Diagnostic accuracy and clinical management by realtime teledermatology. Results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial

Loane, Maria; Corbett, R; Bloomer, S E; Eedy, D.J.; Gore, H E; Mathews, C; Steele, K; Wootton, Richard

doi:10.1258/1357633981932028

Cited by 103 publications

(106 citation statements)

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“…Several studies showing the feasibility and usefulness of e-visits in dermatology have already been described in the literature, and a high accordance for diagnosis between live visits and e-consultations has been reported in all of them [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16]. Most of these studies demonstrate high accordance for the diagnosis of inflammatory and neoplastic skin diseases [17, 18, 19, 20, 21], and particularly for the diagnosis of pigmented skin lesions (teledermoscopy) [22, 23, 24, 25, 26].…”

Section: Discussionmentioning

confidence: 99%

Wound Teleconsultation in Patients with Chronic Leg Ulcers

Salmhofer¹,

Hofmann‐Wellenhof²,

Gabler

et al. 2005

Dermatology

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Background: The treatment of chronic leg ulcers requires frequent assessments of local wound status and adjustment of therapy. The availability of reasonably priced photographic equipment and quick electronic transfer of high-quality digital images should make it possible that the assessment of wound status can be made by remote experts. Objective: This study examines the feasibility of using teledermatology for wound assessment and therapeutic suggestions for patients with chronic leg ulcers. Methods: One hundred ten chronic leg ulcers of different origins were examined in face-to-face consultations. The examining doctor assessed the wound, made therapeutic recommendations and took 1–4 photographs of the wound using a digital camera. The digital images and relevant clinical information were then transmitted via a web application to an expert in wound care, who provided an independent teledermatological assessment of wound status and therapeutic recommendations. Results: In our study, a high accordance between direct consultations and electronic consultations was found in the assessment of chronic leg ulcers, especially for important features like slough (concordance: 84.6%), necrosis (concordance: 98.2%) and granulation tissue formation (concordance: 76.4%). Furthermore, the teledermatologist generally felt confident in recommending further treatment strategies and in planning further wound assessments via the internet. Conclusions: Our results suggest that teledermatology offers great potential for the future in chronic wound care. By reducing the need to travel long distances to the hospital or to consult a physician with expertise in wound care, wound teleconsultation might lower health care costs and improve the quality of life for patients with chronic wounds, while still maintaining a high quality of wound care.

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Section: Discussionmentioning

confidence: 99%

Wound Teleconsultation in Patients with Chronic Leg Ulcers

Salmhofer¹,

Hofmann‐Wellenhof²,

Gabler

et al. 2005

Dermatology

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“…Satellite-based telemedicine modality has been mainly used for patient consultations, monitoring and counseling. [6][7][8][9][10][11][12][13] The same technology when used for medical education (tele-education) offers an alternate, potentially timesaving and cost-effective interface between learners and instructors. Efficacy of tele-education (TI) as compared to conventional classroom teaching (CT) in imparting knowledge and skill needs to be investigated.…”

Section: Introductionmentioning

confidence: 99%

Tele-education vs classroom training of neonatal resuscitation: a randomized trial

