Experience with telepathology in combination with diagnostic assistance systems in countries with restricted resources

Fritz, Péter; Kleinhans, Andreas; Hubler, Monika; Raoufi, Rokai; Firooz, Haroon; Sediqi, Atiq; Khachatryan, Anna; Sotoudeh, Kambiz; Mamunts, David; Desai, Munaf B; Omer, Mohamed; D, Kunze; Hinsch, Nora; Jundt, Gernot; Dalquen, Peter; Ott, German; Aboud, Al Alaboud; Alscher, M. Dominik; Stauch, G.

doi:10.1177/1357633x19840475

Cited by 9 publications

(17 citation statements)

References 22 publications

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“…These departments have been linked to a third centre in Herat, managed by another NGO, which serves about 2 million people. These three departments regularly send digitized microscopic images of histological and cytological preparations and the related clinical information of the patients to European experts via the telemedicine service iPath-Network [ 12 – 14 ]. Up to now, more than 14,500 cases have been diagnosed or confirmed.…”

Section: Introductionmentioning

confidence: 99%

The Importance of Clinical Data for the Diagnosis of Breast Tumours in North Afghanistan

Stauch¹,

Fritz

Rauofi³

et al. 2021

International Journal of Breast Cancer

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Background. This study was performed in knowledge of the increasing gap between breast disease treatment in countries with restricted resources and developed countries with increasingly sophisticated examination methods. Methods. The authors present the analysis of a breast disease register consisting of diagnostic cases from Mazar e Sharif and Herat in 2018 and 2019. The study comprises a total of 567 cases, which were presented to experts via telemedicine for final diagnosis. 62 cases (10.9%) were excluded due to inacceptable data or insufficient image quality. These data provided by daily diagnostic classification were used for the built-up of a profile for each frequent breast disease and a breast cancer register. All images and cases were seen by at least 3 independent experts. The diagnoses were made in 60% of cases by cytology of fine needle aspiration and in 40% by histological images. Results. For each entity of breast diseases (e.g., fibroadenoma), a profile of context variables was constructed allowing to assist medical decisions, as “wait and see,” elective surgery or immediate surgical intervention with R0 (complete) resection. These “profiles” could be described for fibroadenoma, mastitis, galactocele, fibrous-cystic disease, and invasive breast cancer. Conclusions. The presented preliminary data set could serve as a cost-effective basis for a North Afghan breast cancer registry, with option to extent to a national model. These preliminary data are transformed in profiles of breast diseases, which are used by the local physicians in charge of breast disease patients. Each new case can be compared by the local treating physician with the profile of all preceded cases with the same diagnosis.

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Section: Introductionmentioning

confidence: 99%

The Importance of Clinical Data for the Diagnosis of Breast Tumours in North Afghanistan

Stauch¹,

Fritz

Rauofi³

et al. 2021

International Journal of Breast Cancer

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“…The included studies predominantly described telemedicine interventions for conflict-affected populations from Afghanistan [ 32 , 34 – 36 , 40 , 45 , 46 , 49 ], Iraq [ 28 , 30 , 35 , 41 , 47 , 48 , 50 ] and Syria [ 27 , 29 , 31 , 33 , 38 , 39 , 43 , 44 ]. There was one study from Yemen [ 37 ] and Gaza [ 42 ] each, and none from Libya.…”

Section: Resultsmentioning

confidence: 99%

“…However, four studies were conducted in primary care facilities [ 32 , 33 , 43 , 49 ] and three studies specifically aimed to reach rural participants in Afghanistan [ 34 , 49 ] and Yemen [ 37 ]. Most interventions created a network of remote and local providers across numerous clinical sites [ 27 , 30 – 32 , 34 , 35 , 37 – 40 , 42 – 45 , 48 – 50 ], while 3 studies involved communication between just two sites [ 28 , 33 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

