Telemedicine in dermatology: findings and experiences worldwide - a systematic literature review.

Telemedicine has become an important element of health care in many countries and profited from the technological progress of the last two decades. Due to the visual character of the dermatological specialty, teledermatology in particular participated in that development and is becoming a major tool in dermatological consultation. The objective of this article was to identify the use of teledermatology across the world based on published original articles. A systematic literature search of the MEDLINE and Embase databases for eligible publications (predefined inclusion and exclusion criteria) and a cross-validation search were conducted. Search results were reviewed systematically. The search resulted in 204 publications meeting the inclusion criteria for analysis. The highest number of published studies on teledermatology was performed in the United States, followed by the United Kingdom, Spain, the Netherlands, Italy and Austria. The majority of dermatological indications for telemedical consultations were not specified or included various kinds of skin diseases, followed by skin cancer and wounds. Research questions predominantly focused on concordance, effectiveness and cost-effectiveness to determine the value. Teledermatology proved to be a reliable consultation tool in the majority of studies. If specified, telemedicine was used in daily dermatological routine for patient management purposes, to consult patients in peripheral locations, or for medical support in nursing homes or home care settings. The application of teledermatology worldwide is highest in North American and European countries, while countries with poor geographical distribution of physicians seem to be under-represented in teledermatological use, as concluded from publication output. Regarding indications, comparison with classic consultation and area of application, most studies were of general nature. For precise determination of the value, systematic studies would be needed. However, teledermatology is already accepted as a valid tool.

The impact of age on psoriasis health care in Germany.

INTRODUCTION: Inequality between age groups has been demonstrated in the prescription of biologics, yet systematic real-world data about age-related differences in psoriasis care are missing. OBJECTIVE: To investigate disparities in psoriasis characteristics by age groups and to identify potential impact on psoriasis health care. PATIENTS AND METHODS: Data analysis included 3615 patients from the German psoriasis registry PsoBest, which observes adult patients with moderate-to-severe psoriasis or psoriatic arthritis (PsA) on systemic treatment over a time period of 10 years. RESULTS: With 2376 participants (65.7%), the majority of patients was assigned to the age group 35-64, followed by 776 (21.4%) and 463 (12.8%) for the age groups 18-34 and 65+, respectively. Psoriasis vulgaris was the most frequent form of psoriasis with nearly 90% patients affected. Appearance of psoriasis forms did not differentiate significantly between the age groups except for erythrodermic psoriasis, which was more frequent in the elderly than in patients aged 35-64 (1.9%, P ≤ 0.048). Nail psoriasis appeared significantly more often in patients aged 35-64 (55.5%, P ≤ 0.001) and also showed the highest number of nails involved (6.9 ± 3.3). PsA was less frequent in the age group 18-34 (9.5%, P ≤ 0.001). This group showed the highest rate of scalp psoriasis (85.8%) compared to the elder age groups (P ≤ 0.001). Biologicals were used significantly less in younger patients (16.2%) compared to the age groups 35-64 (23.9%, P ≤ 0.001) and 65+ (21.8%, P ≤ 0.042). CONCLUSION: Middle-aged patients show higher rates of PsA and nail psoriasis, which may explain age-dependent disparities in health care including the use of systemic treatment.

Computer-aided transrectal ultrasound: does prostate HistoScanning™ improve detection performance of prostate cancer in repeat biopsies?

BACKGROUND: An imaging tool providing reliable prostate cancer (PCa) detection and localization is necessary to improve common diagnostic pathway with ultrasound targeted biopsies. To determine the performance of transrectal ultrasound (TRUS) augmented by prostate HistoScanning(TM) analysis (PHS) we investigated the detection of prostate cancer (PCa) foci in repeat prostate biopsies (Bx). METHODS: 97 men with a mean age of 66.2 (44-82) years underwent PHS augmented TRUS analysis prior to a repeat Bx. Three PHS positive foci were defined in accordance with 6 bilateral prostatic sectors. Targeted Bx (tBx) limited to PHS positive foci and a systematic 14-core backup Bx (sBx) were taken. Results were correlated to biopsy outcome. Sensitivity, specificity, predictive accuracy, negative predictive value (NPV) and positive predictive value (PPV) were calculated. RESULTS: PCa was found in 31 of 97 (32%) patients. Detection rate in tBx was significantly higher (p < .001). Detection rate in tBx and sBx did not differ on patient level (p ≥ 0.7). PHS sensitivity, specificity, predictive accuracy, PPV and NPV were 45%, 83%, 80%, 19% and 95%, respectively. CONCLUSIONS: PHS augmented TRUS identifies abnormal prostatic tissue. Although sensitivity and PPV for PCa are low, PHS information facilitates Bx targeting to vulnerable foci and results in a higher cancer detection rate. PHS targeted Bx should be considered in patients at persistent risk of PCa.

[Value of perineal HistoScanning™ template-guided prostate biopsy]. / Stellenwert der perinealen HistoScanning™-gestützten Templateprostatabiopsie.

