Medical and Legal Aspects of the Practice of Teledermatology in Spain. / Aspectos medicolegales de la práctica de la teledermatología en España.

Teledermatology is now fully incorporated into our clinical practice. However, after reviewing current legislation on the ethical aspects of teledermatology (data confidentiality, quality of care, patient autonomy, and privacy) as well as insurance and professional responsibility, we observed that a specific regulatory framework is still lacking and related legal aspects are still at a preliminary stage of development. Safeguarding confidentiality and patient autonomy and ensuring secure storage and transfer of data are essential aspects of telemedicine. One of the main topics of debate has been the responsibilities of the physicians involved in the process, with the concept of designating a single responsible clinician emerging as a determining factor in the allocation of responsibility in this setting. A specific legal and regulatory framework must be put in place to ensure the safe practice of teledermatology for medical professionals and their patients.

[Usefulness and efficiency of teledermoscopy in skin cancer management in primary care]. / Utilidad y eficiencia de la teledermatoscopia en el manejo del cáncer de piel en atención primaria.

OBJECTIVE: To evaluate the usefulness of teledermoscopy as a diagnostic and triage method for suspected skin cancer lesions between Primary Care and Dermatology. To analyse the reduction in the number of referrals and estimate the savings achieved. MATERIAL AND METHODS: Concordance study on a non-randomised case series. Descriptive observational study of teleconsultations sent from two Health Centres (urban and rural) to the reference Dermatology service in Cordoba (Spain) between January 2017 and April 2019. The diagnoses proposed by Primary Care before and after the use of dermatoscopy, and the diagnosis of the Dermatologist, along with other epidemiological variables were collected. Descriptive analysis and concordance study were performed. RESULTS: A total of 395 teleconsultations were made. The coefficient of agreement between the diagnoses of both specialists without using dermoscopy was 0.486. Using this technique the concordance was 0.641. A reduction in the number of referrals to Dermatology was 58%. A savings of 2,475€ in transfers by ambulance and 550 working hours were made. The most common diagnoses were basal cell carcinoma (20%; n=79) and seborrheic keratosis (15.2%; n=60). CONCLUSIONS: The addition of dermoscopy increases diagnosis concordance. Teledermatology is a useful system for patient triage and for decreasing the demand for hospital care, with an inherent resources saving.

[Abbreviating the brief. Approach to ultra-short versions of the Yesavage questionnaire for the diagnosis of depression]. / Abreviar lo breve. Aproximación a versiones ultracortas del cuestionario de Yesavage para el cribado de la depresión.

OBJECTIVES: To assess the validity of small questionnaires of 4,5 and 1 questions, based on the 15-question Spanish version of the Yesavage geriatric depression scale (GDS-VE), for diagnosing depression in the over-65s. DESIGN: Study to validate questionnaires. SETTING: Health centre consultations. PARTICIPANTS: 258 patients were selected to adapt and validate the original questionnaire (GDS-15). Then validity data were assessed by using a group with one question (GDS-1), a group with 4 questions (GDS-4) and a group with 5 (GDS-5). The questions were chosen for the greater sensitivity and specificity shown in the validation study of the GDS-VE. MAIN MEASUREMENTS: Inter and intra-observer reliability, internal consistency, convergent validity (Spearman's correlation coefficient: CC), criterion validity (sensitivity, S, and specificity, E), and the diagnostic capacity of each questionnaire (area under the ROC curve: AUC), at their respective 95% confidence intervals (CI), were all analysed. RESULTS: 249 patients concluded the study, with the following results (the cut-off point was taken as 2 or more points on the 4 and 5-question versions): GDS-1: S: 71.1% (61.7-80.4), E: 74.1% (67.3-80.9), AUC: 0.726 (0.659-0.793), CC: 0.679 (0.673-0.684). GDS-4: S: 73.3% (64.2-82.4), E: 77.7% (71.2-84.2), AUC: 0.821 (0.765-0.876), CC: 0.803 (0.754-0.852). GDS-5: S: 81.1% (73.1-89.1), E: 73.2% (66.3-80.1), AUC: 0.833 (0.789-0.887), CC: 0.866 (0.824-0.908). CONCLUSIONS: The sensitivity and specificity results are similar to results of other ultra-short GDS studies. The high reliability of these ultra-short versions leads us to recommend that new studies be run to enable these versions to be consolidated as a valid and very rapid option for diagnosing depression among the elderly.