Lessons learned after a three-year store and forward teledermatology experience using internet: Strengths and limitations

Purpose This paper presents a three-year teledermatology evaluation experience. The aim is to explain the methodology followed, present the evaluation results, discuss critically the issues that emerged during the experience and report the main lessons learned. Methods A complete design and evaluation methodology was conducted to fully address significant issues arising from other previous teledermatology experiences. First, system-design requirements and image quality issues were studied. Then, a detailed clinical concordance study was undertaken to determine the accuracy of diagnoses made using teledermatology in order to assess different dermatological clinics. Finally, an impact study on the health system was performed. Furthermore, clinical, technical, social and alignment outcomes were analyzed during the study and at the end of it, in order to understand how emerging factors affected the final setup of the teledermatology system. Results The most important results reported in this study can be summarized as follows. (1) A complete web-based environment for teledermatology support was developed as a result of a dynamic evaluation process with clinical personnel. (2) A total of 120 teleconsultations (82 pediatric and 28 adult) were made during the clinical concordance study. Concordance analysis was carried out for each dermatological disease group. High concordance rates were found in pediatrics for inflammatory dermatoses (76%) and also for adults (75%) with infections and infestations. (3) Physicians were satisfied with the teledermatology system but the time dedicated to consultation in primary care was a limiting factor (19 min for each teleconsultation). (4) An extensive discussion about the successful and the limiting aspects of the teledermatology experience revealed the reasons behind the final decision not to proceed with its implementation. It was considered not to be aligned with Health Care Organization (HCO) strategy and consequently did not achieve high-level support for its long-term implementation. Conclusions A high degree of diagnostic accuracy both for pediatric and adult consultations was achieved using the teledermatology system with affordable technical requirements. Its usefulness for filtering dermatological referrals was also demonstrated in the study. Nevertheless, other factors such as the reorganization required for the physicians’ time schedule, remuneration issues, absence of EHR (electronic health record) integration and lack of interaction with the HCO were important limiting factors. This led to the conclusion that under the evaluation conditions long-term set-up was not possible. It was also concluded that HCO participation would have been essential for both the evaluation study and the long-term set-up of the system. Highlights This paper reports a realistic experience in the design and evaluation of a telemedicine solution for remote dermatology consultation (tele-dermatology) in Aragón, Spain. ► This study takes a different approach discussing the strengths and limitations of a teledermatology experience in a realistic manner. ► A list of lessons learned is provided for future teledermatology implementations. Many pediatricians are involved in the experience providing in this way a detailed concordance analysis for children dermatological clinics

Inflammatory response in mixed viral-bacterial community-acquired pneumonia

Background The role of mixed pneumonia (virus¿+¿bacteria) in community-acquired pneumonia (CAP) has been described in recent years. However, it is not known whether the systemic inflammatory profile is different compared to monomicrobial CAP. We wanted to investigate this profile of mixed viral-bacterial infection and to compare it to monomicrobial bacterial or viral CAP. Methods We measured baseline serum procalcitonin (PCT), C reactive protein (CRP), and white blood cell (WBC) count in 171 patients with CAP with definite etiology admitted to a tertiary hospital: 59 (34.5%) bacterial, 66 (39.%) viral and 46 (27%) mixed (viral-bacterial). Results Serum PCT levels were higher in mixed and bacterial CAP compared to viral CAP. CRP levels were higher in mixed CAP compared to the other groups. CRP was independently associated with mixed CAP. CRP levels below 26 mg/dL were indicative of an etiology other than mixed in 83% of cases, but the positive predictive value was 45%. PCT levels over 2.10 ng/mL had a positive predictive value for bacterial-involved CAP versus viral CAP of 78%, but the negative predictive value was 48%. Conclusions Mixed CAP has a different inflammatory pattern compared to bacterial or viral CAP. High CRP levels may be useful for clinicians to suspect mixed CAP

