Task Shifting in Dermatology

Brown, Danielle; Langan, Sinéad; Freeman, Esther E.

doi:10.1001/jamadermatol.2017.3342

Cited by 12 publications

(7 citation statements)

References 7 publications

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“…However, specialty care services needed for KS, particularly dermatology and pathology services, are often lacking in low- and middle-income countries (LMICs). 10,11 Until 2009, Botswana did not have its own medical school although a number of residency programs have since been developed, there continues to be no program for training local dermatologists. Historically, there have been 2-3 private dermatologists working in the capital of Botswana.…”

Section: Discussionmentioning

confidence: 99%

Dermatology-Driven Quality Improvement Interventions to Decrease Diagnostic Delays for Kaposi Sarcoma in Botswana

Williams

Narasimhamurthy

Rodriguez

et al. 2019

JGO

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PURPOSEKaposi sarcoma (KS) is an HIV-associated skin cancer that is highly prevalent in Botswana and associated with significant morbidity and mortality. Histopathology-confirmed diagnosis is required for chemotherapeutic interventions in Botswana, which creates barriers to care because of limited biopsy and pathology services. We sought to understand the role a dermatology specialist can play in improving KS care through quality improvement (QI) initiatives to reduce histologic turnaround times (TATs) for KS.METHODSEmployment of a dermatology specialist within a public health care system that previously lacked a local dermatologist generated quality improvements in KS care. Retrospective review identified patients diagnosed with KS by skin biopsy in the predermatology QI interval (January 1, 2015, to December 31, 2015) versus the postdermatology QI interval (January 1, 2016, to November 31, 2017). Histology TATs and clinical characteristics were recorded. A t test compared the median histology TATs in the pre- and post-QI intervals.RESULTSA total of 192 cases of KS were diagnosed by skin biopsy. Nearly all (98.4%) were HIV-positive; and 52.8% of patients were male with a median age of 39 years. Median TAT in the postdermatology QI interval was 11 days (interquartile range, 12-23 days) compared with 32 days in the predermatology QI interval (interquartile range, 24-56 days; P < .00).CONCLUSIONDermatology-led QI initiatives to improve multispecialty care coordination can significantly decrease histology TATs for KS. The reduction of diagnostic delays is a key first step to decreasing the morbidity and mortality associated with this cancer in resource-limited settings.

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Section: Discussionmentioning

confidence: 99%

Dermatology-Driven Quality Improvement Interventions to Decrease Diagnostic Delays for Kaposi Sarcoma in Botswana

Williams

Narasimhamurthy

Rodriguez

et al. 2019

JGO

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“…One solution to this has been the concept of task-shifting, where non-specialists perform the tasks of specialists through protocolized medicine. Examples of task-shifting can be found in medical fields as diverse as surgery (Falk, 2020) to dermatology (Brown, 2018). Artificial Intelligence-based tools can provide improved support to ensure that task-shifting is safe and effective for patients.…”

Section: Ministries Of Health (Mohs) and Non-governmental Organizations (Ngos)mentioning

confidence: 99%

Deep Learning and its Application for Healthcare Delivery in Low and Middle Income Countries

Williams¹,

Hornung²,

Nadimpalli³

et al. 2021

Front. Artif. Intell.

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As anyone who has witnessed firsthand knows, healthcare delivery in low-resource settings is fundamentally different from more affluent settings. Artificial Intelligence, including Machine Learning and more specifically Deep Learning, has made amazing advances over the past decade. Significant resources are now dedicated to problems in the field of medicine, but with the potential to further the digital divide by neglecting underserved areas and their specific context. In the general case, Deep Learning remains a complex technology requiring deep technical expertise. This paper explores advances within the narrower field of deep learning image analysis that reduces barriers to adoption and allows individuals with less specialized software skills to effectively employ these techniques. This enables a next wave of innovation, driven largely by problem domain expertise and the creative application of this technology to unaddressed concerns in LMIC settings. The paper also explores the central role of NGOs in problem identification, data acquisition and curation, and integration of new technologies into healthcare systems.

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“…Task shifting means transferring clinical tasks from physicians to trained non-physician health workers. Although task shifting is being done to a limited extent in dermatology, its need and effectiveness are evident from the literature [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Task shifting in dermatology: Are nurses prepared and willing?

Kavita¹,

Mehta²,

Gupta³

et al. 2022

Our Dermatol Online

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Background: The high burden of skin diseases and the shortage of dermatologists are significant challenges in providing care to millions of people with skin diseases. Task shifting to nurses is a viable option for the delivery of dermatologic care in resource-poor settings. Satisfactory knowledge and a positive attitude are crucial for nurses to undertake the task of managing common skin diseases. This study aimed to investigate the knowledge of registered nurses and their attitude toward common skin conditions. Methods: In this descriptive, cross-sectional study, a total of 187 nurses were included from a nurses training institute by total enumeration sampling. A knowledge questionnaire and five-point Likert type-attitude scale were developed, validated, and employed to collect data. Written informed consent was obtained from the participants after approval from the institute ethics committee. Results: The mean of the knowledge scores were 10.7 ± 2.2. Nearly two thirds (62%) of the subjects demonstrated a low level of knowledge, while the remaining 38% showed a moderate level. There was no participant in the high-knowledge category. A majority of the nurses demonstrated a favorable attitude toward learning and undertaking the task of managing common skin conditions. Conclusion: We observed a low level of knowledge on diagnosing and managing common skin conditions. We recommend incorporating the relevant concepts of common skin conditions in the nursing curriculum with an emphasis on continuing education.

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Task Shifting in Dermatology

Cited by 12 publications

References 7 publications

Dermatology-Driven Quality Improvement Interventions to Decrease Diagnostic Delays for Kaposi Sarcoma in Botswana

Dermatology-Driven Quality Improvement Interventions to Decrease Diagnostic Delays for Kaposi Sarcoma in Botswana

Deep Learning and its Application for Healthcare Delivery in Low and Middle Income Countries

Task shifting in dermatology: Are nurses prepared and willing?

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