; 5:e37517. [PMID: 35891983 PMCID: PMC9302578 DOI: 10.2196/37517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Store-and-forward (SAF) teledermatology uses electronically stored information, including patient photographs and demographic information, for clinical decision-making asynchronous to the patient encounter. The integration of SAF teledermatology into clinical practice has been increasing in recent years, especially during the COVID-19 pandemic. Despite this growth, data regarding the outcomes of SAF teledermatology are limited. A key distinction among current literature involves comparing the quality and utility of images obtained by patients and trained clinicians, as these metrics may vary by the clinical expertise of the photographer. Objective This narrative literature review aimed to characterize the outcomes of SAF teledermatology through the lens of patient- versus clinician-initiated photography and highlight important future directions for and challenges of the field. Methods A literature search of peer-reviewed research was performed between February and April 2021. Key search terms included patient-initiated, patient-submitted, clinician-initiated, clinician-submitted, store-and-forward, asynchronous, remote, image, photograph, and teledermatology. Only studies published after 2001 in English were included. In total, 47 studies were identified from the PubMed electronic database and Google Scholar after omitting duplicate articles. Results Image quality and diagnostic concordance are generally lower and more variable with patient-submitted images, which may impact their decision-making utility. SAF teledermatology can improve the efficiency of and access to care when photographs are taken by either clinicians or patients. The clinical outcomes of clinician-submitted images are comparable to those of in-person visits in the few studies that have investigated these outcomes. Coinciding with the onset of the COVID-19 pandemic, asynchronous teledermatology helped minimize unnecessary in-person visits in the outpatient setting, as many uncomplicated conditions could be adequately managed remotely via images captured by patients and referring clinicians. For the inpatient setting, SAF teledermatology minimized unnecessary contact during dermatology consultations, although current studies are limited by the heterogeneity of their outcomes. Conclusions In general, photographs taken by trained clinicians are higher quality and have better and more relevant diagnostic and clinical outcomes. SAF teledermatology helped clinicians avoid unnecessary physical contact with patients in the outpatient and inpatient settings during the COVID-19 pandemic. Asynchronous teledermatology will likely play a greater role in the future as SAF images become integrated into synchronous teledermatology workflows. However, the obstacles summarized in this review should be addressed before its widespread implementation into clinical practice.
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Affiliation(s)
- Simon W Jiang
- Department of Dermatology Duke University School of Medicine Durham, NC United States
| | - Michael Seth Flynn
- Department of Dermatology Duke University School of Medicine Durham, NC United States
| | - Jeffery T Kwock
- Department of Dermatology Duke University School of Medicine Durham, NC United States
| | - Matilda W Nicholas
- Department of Dermatology Duke University School of Medicine Durham, NC United States
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20
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Olteanu C, Motamedi M, Hersthammer J, Azer B, Rao J. Implementation of Teledermatology in Alberta, Canada: A Report of One Thousand Cases. J Cutan Med Surg 2022; 26:477-484. [PMID: 35801350 PMCID: PMC9476229 DOI: 10.1177/12034754221108990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Teledermatology utilizes photoimaging and background information to allow dermatologists to remotely provide a diagnosis to practitioners. ConsultDerm is an asynchronous, web-based teledermatology software that allows practitioners to submit their electronic referrals for assessment by board-certified dermatologists. Objective Our study aimed to retrospectively analyze teledermatology’s utilization in Canada by using the teledermatology platform ConsultDerm. Methods After implementing inclusion criteria, 1000 patients were selected, and relevant demographic and clinical information were extracted for data analysis. In addition, an online survey with pre-formulated questions was distributed to 7 dermatologists currently using the ConsultDerm platform to determine their experience in utilizing teledermatology. Results Of the 1000 patients, 66.5% had not received treatment prior to their teledermatology referral, and on average, patients experienced symptoms for 489.5 days prior to their referral. Diagnoses made were categorized by conditions, most common being dermatitis (37.1%), followed by acneiform conditions (10.6%), benign lesions/neoplasms (12.1%), infections (9.4%), and dyspigmentation (3.1%). Most consults originated from small population centers, and the referring practitioners were predominantly family physicians. Dermatologists utilizing the platform expressed ease of use, however, areas of improvement were identified such as increasing the quality of imaging and more detailed patient history. Conclusion Through our analysis of 1000 cases, we identified how a teledermatology consultation could be used to assess a wide variety of cutaneous conditions, improving access for patients who may face barriers to seeing a dermatologist.
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Affiliation(s)
- Cristina Olteanu
- 3158 Division of Dermatology, University of Alberta, Edmonton, Canada
| | - Melika Motamedi
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | | | - Brandon Azer
- Faculty of Sciences, University of Alberta, Edmonton, Canada
| | - Jaggi Rao
- 3158 Division of Dermatology, University of Alberta, Edmonton, Canada
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21
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Sun MD, Kentley J, Wilson BW, Soyer HP, Curiel-Lewandrowski CN, Rotemberg V, Halpern AC. Digital skin imaging applications, part I: Assessment of image acquisition technique features. Skin Res Technol 2022; 28:623-632. [PMID: 35652379 PMCID: PMC9907654 DOI: 10.1111/srt.13163] [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: 12/31/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rapid adoption of digital skin imaging applications has increased the utilization of smartphone-acquired images in dermatology. While this has enormous potential for scaling the assessment of concerning skin lesions, the insufficient quality of many consumer/patient-taken images can undermine clinical accuracy and potentially harm patients due to lack of diagnostic interpretability. We aim to characterize the current state of digital skin imaging applications and comprehensively assess how image acquisition features address image quality. MATERIALS AND METHODS Publicly discoverable mobile, web, and desktop-based skin imaging applications, identified through keyword searches in mobile app stores, Google Search queries, previous teledermatology studies, and expert recommendations were independently assessed by three reviewers. Applications were categorized by primary audience (consumer-facing, nonhospital-based practice, or enterprise/health system), function (education, store-and-forward teledermatology, live-interactive teledermatology, electronic medical record adjunct/clinical imaging storage, or clinical triage), in-app connection to a healthcare provider (yes or no), and user type (patient, provider, or both). RESULTS Just over half (57%) of 191 included skin imaging applications had at least one of 14 image acquisition technique features. Those that were consumer-facing, intended for educational use, and designed for both patient and physician users had significantly greater feature richness (p < 0.05). The most common feature was the inclusion of text-based imaging tips, followed by the requirement to submit multiple images and body area matching. CONCLUSION Very few skin imaging applications included more than one image acquisition technique feature. Feature richness varied significantly by audience, function, and user categories. Users of digital dermatology tools should consider which applications have standardized features that improve image quality.