Patient reported outcomes (PROS) in psoriasis patients

P20 Introduction: Psoriasis is a chronic skin disease with negative physical, mental and social manifestations. Method: We carried out a longitudinal and prospective study under routine clinical practice conditions. The objective of the study was to measure quality of life with the Short Form-36 Survey (SF-36) and correlate the results with clinical variables using the PASI and BSA in a group of 17 patients with moderate to severe psoriasis treated with Ustekinumab. Results: In the baseline evaluation we observed the following results: 35.3% reported physical malfunction, 64.7% debilitating pain, 82.3% poor health in general, 76.4% bad vitality, 88.2% social malfunction, 100% emotional malfunction and 82.3% poor mental health. At week 78 we observed the following results: 41.15% reported very good physical functioning, 76.1% no pain, 58.8% good general health, 58.8% very good vitality, 70%, 5% good social functioning, 70.5% good emotional functioning and 52.9% good mental health. Conclusion: We observed that the perception of patients with moderate-severe psoriasis regarding their health at the beginning of treatment with Ustekinumab was poor and that they experienced a significant improvement throughout the successive weeks of treatment

Inflammatory response in mixed viral-bacterial community-acquired pneumonia

BACKGROUND: The role of mixed pneumonia (virus + bacteria) in community-acquired pneumonia (CAP) has been described in recent years. However, it is not known whether the systemic inflammatory profile is different compared to monomicrobial CAP. We wanted to investigate this profile of mixed viral-bacterial infection and to compare it to monomicrobial bacterial or viral CAP. METHODS: We measured baseline serum procalcitonin (PCT), C reactive protein (CRP), and white blood cell (WBC) count in 171 patients with CAP with definite etiology admitted to a tertiary hospital: 59 (34.5%) bacterial, 66 (39.%) viral and 46 (27%) mixed (viral-bacterial). RESULTS: Serum PCT levels were higher in mixed and bacterial CAP compared to viral CAP. CRP levels were higher in mixed CAP compared to the other groups. CRP was independently associated with mixed CAP. CRP levels below 26 mg/dL were indicative of an etiology other than mixed in 83% of cases, but the positive predictive value was 45%. PCT levels over 2.10 ng/mL had a positive predictive value for bacterial-involved CAP versus viral CAP of 78%, but the negative predictive value was 48%. CONCLUSIONS: Mixed CAP has a different inflammatory pattern compared to bacterial or viral CAP. High CRP levels may be useful for clinicians to suspect mixed CAP

Consideraciones acerca de algunos parámetros sanguíneos ovinos (Na, K plasmáticos y valor hematocrito)

Una de las primeras líneas de investigación que nuestro Departamento de Genética y Mejora se marcó, hace ya algún tiempo, fue el estudio de los tipos K y Na eritrocitarios existentes en nuestras poblaciones ovinas. El estudio en cuestión, desde el punto de vista analítico-laboratorial, exige la determinación, entre otras, del valor hematocrito (V.H.) y de las concentraciones de Na y K en el plasma sanguíneo, como datos analíticos previos al estudio final de los polimorfismos comentados. El hecho de que estos tres valores estén considerados como constantes bioquímicas sanguíneas, por un lado y el que no hayamos encontrado una información precisa a este respecto en nuestras razas ovinas, por otro, nos ha inducido a publicar estos datos en el ánimo de que pueden representar una aportación a los interesados en estas materias, teniendo en cuenta que el muestreo realizado ha sido muy amplio.Peer reviewe

Ubiquitous healthcare systems and medical rules in COPD Domain

Chronic Obstructive Pulmonary Disease (COPD) is a severe lung illness that causes a progressive deterioration in the function and structure of the respiratory system. Recently, COPD became the fifth cause of mortality and the seventh cause of morbidity in Canada. The advancement of context-aware technology creates a new and important opportunity to transform the standard shape of healthcare services into a more dynamic and interactive form. This research project design and validates a rule-based ontology-reasoning framework that provides a context-aware system for COPD patients. The originality of the proposed approach consists in its methodology to prove the efficiency of this model in simulated examples of real-life scenarios based on collaborative data analysis, recognized by specialized medical experts