BackgroundInternationally, teledermatology has proven to be a viable alternative to conventional physical referrals. Travel cost and referral times are reduced while patient safety is preserved. Especially patients from rural areas benefit from this healthcare innovation. Despite these established facts and positive experiences from EU neighboring countries like the Netherlands or the United Kingdom, Germany has not yet implemented store-and-forward teledermatology in routine care.MethodsThe TeleDerm study will implement and evaluate store-and-forward teledermatology in 50 general practitioner (GP) practices as an alternative to conventional referrals. TeleDerm aims to confirm that the possibility of store-and-forward teledermatology in GP practices is going to lead to a 15% (n = 260) reduction in referrals in the intervention arm. The study uses a cluster-randomized controlled trial design. Randomization is planned for the cluster “county”. The main observational unit is the GP practice. Poisson distribution of referrals is assumed. The evaluation of secondary outcomes like acceptance, enablers and barriers uses a mixed-methods design with questionnaires and interviews.DiscussionDue to the heterogeneity of GP practice organization, patient management software, information technology service providers, GP personal technical affinity and training, we expect several challenges in implementing teledermatology in German GP routine care. Therefore, we plan to recruit 30% more GPs than required by the power calculation. The implementation design and accompanying evaluation is expected to deliver vital insights into the specifics of implementing telemedicine in German routine care.Trial registrationGerman Clinical Trials Register, DRKS00012944. Registered prospectively on 31 August 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2955-2) contains supplementary material, which is available to authorized users.
Feeding in emergencies has been based on anthropometric measurements that mostly depend on weight measures and tend to focus on shortterm weight gain as its goal. One of the new trends in emergency feeding is to provide feeding therapy at the community where patients are rather than keeping them as inpatients. A community-based feeding program has made the feeding program more sustainable, which is particularly important in the era of protracted emergencies and civil war. Little is known, however, about the impact of nutritional support on long-term neurocognitive development in chronic emergencies. KinderBerg International, eV, has implemented a long-term supplementary feeding program for 6 months after children were discharged from our feeding center. After establishing mother-child bonding before discharge, the children were followed-up for 6 months through monthly visits with anthropometric measurements and neurocognitive assessments. We report our initial findings, which indicate that there are significant continuous gain in both weight and height in children aged 5 years and younger after discharge.
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