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Affiliation(s)
- Mary D Sun
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Dermatology Service, Memorial Sloan Kettering, New York, New York, USA
| | | | - Britney W Wilson
- Dermatology Service, Memorial Sloan Kettering, New York, New York, USA.,Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | | | | | - Allan C Halpern
- Dermatology Service, Memorial Sloan Kettering, New York, New York, USA
| | -
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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22
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Daneshjou R. Toward Augmented Intelligence: The First Prospective, Randomized Clinical Trial Assessing Clinician and Artificial Intelligence Collaboration in Dermatology. J Invest Dermatol 2022; 142:2301-2302. [PMID: 35659393 DOI: 10.1016/j.jid.2022.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 01/10/2023]
Abstract
Han et al. (2022) report the first randomized, prospective clinical trial in dermatology evaluating the performance of clinicians working in collaboration with artificial intelligence (AI). This foundational work shows the limitations of AI in a real-world clinical setting and shows its potential for improving the performance of nonspecialists diagnosing skin diseases.
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Affiliation(s)
- Roxana Daneshjou
- Department of Dermatology, Stanford University, California, USA; Department of Biomedical Data Science, Stanford University, California, USA.
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23
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Mocharnuk J, Lockard T, Georgesen C, English JC. Inpatient Teledermatology: a Review. CURRENT DERMATOLOGY REPORTS 2022; 11:52-59. [PMID: 35402084 PMCID: PMC8976271 DOI: 10.1007/s13671-022-00360-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
Purpose of Review Inpatient teledermatology is a rapidly growing field with significant potential to add value and streamline patient care. This review summarizes the current literature on inpatient teledermatology, primarily focusing on its diagnostic and clinical management utility as compared to live dermatologic evaluation. Recent Findings The COVID-19 pandemic has accelerated the adoption of inpatient teledermatology, which has been shown to be comparable to live hospitalist evaluation for triage, diagnosis, and management of hospitalized patients for a wide variety of conditions. Despite its comparative cost-effectiveness and recent changes in reimbursement practices, inpatient teledermatology still lacks sufficient reimbursement incentive for widespread implementation. Summary Inpatient teledermatology is an effective, efficient, accurate, and cost-effective means of managing the hospital burden of skin disease, especially in areas where access to dermatologic care is limited. It is essential that dermatologists and referring providers comprehend the use and potential pitfalls of inpatient teledermatology to effectively incorporate it into hospital practice.
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24
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Paudel V. Patterns and Barriers of Teledermatology in Resource Limited Settings in COVID-19 Pandemic: A Descriptive Cross-sectional Survey of Nepalese Dermatologists. JAAD Int 2022; 7:62-66. [PMID: 35281323 PMCID: PMC8901366 DOI: 10.1016/j.jdin.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Objective Methods Results Limitations Conclusion
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25
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Elsaie ML, Shehata HA, Hanafi NS, Ibrahim SM, Ibrahim HS, Abdelmaksoud A. Egyptian dermatologists attitude toward telemedicine amidst the COVID19 pandemic: a cross-sectional study. J DERMATOL TREAT 2022; 33:1067-1073. [PMID: 32723123 DOI: 10.1080/09546634.2020.1800576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Telemedicine involves distant exchange of medical information between health providers and patients via a telecommunication device with/without the aid of an audiovisual interactive assistance. The current COVID 19 pandemic impact on health services mandated an utmost readiness to implement telemedicine which in part is dependent on health care providers willingness to adopt such platforms. AIM The aim of this cross sectional study was to assess knowledge and attitude toward telemedicine Egyptian dermatologists amidst the COVID 19 pandemic. PATIENTS AND METHODS A cross sectional study was designed and data were collected using structured self-administered online questionnaires. RESULTS Dermatologists had a good knowledge about telemedicine (mean 4.17 ± 1.63; p < .05). Of those completing the questionnaire, 193 (68.9%) were familiar with the term 'telemedicine' and 164 (58.6%) were familiar with tools like teleconferencing. The majority of responding dermatologists 227 (81.1%) were confident that the COVID 19 pandemic is a good opportunity to start applying telemedicine protocols however the majority 234 (83.6%) preferred using it on trial basis at first before full implementation. CONCLUSION In conclusion an overall good attitude toward telemedicine was reported with a mean of 3.39 (p < .05). Further large scale studies are required to verify such findings.
