BackgroundAlthough store-and-forward teledermatology is increasingly becoming popular, evidence on its effects on efficiency and costs is lacking. The aim of this study, performed in addition to a clustered randomised trial, was to investigate to what extent and under which conditions store-and-forward teledermatology can reduce costs from a societal perspective.MethodsA cost minimisation study design (a model based approach) was applied to compare teledermatology and conventional process costs per dermatology patient care episode. Regarding the societal perspective, total mean costs of investment, general practitioner, dermatologists, out-of-pocket expenses and employer costs were calculated. Uncertainty analysis was performed using Monte Carlo simulation with 31 distributions in the used cost model. Scenario analysis was performed using one-way and two-way sensitivity analyses with the following variables: the patient travel distance to physician and dermatologist, the duration of teleconsultation activities, and the proportion of preventable consultations.ResultsTotal mean costs of teledermatology process were €387 (95%CI, 281 to 502.5), while the total mean costs of conventional process costs were €354.0 (95%CI, 228.0 to 484.0). The total mean difference between the processes was €32.5 (95%CI, -29.0 to 74.7). Savings by teledermatology can be achieved if the distance to a dermatologist is larger (> = 75 km) or when more consultations (> = 37%) can be prevented due to teledermatology.ConclusionsTeledermatology, when applied to all dermatology referrals, has a probability of 0.11 of being cost saving to society.In order to achieve cost savings by teledermatology, teledermatology should be applied in only those cases with a reasonable probability that a live consultation can be prevented.Trail RegistrationThis study is performed partially based on PERFECT D Trial (Current Controlled Trials No.ISRCTN57478950).

Using the chromogenic substrate S-2222, we have optimized and automated an amidolytic assay for heparin. The assay is based on the detection of anti-Xa activity generated by heparin in plasma. The method is reproducible (intra- and interassay CVs of 2.4 and 3.3%, respectively) and reliable in antithrombin III-deficient plasma. Results of this assay, obtained for plasma samples from patients and volunteers treated with heparin, correlate well (r = 0.899) with those of the test for activated partial thromboplastin time. Upon administration of a low-Mr heparinoid (Org 10172) and heparin fragment ( Kabi 2165), however, the activated partial thromboplastin time failed to detect anticoagulant activity, whereas the chromogenic heparin assay revealed anti-Xa activity. This automated amidolytic assay for heparin is therefore suitable not only for monitoring standard therapy with heparin but also for measuring the activity of recently developed heparin fractions.

Summary Objective : To elicit and analyze information needs of patients and primary care physicians (GPs) regarding the information services (static and functional) that a GP's practice website should provide. Methods : To find candidate information services, we conducted a literature search and examined primary care physicians' websites, especially Dutch websites. Semi-structured depth interviews with the stakeholders, Dutch patients and GPs, were done to arrive at a final checklist. We then conducted a survey to elicit the level of importance associated with each service on the checklist. The data underwent statistical analysis and relevant requirements were formulated. The requirements were then validated by interviews. General website quality and usability aspects were elicited from the literature. Results : The research resulted in a checklist of 38 selected information services including their priority ratings for patients and GPs; a discrepancy list between GP and patient priorities; and a requirements document containing information services (14 static and 6 functional), and general quality and usability aspects (8 and 5). Conclusion : The following items occurred in the top 10 of both user groups: general practice information, information of local public health institutions, self-help information, repeat prescription, links to health websites. At the bottom on both priority lists were: links to journals, tests and forums. Dutch GPs are much more selective in terms of which information services to provide on-line. Discrepancy between the two groups concerns on-line services that seem to require a change to the GP's workflow, or those services that are not recognized for reimbursing the GP. Although the Dutch patients' requirements seem to generalize to other patients, the conflict list might depend on the primary care system.

Following subcutaneous injection of the tripeptide H-Pro-[3H]Leu-Gly-NH2 ([3H]PLG) in rats, the profile of intact peptide and its radioactively labeled metabolites was examined both in plasma and in brain tissue. [3H]PLG and metabolites were determined in trichloroacetic acid extracts by reverse-phase paired-ion HPLC. Maximal plasma levels of unmetabolized PLG were reached 6-8 min after administration, after which they decreased with an elimination half-life of 20 min. The uptake of [3H]PLG in the brain ranged from 0.0013% to 0.0017% of the administered dose per g tissue at 6-30 min following subcutaneous injection. After comparing these results with our previous findings with intravenous injection of [3H]PLG, it seemed likely that the subcutaneous route of administration might be more effective in eliciting CNS effects of PLG than the intravenous route of administration. The metabolite profiles in plasma and brain point to an initial cleavage of PLG at the NH2-terminal side and a very rapid degradation of the peptide intermediate H-Leu-Gly-NH2.

Two recently developed and simplified anti-Xa methods, a chromogenic assay and a clot-based assay (Heptest) were investigated on their accuracy and ex-vivo characteristics. The coefficients of variation (c.v.) for heparin, a heparin fragment (K 2165) and a LMW hepa-rinoid (Org 10172) were respectively: Heptest, within assay c.v.: 5.4; 4.5; 5.0 % between-assay c.v.: 7.8; 5.8; 9.5 %. Chromogenic Anti-Xa assay, within assay c.v.: 3.7; 5.6; 4.6 %, between assay c.v.: 6.6; 8.2; 12.1 %. In plasma samples obtained from volunteers and patients who participated in clinical studies using heparin, K 2165 and Org 10172, the ex-vivo correlation between both assays were determined. Generally, heparin and K 2165 induced anti-Xa activities correlated very well (0.83 < r< 0.99) and the slopes of the regression lines approached the value of 1. K 2165 in haemodial-ysis patients produced much higher Heptest values compared to the chromogenic anti-Xa assay, for which no explanation is provided. For Org 10172 the anti-Xa assay was more sensitive than the Heptest, although both tests detected anti-Xa activities at very low levels (± 0.02 U/ml). After s.c. injection of Org 10172 a poor correlation was found (r=0.49), which may be due to inter-individual differences in bio-availability. In conclusion, the chromogenic anti-Xa assay and the Heptest are accurate and sensitive assays. However, the tests give substantial differences in results depending upon the heparin preparation and patient category treated.