et al. 2010

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Objective: To compare gain in knowledge and skills of neonatal resuscitation using tele-education instruction vs conventional classroom teaching.Study Design: This randomized controlled trial was conducted in the tele-education facility of a tertiary care center. In-service staff nurses were randomized to receive training by tele-education instruction (TI, n ¼ 26) or classroom teaching (CT, n ¼ 22) method from two neonatology instructors using a standardized teaching module on neonatal resuscitation. Gain in knowledge and skill scores of neonatal resuscitation were measured using objective assessment methods.Result: Age, educational qualification and professional experience of the participants in two groups were comparable. Pre-training mean knowledge scores were higher in TI group (8.3±1.7 vs 6.6±1.4, P ¼ 0.004). However, skill scores were comparable in the two groups (11.7±3 vs 10.3±2.9, P ¼ 0.13). Training resulted in a significant and comparable gain in knowledge scores (4.2 ± 2.2 vs 5.3 ± 1.7; P ¼ 0.06) and skills scores (4.5±3.3 vs 5.0±3.1, P ¼ 0.62) in both the groups. The post-training knowledge scores (TI: 12.5 ± 1.7 vs CT: 12.0 ± 1.7, P ¼ 0.37) and the post-training skill scores (TI: 16.0±0.5 vs CT: 15.6 ± 2.5, P ¼ 0.55) were comparable in the two groups. However, the post-training scores, adjusted for baseline knowledge scores, were statistically higher in the in-person group compared with the telemedicine group (knowledge: 12.46 ± 0.03 vs 12.16 ± 0.01, P ¼ 0.00; skills: 15.6±2.5 vs 16.0±2.8, P ¼ 0.00). The quantum of lower scores in the telemedicine group was only 2% for knowledge and 6% for skills. This difference was felt to be of only marginal importance. Satisfaction scores among trainees and instructors were comparable in the two groups. Conclusion:Tele-education offers a feasible and effective alternative to conventional training in neonatal resuscitation among health-care providers.

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“…Partial Diagnostic Agreement (Loane et al, 1998b) .71 .87 (Gilmour et al, 1998) .59 .76 (Oakley et al, 1997) .75 .82 Table 5. Intraobserver Reliability for LI Teledermatology…”

Section: Reference Complete Diagnostic Agreementmentioning

confidence: 99%

“…Partial Diagnostic Agreement (Nordal et al, 2001) .72 .86 (Phillips et al, 1998) .59 - (Loane et al, 1998b) .60 .76 (Lowitt et al, 1998) .80 - (Gilmour et al, 1998) .54 .80 (Lesher et al, 1998) .78 .99 (Phillips et al, 1997) .77 - …”

Section: Reference Complete Diagnostic Agreementmentioning

confidence: 99%

Teledermatology: Outcomes and Economic Considerations

Pathipati¹,

Armstrong²

2011

Telemedicine Techniques and Applications

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IntroductionTeledermatology is defined as the provision of dermatologic care through the use of communications technology (Goldyne & Armstrong, 2010). It offers many benefits that include increased access to dermatologic services and potential reduction in costs associated with care. Teledermatology is traditionally categorized into two different models based on the technology that is employed: store-and-forward (S&F) teledermatology, and live, interactive (LI) teledermatology (Goldyne & Armstrong, 2010). While hybrid models (a combination of S&F and LI technology) are practiced at selected institutions, this chapter focuses primarily on S&F and LI models. We will present operational flows of these two technology-enabled modalities, common outcomes measures used for evaluation of teledermatology quality metrics, and economic analyses. At the end of the chapter (in section 5), we will consider a novel, technology-independent framework for categorizing teledermatology models as well. This system relies on classification of teledermatology based on healthcare delivery models, and serves as an alternative way to organize and evaluate the provision of teledermatologic care. Store-and-forward teledermatologyStore-and-forward teledermatology is an asynchronous means for providing dermatologic care, as it relies on the asynchronous transmission of static digital images, patient histories, and specialist recommendations rather than real-time interaction between the specialist and the patient (Goldyne & Armstrong, 2010). In the S&F model, a medical staff personnel at the referral site typically takes images of the relevant skin condition and obtains medical history. This information is then sent to a dermatologist via a secure internet connection. The dermatologist evaluates the patient's condition asynchronously and transmits the recommendations back to the primary care provider at the referral site (Pak et al., 2009). Outcomes measures of store-and-forward teledermatologyTeledermatology studies have assessed numerous outcomes measures, including learning effects, length of consultation, and technical aspects (Eminovic et al., 2007). We will focus this discussion on four extensively used outcomes measures: diagnostic accuracy, diagnostic reliability, clinical outcomes, and satisfaction.

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Diagnostic accuracy and clinical management by realtime teledermatology. Results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial

Cited by 103 publications

References 0 publications

Wound Teleconsultation in Patients with Chronic Leg Ulcers

Wound Teleconsultation in Patients with Chronic Leg Ulcers

Tele-education vs classroom training of neonatal resuscitation: a randomized trial

Teledermatology: Outcomes and Economic Considerations

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