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Affiliation(s)
- Mohamed L Elsaie
- Department of Dermatology, National Research Centre, Cairo, Egypt
| | - Hany A Shehata
- Department of Dermatology, National Research Centre, Cairo, Egypt
| | - Noha S Hanafi
- Department of Dermatology, National Research Centre, Cairo, Egypt
| | - Shady M Ibrahim
- Department of Dermatology, Al Azhar University, Cairo, Egypt
| | - Hany S Ibrahim
- Department of Dermatology, Al Azhar University, Cairo, Egypt
| | - Ayman Abdelmaksoud
- Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt
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26
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López-Liria R, Valverde-Martínez MÁ, López-Villegas A, Bautista-Mesa RJ, Vega-Ramírez FA, Peiró S, Leal-Costa C. Teledermatology versus Face-to-Face Dermatology: An Analysis of Cost-Effectiveness from Eight Studies from Europe and the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2534. [PMID: 35270227 PMCID: PMC8909884 DOI: 10.3390/ijerph19052534] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: The aim of this systematic review was to compare the cost-effectiveness of two follow-up methods (face-to-face and telemedicine) used in dermatology in the last ten years. (2) Methods: A search for articles that included economic analyses was conducted in August 2021 in the databases PubMed, Medline, Scielo and Scopus using the following keywords: "Cost-Benefit Analysis", "Dermatology", "Telemedicine", "Primary Health Care", as well as other search terms and following the PICOS eligibility criteria. (3) Results: Three clinical trials and five observational studies were analyzed, providing information for approximately 16,539 patients (including four cost-minimization or saving analyses, three cost-effectiveness analyses, and one cost-utility analysis) in Europe and the United States. They describe the follow-up procedures in each of the cases and measure and analyze the direct and indirect costs and effectiveness. All the articles indicate that teledermatology lowers costs and proves satisfactory to both patients and professionals. (4) Conclusions: Although it has been found that follow-up via teledermatology can be more efficient than traditional hospital follow-up, more work is needed to establish evaluation protocols and procedures that measure key variables more equally and demonstrate the quality of the evidence of said studies.
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Affiliation(s)
- Remedios López-Liria
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almeria, Spain; (R.L.-L.); (M.Á.V.-M.)
| | - María Ángeles Valverde-Martínez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almeria, Spain; (R.L.-L.); (M.Á.V.-M.)
| | - Antonio López-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Poniente Hospital, 04700 El Ejido, Spain
| | | | | | - Salvador Peiró
- Health Services Research Unit, FISABIO-Public Health, 46020 Valencia, Spain;
| | - Cesar Leal-Costa
- Nursing Department, University of Murcia, 30120 El Palmar, Spain;
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27
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Nikolakis G, Baroud S, Georgopoulos I, Appel L, Zouboulis CC. Teledermatologie: Fluch oder Segen? AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1645-9932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungTeledermatologische Dienste haben sich insbesondere während der COVID-19-Pandemie als Alternative zu „Echt“visiten verbreitet. Der Mangel an Dermatologen und die Möglichkeit einer präzisen Diagnose auch bei unterversorgten Regionen macht diese Alternative für alle Beteiligten besonders attraktiv. Trotzdem ist der Bedarf an Schulungen des Personals und der Anwender hoch. Ebenfalls können Implementierungs-, Instandhaltungs- und Wartungskosten der notwendigen Ausrüstung und die Heterogenität der unterschiedlichen Anbieter nachteilig für Patient und Arzt sein. In diesem Artikel werden wesentliche Vorteile und Nachteile der Teledermatologie zusammengefasst.
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Affiliation(s)
- Georgios Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
| | - Sumer Baroud
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
- Sharjah Universität, Sharjah, Vereinigte Arabische Emirate
| | - Ioannis Georgopoulos
- Klinik für Chirurgie, Allgemeines Pädiatrisches Krankenhaus Agia Sofia, Athen, Griechenland
- DOCANDU LTD, London, Vereinigtes Königreich
| | - Lena Appel
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
- Medizinisches Versorgungszentrum des Städtischen Klinikums Dessau, Dessau, Deutschland
| | - Christos C. Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
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28
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Wang RH, Barbieri JS, Kovarik CL, Lipoff JB. Synchronous and asynchronous teledermatology: A narrative review of strengths and limitations. J Telemed Telecare 2022; 28:533-538. [PMID: 35108130 DOI: 10.1177/1357633x221074504] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The policy changes prompted by the COVID-19 pandemic caused synchronous models (primarily video visits) to supplant asynchronous models (store-and-forward or shared digital photographs) as the default and predominant modality of teledermatology care. Here, we call attention to the unique strengths and limitations of these models in terms of clinical utility, accessibility, and cost-effectiveness. Strengths of synchronous visits include direct physician-patient interaction and current reimbursement parity; limitations include variable video image quality, technological difficulties, and accessibility barriers. Strengths of asynchronous visits include greater convenience, especially for clinicians, and potential for image quality superior to video; limitations include less direct physician-patient communication, barriers to follow-up, and limited reimbursement. Both synchronous and asynchronous models have been shown to be cost-effective. Teledermatology is positioned to play a prominent role in patient care post-pandemic. Moving forward, dermatologists are challenged to optimize teledermatology use in order to improve outcomes, efficiency, and workflows to meet diverse patient needs. Future directions will depend on sustainable reimbursement of both teledermatology formats by government and private payers.
