ABSTRACT
We studied patient preferences for a real-time teledermatology consultation or a conventional dermatology consultation. Dermatology patients were given the option of being seen by a dermatologist at their outlying primary care site via telemedicine or of being examined face-to-face by the same dermatologist at the primary care site. The same dermatologist provided the teleconsultations and the conventional consultations. During a 16-month study period, 52 patients were evaluated via telemedicine and 46 patients were seen face-to-face. The demographics for both study groups were similar. Those patients who selected telemedicine were more likely to have seen a dermatologist fewer than twice during the previous year, more likely to self-describe themselves in excellent health and more likely to choose a face-to-face evaluation when presenting with a possible skin cancer or a mole. Patients aged 56 years or less tended to be more likely to be seen via telemedicine, although the association with age was not significant (P = 0.06). This information may help providers to devise strategies to direct patients to telemedicine if and when it is appropriate.
Subject(s)
Dermatology/organization & administration , Patient Satisfaction/statistics & numerical data , Remote Consultation , Skin Diseases/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Physician-Patient Relations , Videoconferencing/instrumentationABSTRACT
The aim of this study was to determine whether outpatient telemedicine specialty consultations to primary care clinicians result in changes in a patient's diagnosis, treatment management, and clinical outcomes. Medical records of patients who received two or more clinical telemedicine consultations in dermatology, psychiatry, and endocrinology were evaluated in a nonconcurrent retrospective analysis. Three indicators were used to measure changes in the processes of care and clinical outcomes: change in diagnosis, change in treatment, and patient clinical improvement. A retrospective review of 223 individual telemedicine patient medical records was conducted. Specialty telemedicine consultations were found to result in changes in diagnoses in 48% of the cases, changes in treatment therapy in 81.6% of the cases, and clinical improvement in 60.1%. These results are consistent with previous literature that has assessed changes in processes of care and outcomes from face-to-face specialty consultations in outpatient clinics. Changes in diagnosis and treatment therapy were found to be associated with clinical improvement with odds ratios (ORs) of 2.66 (95% confidence interval [CI]: 1.47-4.83) and 11.22 (95% CI: 4.49-31.48), respectively. This study found that telemedicine consultations resulted in changes in diagnosis and treatment regimens and also are associated with clinical improvements.
Subject(s)
Diagnosis , Referral and Consultation , Telemedicine , Therapeutics , Adolescent , Adult , Aged , Aged, 80 and over , California , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Observer Variation , Quality of Health CareABSTRACT
BACKGROUND: Temporal hair loss has been reported to occur in up to 8.4% of patients after rhytidectomy. To date, no one has described the associated histopathologic findings. OBJECTIVE: The objective was to illustrate the microscopic findings seen in the affected area of hair loss after rhytidectomy. METHODS: Two punch biopsies from the temporal area were performed, and pathologic material was submitted. RESULTS: Histopathologic finding was suggestive of acute localized telogen effluvium. CONCLUSION: One mechanism for temporal hair loss after rhytidectomy is an acute localized telogen effluvium.
Subject(s)
Alopecia/etiology , Rhytidoplasty/adverse effects , Alopecia/pathology , Female , Humans , Middle AgedABSTRACT
BACKGROUND: Nevus lipomatosus cutaneous superficialis of Hoffmann-Zurhelle (NLCS) is a rare disorder that is characterized by tumors of mature fat cells situated within the dermis. OBJECTIVE: To illustrate by a case report the clinical presentation and management of this rare condition. METHODS: Wide excision of the right thigh and buttock mass was performed, and pathological material was submitted. The defect was repaired with a split-thickness skin graft. RESULTS: The largest measured nevus lipomatosus, congenital type (20 x 30 cm), was removed from this patient. CONCLUSION: Physicians should be aware of this rare tumor, which can become extremely large if untreated.