BACKGROUND: Modern imaging modalities improve prostate diagnostics. OBJECTIVES: This study was performed to determine the outcome characteristics of biopsy procedures using the results of HistoScanning(TM) analysis (HS) for identifying prostate cancer (PCa) in patients with perineal template-guided prostate biopsy. PATIENTS AND METHODS: A total of 104 consecutive men (mean age 69 years, mean PSA 9.9 ng/ml) underwent HS prior to the extended prostate biopsy procedure. Patients received a targeted transperineal (template-assisted) as well as a targeted transrectal prostate biopsy using HS projection reports supplemented by a standardized 14-core systematic transrectal prostate biopsy (Bx). The cancer detection rate was analyzed on the sector level and HS targeted results were correlated to biopsy outcome, sensitivity, specificity, predictive accuracy, negative predictive value (NPV) and positive predictive value (PPV). RESULTS: Of 104 patients, 44 patients (42%) were found to have PCa. Histology detected atypical small acinar proliferation in 3 patients (2.9%), high-grade prostatic intraepithelial neoplasia in 16 (15.4%), and chronic active inflammation in 74 (71.1%), respectively. The detection rate for each region was significantly higher in HS-targeted biopsies compared to Bx. The detection rate per patient was not significantly different, although a smaller number of regions were biopsied with the targeted approach. The overall sensitivity, specificity, predictive accuracy, NPV, and PPV on the sector level were 37.2, 85.6, 78.6, 88.7 and 30.8%, respectively. CONCLUSION: The use of HS analysis results in a higher detection rate of prostate cancer compared to common transrectal ultrasonography (TRUS)-guided Bx. This technique increases the informative value of TRUS imaging and improves the diagnostic impact at least in the targeted biopsy setting.

The great beauty: a neuroaesthetic study by neuroelectric imaging during the observation of the real Michelangelo's Moses sculpture.

Recent studies have been showed as the perception of real or displayed masterpieces by ancient or modern painters generate stable neuroelectrical correlates in humans. In this study, we collected the neuroelectrical brain activity correlated with the observation of the real sculpture of Michelangelo's Moses within the church where it is actually installed in a group of healthy subjects. In addition to the cerebral activity also the heart rate (HR) and the galvanic skin response (GSR) were collected simultaneously, to assess the emotional engage of the investigated population. The Moses sculpture was observed by the group from three different point of views, each one revealing different details of the sculpture. In addition, in each location the light conditions related to the specific observation of the sculpture were explicitly changed. Results showed that cerebral activity of the subjects varied significantly across the three different views and for light condition against no light condition (p<;0.04). Furthermore, the emotional engage estimated on the whole population is higher for a point of observation in which the Mose's face is directed toward the eyes of the observers (p<;0.02). Finally, the cerebral appreciation of the investigated group was found maximum from a perspective in which all the details of the sculpture could be easily grab by the eyes. Results suggested how the perception of the sculpture depends critically by the point of view of the observers and how such point of view can produce separate emotional and cerebral responses.

An electroencephalographic Peak Density Function to detect memorization during the observation of TV commercials.

Nowadays, there is a growing interest in measuring the impact of advertisements through the estimation of cerebral reactions. Several techniques and methods are used and discussed in the consumer neuroscience. In such a context, the present paper provides a novel method to estimate the level of memorization occurred in subjects during the observation of TV commercials. In particular, the present work introduce the Peak Density Function (PDF) as an electroencephalographic (EEG) time-varying variable which is correlated with the cerebral events of memorization of TV commercials. The analysis has been performed on the EEG activity recorded on twenty healthy subjects during the exposition to several advertisements. After the EEG recordings, an interview has been performed to obtain the information about the memorized scenes for all the video clips watched by the subjects. Such information has been put in correlation with the occurrence of transient peaks of EEG synchronization in the theta band, by computing the PDF. The present results show that the increase of PDF is positively correlated, scene by scene, (R=0.46, p<;0.01) with the spontaneous recall of subjects. This technology could be of help for marketers to overcome the drawbacks of the standard marketing tools (e.g., interviews, focus groups) when analyzing the impact of advertisements.

Neuroelectric brain imaging during a real visit of a fine arts gallery: a neuroaesthetic study of XVII century Dutch painters.

Neuroaesthetic is a scientific discipline founded more than a decade ago and it refers to the study of the neural bases of beauty perception in art. The aim of this paper is to investigate the neuroelectrical correlates of brain activity of the observation of real paintings showed in a national fine arts gallery (Scuderie del Quirinale) in Rome, Italy. In fact, the present study was designed to examine how motivational factors as indexed by EEG asymmetry over the prefrontal cortex (relative activity of the left and right hemispheres) could be related to the experience of viewing a series of figurative paintings. The fine arts gallery was visited by a group of 25 subjects during an exhibition of the XVII century Dutch painters. Results suggested a strict correlation of the estimated EEG asymmetry with the verbal pleasantness scores reported by the subjects (p<0,05) and an inverse correlation of the perceived pleasantness with the observed painting's surface dimensions (p<0,002).