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Affiliation(s)
- Robin H Wang
- 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John S Barbieri
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jules B Lipoff
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,43358Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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29
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Cheng YW, Wu CY, Wang BC, Lan KC, Ou SY, Lin LM, Liao HC, Wang CC, Lee CH. A Desperate Need for Psoriasis Health Care in Remote Regions as Revealed by a Live Interactive Teledermatology Program Serving Penghu Islands in Taiwan Strait. Telemed J E Health 2021; 28:1109-1116. [PMID: 34941459 DOI: 10.1089/tmj.2021.0349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Several studies indicated that teledermatology is good for people living on offshore islands. However, what disease benefits the most from interactive dermatology geographically in offshore islands remain uncertain. Objectives: This study aimed to investigate the seasonal and geographical distribution with different diseases in remote regions of Penghu islands in Taiwan Strait, thus to study the medical needs for specific disease in remote islands. The cost differences among three models by professional dermatologists were analyzed. Methods: This interactive teledermatology program serving Penghu Hospital, Ministry of Health and Welfare (MOHW-PH, March 2020 to February 2021) from a medical center in Taiwan recruited 145 patients with 280 patient-visits. The seasons, the timing from residential houses to MOHW-PH, the number of disease diagnosis, and the numbers of teledermatology visits are compared. The association of the distance from residential houses to MOHW-PH with different disease diagnosis was analyzed. Results: Eczema (33%), dermatophytosis (13%), and psoriasis (11%) were most common. Seasonal analysis showed dermatophytosis and eczema are more common in summer and winter, respectively. Geographical analysis showed that psoriasis has relatively higher case numbers, higher visits per case, with cases living in longer distances. The patient satisfaction was good (>95%). Among the three care modes of dermatologist, the cost estimation of interactive teledermatology and in-person clinic were similar yearly (2.4-2.9 million New Taiwan Dollars, roughly 80,000-90,000 USD). Conclusions: The study indicates that health care for psoriasis, being underprivileged but in desperate need in distant regions, could be delivered with quality and satisfaction by interactive teledermatology.
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Affiliation(s)
- Yu-Wen Cheng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chia-Ying Wu
- Administrative Office, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Bing-Chang Wang
- Penghu Hospital, Ministry of Health and Welfare, Penghu, Taiwan
| | - Kuo-Chung Lan
- Administrative Office, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Su-Yun Ou
- Penghu Hospital, Ministry of Health and Welfare, Penghu, Taiwan
| | - Li-Man Lin
- Administrative Office, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hung-Chang Liao
- Penghu Hospital, Ministry of Health and Welfare, Penghu, Taiwan
| | - Chih-Chi Wang
- Administrative Office, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan
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30
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Castillo F, Peracca S, Oh DH, Twigg AR. The Utilization and Impact of Live Interactive and Store-and-Forward Teledermatology in a Veterans Affairs Medical Center During the COVID-19 Pandemic. Telemed J E Health 2021; 28:1186-1192. [PMID: 34919470 DOI: 10.1089/tmj.2021.0275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Teledermatology has emerged as a promising method of continuing dermatologic care during the coronavirus 2019 (COVID-19) pandemic, including in the Department of Veterans Affairs (VA). Analysis of the utilization and impact of teledermatology within the San Francisco Veterans Affairs Health Care System (SFVAHCS) may elucidate the ways that teledermatology programs can continue to be optimized. Methods: We conducted a retrospective analysis of live interactive encounters, Veterans Affairs Video Connect (VVC), store-and-forward telehealth (SFT), and face-to-face (FTF) consultations, performed within the SFVAHCS from March 2020 to December 2020. To assess utilization, we analyzed numbers of encounters throughout 2020. To assess impact, we analyzed primary diagnoses for each encounter and rates of recommendations for medications and lesion biopsies. Additionally, we assessed diagnostic accuracy associated with each teledermatology type by measuring concordance between teledermatologists' clinical diagnoses and histopathological diagnoses. Results: Two thousand two hundred fifty FTF, 347 VVC, and 470 SFT encounters were conducted from March to December 2020. More female patients utilized VVC, and patients who utilized VVC were younger than SFT and FTF users (p < 0.01). SFT was utilized more by patients from rural areas (p < 0.01). Diagnoses addressed were significantly different between VVC and SFT. A majority of VVC encounters involved referrals for inflammatory conditions; primary diagnoses associated with SFT consultations were most frequently neoplasms. Comparison of VVC and SFT outcomes showed that more VVC visits resulted in a medication recommendation, while more SFT consultations resulted in a biopsy recommendation. Conclusions: Teledermatology contributed to meeting patient needs throughout 2020 and created an impact on clinical management. Patient characteristics, diagnoses, and type of impact associated with encounters varied between SFT and VVC. This analysis provides insight into teledermatology utilization within the VA system and can contribute to efforts to improve the quality of teledermatology care for veterans.
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Affiliation(s)
- Francine Castillo
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Sara Peracca
- Dermatology Research Unit, San Francisco VA Health Care System, San Francisco, California, USA
| | - Dennis H Oh
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA.,Dermatology Research Unit, San Francisco VA Health Care System, San Francisco, California, USA
| | - Amanda R Twigg
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA.,Dermatology Research Unit, San Francisco VA Health Care System, San Francisco, California, USA
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31
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Skudalski L, Waldman R, Kerr PE, Grant-Kels JM. Melanoma: How and When to Consider Clinical Diagnostic Technologies. J Am Acad Dermatol 2021; 86:503-512. [PMID: 34915058 DOI: 10.1016/j.jaad.2021.06.901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
In response to rising rates of melanoma worldwide, novel non-invasive melanoma detection techniques are emerging to facilitate the early detection of melanoma and decrease unnecessary biopsies of benign pigmented lesions. Because they often report similar study findings, it may be difficult to determine how best to incorporate these technologies into clinical practice based on their supporting studies alone. As an expansion of the recent article by Fried et al.1, which reviewed the clinical data supporting these non-invasive melanoma detection techniques, the first article in this continuing medical education series provides practical advice on how and when to use various non-invasive melanoma detection techniques into clinical practice.
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Affiliation(s)
- Lauren Skudalski
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Reid Waldman
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Philip E Kerr
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA.
