4 research outputs found
Proposed technical guidelines for the acquisition of clinical images of skin-related conditions
IMPORTANCE Standardizing dermatological imaging is important to improve monitoring of skin lesions and skin conditions, ensure the availability of high-quality images for teledermatology, and contribute to the development of a robust archive of skin images to be used for research
Technique standards for skin lesion imaging: a delphi consensus statement
IMPORTANCE Variability in the metrics for image acquisition at the total body, regional, close-up, and dermoscopic levels impacts the quality and generalizability of skin images. Consensus guidelines are indicated to achieve universal imaging standards in dermatology. OBJECTIVE To achieve consensus among members of the International Skin Imaging Collaboration (ISIC) on standards for image acquisition metrics using a hybrid Delphi method. EVIDENCE REVIEW Delphi study with 5 rounds of ratings and revisions until relative consensus was achieved. The initial set of statements was developed by a core group (CG) on the basis of a literature review and clinical experience followed by 2 rounds of rating and revisions. The consensus process was validated by an extended group (EG) of ISIC members through 2 rounds of scoring and revisions. In all rounds, respondents rated the draft recommendations on a 1 (strongly agree) to 5 (strongly disagree) scale, explained ratings of less than 5, and optionally provided comments. At any stage, a recommendation was retained if both mean and median rating was 4 or higher. RESULTS The initial set of 45 items (round 1) was expanded by the CG to 56 variants in round 2, subsequently reduced to 42 items scored by the EG in round 3, yielding an EG set of 33 recommendations (rounds 4 and 5): General recommendation (1 guideline), lighting (5), background color (3), field of view (3), image orientation (8), focus/depth of field (3), resolution (4), scale (3), color calibration (2), and image storage (1). CONCLUSIONS AND RELEVANCE This iterative process of ratings and comments yielded a strong consensus on standards for skin imaging in dermatology practice. Adoption of these methods for image standardization is likely to improve clinical practice, information exchange, electronic health record documentation, harmonization of clinical studies and database development, and clinical decision support. Feasibility and validity testing under real-world clinical conditions is indicated
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End Stage Renal Disease (ESRD) Dialysis Workforce Study in the U.S.
Previous studies have shown that in the U.S., dialysis care has struggled with insufficient workforce to meet patient demand. In addressing this gap, the contribution of this study is that it goes beyond nephrologists workforce to include other dialysis workforce such as registered nurses (RNs) and advanced nurse practitioners (ANPs), licensed practical nurses (LPNs)/licensed vocational nurses (LVNs) and dialysis technicians in examining the effect of patient demand on the clinical responsibilities. The study examines historical End Stage Renal Disease (ESRD) patient population levels and trained workforce levels to make predictions about future workforce levels needed to provide dialysis care for this population in the U.S. Forecasting analysis was first conducted to obtain patient demand and workforce supply estimates for 2030 using available historical data beginning 2008. These forecasted estimates were next used for the workforce scenario analysis to make predictions on the workforce supply in 2030 at the patient level and dialysis center level. The results from this study indicated that in 2030, a shortage of nephrologists and dialysis technicians and surplus of nursing workforce needs to be addressed to meet the estimated increase in dialysis patient demand.Release after 01-June-201