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Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: a systematic review

et al. 2022

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Background The COVID-19 pandemic has escalated the use of telemedicine in both high and low resource settings however its use has preceded this, particularly in conflict-affected settings. Several countries in the WHO Eastern Mediterranean (EMR) region are affected by complex, protracted crises. Though telemedicine has been used in such settings, there has been no comprehensive assessment of what interventions are used, their efficacy, barriers, or current research gaps. Main body A systematic search of ten academic databases and 3 grey literature sources from January 1st 2000 to December 31st 2020 was completed, identifying telemedicine interventions in select EMR conflict-affected settings and relevant enablers and barriers to their implementation. Included articles reported on telemedicine use in six conflict-affected EMR countries (or territories) graded as WHO Health Emergencies: Afghanistan, Gaza, Iraq, Libya, Syria and Yemen. Data were extracted and narratively synthesised due to heterogeneity in study design and outcomes. Of 3419 articles identified, twenty-one peer-reviewed and three grey literature sources met the inclusion criteria. We analysed these by context, intervention, and evaluation. Context: eight related to Afghanistan, eight to Syria and seven to Iraq with one each in Yemen and Gaza. Most were implemented by humanitarian or academic organisations with projects mostly initiated in the United States or Europe and mostly by physicians. The in-country links were mostly health professionals rather than patients seeking specialist inputs for specialities not locally available. Interventions: these included both SAF (store and forward) and RT (real-time) with a range of specialities represented including radiology, histopathology, dermatology, mental health, and intensive care. Evaluation: most papers were observational or descriptive with few describing quality measures of interventions. Conclusions Telemedicine interventions are feasible in conflict-affected settings in EMR using low-cost, accessible technologies. However, few implemented interventions reported on evaluation strategies or had these built in. The ad hoc nature of some of the interventions, which relied on volunteers without sustained financial or academic investment, could pose challenges to quality and sustainability. There was little exploration of confidentiality, ethical standards, data storage or local healthcare worker and patient acceptability.

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“…Memem7 [ 22 – 24 ]: Is a currently non-commercial DDX developed by two of the authors (KA, PF). Memem7 is based on a large semantic network (about 560,000 nodes) that is transparently represented to the user, containing all kinds of entities and relationships such as objects, classes, parts, attributes, processes, states, properties, etc.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of medical decision support systems (DDX generators) using real medical cases of varying complexity and origin

Fritz

Kleinhans²,

Raoufi³

et al. 2022

BMC Med Inform Decis Mak

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Background Medical decision support systems (CDSSs) are increasingly used in medicine, but their utility in daily medical practice is difficult to evaluate. One variant of CDSS is a generator of differential diagnoses (DDx generator). We performed a feasibility study on three different, publicly available data sets of medical cases in order to identify the frequency in which two different DDx generators provide helpful information (either by providing a list of differential diagnosis or recognizing the expert diagnosis if available) for a given case report. Methods Used data sets were n = 105 cases from a web-based forum of telemedicine with real life cases from Afghanistan (Afghan data set; AD), n = 124 cases discussed in a web-based medical forum (Coliquio data set; CD). Both websites are restricted for medical professionals only. The third data set consisted 50 special case reports published in the New England Journal of Medicine (NEJM). After keyword extraction, data were entered into two different DDx generators (IsabelHealth (IH), Memem7 (M7)) to examine differences in target diagnosis recognition and physician-rated usefulness between DDx generators. Results Both DDx generators detected the target diagnosis equally successfully (all cases: M7, 83/170 (49%); IH 90/170 (53%), NEJM: M7, 28/50 (56%); IH, 34/50 (68%); differences n.s.). Differences occurred in AD, where detection of an expert diagnosis was less successful with IH than with M7 (29.7% vs. 54.1%, p = 0.003). In contrast, in CD IH performed significantly better than M7 (73.9% vs. 32.6%, p = 0.021). Congruent identification of target diagnosis occurred in only 46/170 (27.1%) of cases. However, a qualitative analysis of the DDx results revealed useful complements from using the two systems in parallel. Conclusion Both DDx systems IsabelHealth and Memem7 provided substantial help in finding a helpful list of differential diagnoses or identifying the target diagnosis either in standard cases or complicated and rare cases. Our pilot study highlights the need for different levels of complexity and types of real-world medical test cases, as there are significant differences between DDx generators away from traditional case reports. Combining different results from DDx generators seems to be a possible approach for future review and use of the systems.

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Experience with telepathology in combination with diagnostic assistance systems in countries with restricted resources

Cited by 9 publications

References 22 publications

The Importance of Clinical Data for the Diagnosis of Breast Tumours in North Afghanistan

The Importance of Clinical Data for the Diagnosis of Breast Tumours in North Afghanistan

Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: a systematic review

Evaluation of medical decision support systems (DDX generators) using real medical cases of varying complexity and origin

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