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32
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Remote Skin Cancer Diagnosis: Adding Images to Electronic Referrals Is More Efficient Than Wait-Listing for a Nurse-Led Imaging Clinic. Cancers (Basel) 2021; 13:cancers13225828. [PMID: 34830982 PMCID: PMC8616500 DOI: 10.3390/cancers13225828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Skin cancer is a significant cause of death and disability, particularly in New Zealand. Expert diagnosis reduces unnecessary excision of benign lesions, reduces patient anxiety, and allows early identification of skin cancer, particularly of melanoma. The study assessed an electronic referral pathway for teledermatology—diagnosing skin lesions remotely using a standardised template with regional, close-up, and dermoscopic images—and compared this to scheduled nurse-led teledermoscopy clinics. A dermatology opinion was reached more rapidly with comparable efficacy when referrals include good quality images, compared to nurse-led imaging clinics. Abstract We undertook a retrospective comparison of two teledermatology pathways that provide diagnostic and management advice for suspected skin cancers, to evaluate the time from referral to diagnosis and its concordance with histology. Primary Care doctors could refer patients to either the Virtual Lesion Clinic (VLC), a nurse-led community teledermoscopy clinic or, more recently, to the Suspected Skin Cancer (SSC) pathway, which requires them to attach regional, close-up, and dermoscopic images. The primary objective of this study was to determine the comparative time course between the SSC pathway and VLC. Secondary objectives included comparative diagnostic concordance, skin lesion classification, and evaluation of missed skin lesions during subsequent follow-up. VLC referrals from July to December 2016 and 2020 were compared to SSC referrals from July to December 2020. 408 patients with 682 lesions in the VLC cohort were compared with 480 patients with 548 lesions from the 2020 SSC cohort, matched for age, sex, and ethnicity, including histology where available. Median time (SD) from referral to receipt of teledermatology advice was four (2.8) days and 50 (43.0) days for the SSC and VLC cohorts, respectively (p < 0.001). Diagnostic concordance between teledermatologist and histopathologist for benign versus malignant lesions was 70% for 114 lesions in the SSC cohort, comparable to the VLC cohort (71% of 122 lesions). Referrals from primary care, where skin lesions were imaged with variable devices and quality resulted in faster specialist advice with similar diagnostic performance compared to high-quality imaging at nurse-led specialist dermoscopy clinics.
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Mahmood F, Cyr J, Keely E, Afkham A, Gugiani S, Walker J, DesGroseilliers JP, Kirshen C. Teledermatology Utilization and Integration in Residency Training Over the COVID-19 Pandemic. J Cutan Med Surg 2021; 26:135-142. [PMID: 34551623 PMCID: PMC8950709 DOI: 10.1177/12034754211045393] [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] [Indexed: 12/16/2022]
Abstract
Background During the 2019 Coronavirus (COVID-19) pandemic, the Division of Dermatology, University of Ottawa, adapted pre-existing local healthcare infrastructures to provide increased provider-to-provider teledermatology services as well as integrated teledermatology into the dermatology residency training program. Objectives (1) To assess the differences in utilization of provider-to-provider teledermatology services before and during the COVID-19 pandemic; and (2) to assess dermatology resident and faculty experiences with the integration of teledermatology into dermatology residency training at the University of Ottawa. Methods We conducted a cross-sectional analysis comparing provider-to-provider teledermatology consults submitted to dermatologists from April 2019 to October 2019 pre-pandemic with the same period during the pandemic in 2020. Two different questionnaires were also disseminated to the dermatology residents and faculty at our institution inquiring about their perspectives on teledermatology, education, and practice. Results The number of dermatologists completing consults, the number of providers submitting a case to Dermatology, and the number of consults initiated all increased during the pandemic period. Ninety-one percent of residents agreed that eConsults and teledermatology enhanced their residency education, enabled continuation of training during the pandemic, and that eConsult-based training should be incorporated into the curriculum. Ninety-six percent of staff incorporated a virtual dermatology practice model, and one-third used teledermatology with residents during the pandemic. Most staff felt there was value in providing virtual visits in some capacity during the pandemic. Conclusions Our study confirms that the use of teledermatology services continues to increase accessibility during the pandemic. Teledermatology enhances the education and training of residents and will be incorporated into dermatology residency programs.
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Affiliation(s)
- Farhan Mahmood
- 6363 Faculy of Medicine, University of Ottawa, ON, Canada
| | - Janelle Cyr
- Division of Dermatology, Department of Medicine, The Ottawa Hospital, ON, Canada
| | - Erin Keely
- Division of Endocrinology/Metabolism, Department of Medicine, The Ottawa Hospital, ON, Canada
| | - Amir Afkham
- 104255 The Champlain Local Health Integration Network, Ottawa, ON, Canada
| | - Sheena Gugiani
- 104255 The Champlain Local Health Integration Network, Ottawa, ON, Canada
| | - Jim Walker
- Division of Dermatology, Department of Medicine, The Ottawa Hospital, ON, Canada
| | | | - Carly Kirshen
- Division of Dermatology, Department of Medicine, The Ottawa Hospital, ON, Canada
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Abstract
Purpose of Review The use of teledermatology has been evolving slowly for the delivery of health care to remote and underserved populations. Improving technology and the recent COVID-19 pandemic have hastened its use internationally. Recent Findings Some barriers to the use of teledermatology have fallen considerably in the last year. Summary Teledermatology use has increased significantly in recent years in both government-sponsored and private health care systems and individual practices. There are no recognized international practice guidelines and variable use within countries. Many barriers remain to increasing the use of teledermatology.
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Teledermatology Addressing Disparities in Health Care Access: a Review. CURRENT DERMATOLOGY REPORTS 2021; 10:40-47. [PMID: 33747638 PMCID: PMC7953516 DOI: 10.1007/s13671-021-00329-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
Purpose of Review Dermatologists have been at the forefront of researching telemedicine to expand access to care. The current COVID-19 pandemic has prompted even greater expansion and implementation of teledermatology. This review discusses the research examining the potential impact of teledermatology addressing disparities in care. Recent Findings Teledermatology appears to increase access to dermatology given expanded means to deliver care. Specifically, recent studies have found increased access among Medicaid-insured, resource-poor urban and rural, and elderly populations. Teledermatology implementation also facilitates education among providers at different levels of training. Still, as some patients have inconsistent access to the required technology, increased reliance on telemedicine may also potentially increase disparities for some populations. Summary Teledermatology may serve to reduce disparities in health care access in many underserved and marginalized communities. Future research should continue to study implementation, especially given the expansion during the COVID-19 pandemic. Ultimately, teledermatology may play an important role in ensuring equitable care access for all.
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Samuels-Kalow M, Jaffe T, Zachrison K. Digital disparities: designing telemedicine systems with a health equity aim. Emerg Med J 2021; 38:474-476. [PMID: 33674277 DOI: 10.1136/emermed-2020-210896] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/13/2021] [Accepted: 02/14/2021] [Indexed: 11/03/2022]
Abstract
The use of telemedicine has grown immensely during the COVID-19 pandemic. Telemedicine provides a means to deliver clinical care while limiting patient and provider exposure to the COVID-19. As such, telemedicine is finding applications in a variety of clinical environments including primary care and the acute care setting and the array of patient populations who use telemedicine continues to grow. Yet as telehealth becomes ubiquitous, it is critical to consider its potential to exacerbate disparities in care. Challenges accessing technology and digital literacy, for example, disproportionately impact older patients and those living in poverty. When implemented with the consideration of health disparities, telemedicine provides an opportunity to address these inequities. This manuscript explores potential mechanisms by which telemedicine may play a role in exacerbating or ameliorating disparities in care. We further describe a framework and suggested strategies with which to implement telemedicine systems to improve health equity.
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Affiliation(s)
| | - Todd Jaffe
- Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kori Zachrison
- Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Clarke EL, Reichenberg JS, Ahmed AM, Keeling B, Custer J, Rathouz PJ, Jambusaria-Pahlajani A. The utility of teledermatology in the evaluation of skin lesions. J Telemed Telecare 2021; 29:382-389. [PMID: 33461401 DOI: 10.1177/1357633x20987423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Past studies have shown mixed results about the accuracy of store-and-forward (SAF) teledermatology in the evaluation of skin lesions. The objective of this study is to determine the accuracy of SAF teledermatology in the diagnosis of skin lesions and biopsy decision compared to in-person clinical evaluation. METHODS Histories and photographs of skin lesions gathered at clinic visits were sent as SAF consults to teledermatologists, whose diagnoses and biopsy decisions were recorded and compared statistically to the clinic data.Results and Discussion: We enrolled 206 patients with 308 lesions in the study. The study population was composed of 50% males (n = 104), and most patients were white (n = 179, 87%) and not Hispanic/Latino (n = 167, 81%). There was good concordance for biopsy decision between the clinic dermatologist (CD) and teledermatologist (TD) (Cohen's kappa (κ) = 0.51), which did not significantly differ when melanocytic lesions were excluded (κ = 0.54). The sensitivity and specificity of teledermatology based on biopsy decision was 0.71 and 0.85, respectively. Overall concordance in first diagnosis between the CD and TD was good (κ = 0.60). While there was no difference between CD and TD in proportion of correct diagnoses compared to histopathology, two skin cancers presentations were missed by TD. Study limitations included sample size, enrolment bias and differing amounts of teledermatologist case experience. Teledermatology has good concordance in diagnosis and biopsy decision when compared to clinic dermatology. Teledermatology may be utilized in the evaluation of skin lesions to expand access to dermatologic care.
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Affiliation(s)
- Emily L Clarke
- Dell Medical School at the University of Texas at Austin, USA
| | - Jason S Reichenberg
- Division of Dermatology, Dell Medical School at the University of Texas at Austin, USA
| | - Ammar M Ahmed
- Division of Dermatology, Dell Medical School at the University of Texas at Austin, USA
| | - Brett Keeling
- Division of Dermatology, Dell Medical School at the University of Texas at Austin, USA
| | - James Custer
- Department of Population Health, Dell Medical School at the University of Texas at Austin, USA
| | - Paul J Rathouz
- Department of Population Health, Dell Medical School at the University of Texas at Austin, USA
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Giavina-Bianchi M, Santos AP, Cordioli E. Teledermatology reduces dermatology referrals and improves access to specialists. EClinicalMedicine 2020; 29-30:100641. [PMID: 33437950 PMCID: PMC7788431 DOI: 10.1016/j.eclinm.2020.100641] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Teledermatology may be used for triage in primary care to address skin conditions, improving access and reducing time to treat the most severe or surgical cases. We aimed to evaluate the proportion of individuals who could be assessed in primary care using teledermatology, and how this affected the waiting time for an in-person dermatologist appointment. METHODS A cross-sectional retrospective study, involving 30,976 individuals and 55,624 skin lesions, was performed from July 2017 to July 2018 We assessed the frequency of diagnoses and referrals to biopsy, to in-person dermatologists, or to primary care, and compared the waiting time for an in-person dermatologist appointment before and after the teledermatology implementation. FINDINGS 53% of the patients were managed with the primary care physician, 43% were referred to in-person dermatologists and 4% directly to biopsy, leading to a reduction of 78% in the waiting time for in-person appointments when compared to the previous period. The most frequent diseases were: melanocytic nevus, seborrheic keratosis, acne, benign neoplasms, onychomycosis, atopic dermatitis, solar lentigo, melasma, xerosis, and epidermoid cyst, with significant differences according to sex, age and referrals. The most frequent treatment prescribed was emollient. INTERPRETATION The use of teledermatology as a triage tool significantly reduced the waiting time for in-person visits, improving health care access and utilizing public resources wisely. Knowledge of sex, age, diagnoses and treatment of common skin conditions can enable public policies for the prevention and orientation of the population, as it can be used to train general physicians to address such cases. FUNDING None.
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Krueger S, Leonard N, Modest N, Flahive J, Guilarte-Walker Y, Rashighi M, LaChance AH. Identifying trends in patient characteristics and visit details during the transition to teledermatology: Experience at a single tertiary referral center. J Am Acad Dermatol 2020; 85:1592-1594. [PMID: 33253853 DOI: 10.1016/j.jaad.2020.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Steven Krueger
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nicholas Leonard
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nicholas Modest
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Julie Flahive
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Yurima Guilarte-Walker
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Mehdi Rashighi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Avery Heather LaChance
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Asabor EN, Bunick CG, Cohen JM, Perkins SH. Patient and physician perspectives on teledermatology at an academic dermatology department amid the COVID-19 pandemic. J Am Acad Dermatol 2020; 84:158-161. [PMID: 32946971 PMCID: PMC7491373 DOI: 10.1016/j.jaad.2020.09.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Emmanuella Ngozi Asabor
- Yale School of Medicine, Yale University, New Haven, Connecticut; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Christopher G Bunick
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Sara H Perkins
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut.
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Present status and prospect of skin imaging equipment in some public hospitals in China. Chin Med J (Engl) 2020; 133:2129-2131. [PMID: 32769496 PMCID: PMC7478482 DOI: 10.1097/cm9.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Dahy A, El-Qushayri AE, Mahmoud AR, Al-Kelany TA, Salman S. Telemedicine approach for psoriasis management, time for application? A systematic review of published studies. Dermatol Ther 2020; 33:e13908. [PMID: 32592525 DOI: 10.1111/dth.13908] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 01/29/2023]
Abstract
Psoriasis is a common chronic inflammatory skin condition. It has a chronic course with multiple evolving relapses and patients require long-term treatment and follow-up. Teledermatology was introduced for diagnosis, treatment and follow-up of chronic diseases. Thus, we performed a systematic review for collecting the evidence regarding the efficacy of telemedicine in psoriasis management. Out of 287 records, we included seven studies (four of which were randomized controlled trials). We found that telemedicine alone or combined with usual care had the same or higher efficacy of psoriasis management compared to usual care or control group. We recommend further studies for assessing the pros and cons of this intervention which can replace conventional strategies especially in pandemic times.
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Affiliation(s)
| | | | | | | | - Samar Salman
- Faculty of Medicine, Department of Dermatology and Venereology, Tanta University Hospital, Tanta University, Tanta, Egypt
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Marin-Gomez FX, Vidal-Alaball J, Poch PR, Sariola CJ, Ferrer RT, Peña JM. Diagnosis of Skin Lesions Using Photographs Taken With a Mobile Phone: An Online Survey of Primary Care Physicians. J Prim Care Community Health 2020; 11:2150132720937831. [PMID: 32590923 PMCID: PMC7328057 DOI: 10.1177/2150132720937831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Skin conditions are one of the most frequent reasons for visiting a primary
health care facility, making it of vital importance that general practitioners
(GPs) have the right knowledge and tools to diagnose the most frequent
dermatological conditions. Methods: This study evaluates the
accuracy of dermatological diagnoses made by 120 GPs based on photographs taken
with a smartphone by an anonymous online cross-sectional survey.
Results: The study was carried out between August and October
2018. The results show that the majority of the participants are in favor of
using mobile phones to communicate with other professionals and use them to
consult medical images. The majority (69%) took dermatological photographs and
the preferred device was a smartphone (70%). From 22 different images evaluated,
in 69% of responses, participants expressed a high degree of confidence in their
ability to diagnose the lesion shown and in 72% of the cases, the diagnosis
chosen was correct. Conclusions: The study confirms that the use of
smartphone to send medical images is growing rapidly and its potential for
taking medical images is an opportunity to help primary care teams deal with
dermatological problems. The results suggest that GPs need further training in
interpreting dermatological images, to increase their diagnostic confidence and
to avoid the need for referrals to face-to-face visits.
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Affiliation(s)
- Francesc X Marin-Gomez
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Josep Vidal-Alaball
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Pere Roura Poch
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | | | | | - Jacobo Mendioroz Peña
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
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Rinner C, Kittler H, Rosendahl C, Tschandl P. Analysis of Collective Human Intelligence for Diagnosis of Pigmented Skin Lesions Harnessed by Gamification Via a Web-Based Training Platform: Simulation Reader Study. J Med Internet Res 2020; 22:e15597. [PMID: 32012058 PMCID: PMC7007585 DOI: 10.2196/15597] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/05/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022] Open
Abstract
Background The diagnosis of pigmented skin lesion is error prone and requires domain-specific expertise, which is not readily available in many parts of the world. Collective intelligence could potentially decrease the error rates of nonexperts. Objective The aim of this study was to evaluate the feasibility and impact of collective intelligence for the detection of skin cancer. Methods We created a gamified study platform on a stack of established Web technologies and presented 4216 dermatoscopic images of the most common benign and malignant pigmented skin lesions to 1245 human raters with different levels of experience. Raters were recruited via scientific meetings, mailing lists, and social media posts. Education was self-declared, and domain-specific experience was tested by screening tests. In the target test, the readers had to assign 30 dermatoscopic images to 1 of the 7 disease categories. The readers could repeat the test with different lesions at their own discretion. Collective human intelligence was achieved by sampling answers from multiple readers. The disease category with most votes was regarded as the collective vote per image. Results We collected 111,019 single ratings, with a mean of 25.2 (SD 18.5) ratings per image. As single raters, nonexperts achieved a lower mean accuracy (58.6%) than experts (68.4%; mean difference=−9.4%; 95% CI −10.74% to −8.1%; P<.001). Collectives of nonexperts achieved higher accuracies than single raters, and the improvement increased with the size of the collective. A collective of 4 nonexperts surpassed single nonexperts in accuracy by 6.3% (95% CI 6.1% to 6.6%; P<.001). The accuracy of a collective of 8 nonexperts was 9.7% higher (95% CI 9.5% to 10.29%; P<.001) than that of single nonexperts, an improvement similar to single experts (P=.73). The sensitivity for malignant images increased for nonexperts (66.3% to 77.6%) and experts (64.6% to 79.4%) for answers given faster than the intrarater mean. Conclusions A high number of raters can be attracted by elements of gamification and Web-based marketing via mailing lists and social media. Nonexperts increase their accuracy to expert level when acting as a collective, and faster answers correspond to higher accuracy. This information could be useful in a teledermatology setting.
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Affiliation(s)
- Christoph Rinner
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Cliff Rosendahl
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Holmes AN, Chansky PB, Simpson CL. Teledermatology Consultation Can Optimize Treatment of Cutaneous Disease by Nondermatologists in Under-Resourced Clinics. Telemed J E Health 2019; 26:1284-1290. [PMID: 31800369 DOI: 10.1089/tmj.2019.0217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Access to dermatologists is limited for disadvantaged patients, who may receive suboptimal dermatologic care from nonspecialists. We assessed if teledermatology could improve primary care provider (PCP)-delivered care for cutaneous disease at a clinic serving uninsured patients. Materials and Methods: Utilizing the American Academy of Dermatology's free AccessDerm program, we offered store-and-forward teledermatology to PCPs, who initiated consultations at will during clinical care independent of the study. We retrospectively analyzed all consultations from 2013 to 2017 and collected patient age/sex, teledermatologist diagnosis, time to teledermatologist reply, time to next dermatology appointment, as well as PCP- and teledermatologist-proposed care plans. Results: Retrospective analysis of 131 consults revealed a 37-h mean teledermatology response-time versus a 14-day appointment wait (p < 0.00001). Teledermatologists provided a definitive care plan without in-person evaluation for 82 (65%) of completed consults and recommended interim treatments while awaiting appointments in 15 cases, thus accelerating care plan delivery in 97 cases (76%). The triage decision rate differed among diagnostic categories; deferral to in-person evaluation was more frequent for neoplasms (p < 0.0001). When PCPs specified preconsult treatment plans, 82% differed from teledermatologist-advised management. Following teledermatologist recommendations would have changed the clinical course in 70% of cases, potentially avoiding suboptimal care, including inappropriate corticosteroids, antimicrobials, and emergency room referrals. Conclusions: We found teledermatology can effectively guide PCPs in resource-limited settings by accelerating delivery of dermatologist-recommended care plans for uninsured patients. Expanding teledermatology for PCPs in under-resourced clinics has the potential to improve treatment of cutaneous disease by nonspecialists and to mitigate suboptimal care for disadvantaged patients.
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Affiliation(s)
- Alexis N Holmes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter B Chansky
- Department of Dermatology, New York University, New York, New York, USA
| | - Cory L Simpson
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wang RF, Trinidad J, Lawrence J, Pootrakul L, Forrest LA, Goist K, Levine E, Nair S, Rizer M, Thomas A, Wexler R, Kaffenberger BH. Improved patient access and outcomes with the integration of an eConsult program (teledermatology) within a large academic medical center. J Am Acad Dermatol 2019; 83:1633-1638. [PMID: 31678336 DOI: 10.1016/j.jaad.2019.10.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/13/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Insurance, racial, and socioeconomic health disparities continue to pose significant challenges for access to dermatologic care. Studies applying teledermatology to increase access to underinsured individuals and ethnic minorities are limited. OBJECTIVE To determine how the implementation of a teledermatology program affects access to health care and patient outcomes. METHODS A cross-sectional evaluation was performed of all ambulatory dermatology referrals and electronic dermatology consultations (eConsults) at Ohio State University within a 25-month period. RESULTS Compared with ambulatory referrals, eConsults served more nonwhite patients (612 of 1698 [36.0%] vs 4040 of 16,073 [25.1%]; P < .001) and more Medicaid enrollees (459 of 1698 patients [27.0%] vs 3266 of 16,073 [20.3%]; P < .001). In addition, ambulatory referral patients were significantly less likely to attend their scheduled appointment compared with eConsult patients, as either "no-shows" (246 of 2526 [9.7%] vs 3 of 62 [4.8%]) or cancellations (742 of 2526 [29.4%] vs 8 of 62 [12.9%]; P = .003). There were fewer median days to extirpation for eConsult patients compared with ambulatory referral patients (interquartile range; 80.7 ± 79.8 vs 116.9 ± 86.6 days; P = .004). CONCLUSION Integrating dermatologic care through a telemedicine system can result in improved access for underserved patients through improved efficiency outcomes.
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Affiliation(s)
- Rebecca F Wang
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John Trinidad
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey Lawrence
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Llana Pootrakul
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - L Arick Forrest
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kevin Goist
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Edward Levine
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shalina Nair
- Department of Family Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Milisa Rizer
- Department of Family Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andrew Thomas
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Randell Wexler
- Department of Family Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio.
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Muslu Ü, Demir E, Kör H, Şenel E. Multidisipliner Teletıp Uygulaması: Cerrahi Öncesi Telecerrahi Tanılarının Histopatoloji İle Karşılaştırılması. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.574816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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