Evaluation of Teledermatology Practice Guidelines and Recommendations for Improvement.

Background: The current coronavirus disease 2019 (COVID-19) pandemic has forced dermatology practices to rapidly adopt or expand teledermatology services. To date, teledermatology clinical practice guidelines (CPGs) have not been evaluated for quality. This may hinder the implementation and sustainability of high-quality teledermatology services. The objective of this study is to evaluate teledermatology CPGs by using a comprehensive, validated appraisal tool and provide actionable recommendations for improvement for future guideline developers. Materials and Methods: A systematic literature search was performed to identify all CPGs published in teledermatology. Identified guidelines meeting inclusion criteria were scored for guideline quality by three researchers using the Appraisal of Guidelines and Research and Evaluation tool (AGREE II). Results: Three guidelines met inclusion criteria, including guidelines published by the American Telemedicine Association, the British Association of Dermatologists, and the Australian College of Dermatologists and the University of Queensland. Each of these guidelines exhibited unique strengths and areas for improvement. Areas of strength include clear objective statements, stakeholder involvement, and clarity of presentation. Areas for improvement include rigor of guideline development, applicability, and editorial independence. Conclusions: All guidelines were determined to be of sufficient quality for adoption based on AGREE scoring. Adoption of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence appraisal framework would improve the rigor of development of each guideline. Administering and publishing questionnaires to assess financial competing interests and external review processes would shed more light on the presence and/or extent of author bias. One inherent limitation of CPG selection criteria is that large providers of teledermatology services, such as the United States Veterans Affairs, were not examined in this review. However, the results of this study provide actionable targets to improve the quality of the teledermatology CPGs examined in this study.

A Framework-Driven Systematic Review of the Barriers and Facilitators to Teledermatology Implementation.

Purpose of Review: Telemedicine use in dermatology, termed "teledermatology", offers a cost-effective model to improve healthcare efficiency and access. Only a minority of dermatology practices has integrated teledermatology into their practice prior to COVID-19. A thorough understanding of the barriers and facilitators may promote teledermatology adoption. Implementation science frameworks offer theoretically driven ways to assess factors affecting teledermatology implementation. This review uses a comprehensive implementation science framework to summarize barriers and facilitators of teledermatology implementation and appraises the quality of existing research. Recent Findings: Technological characteristics of teledermatology (e.g., user-friendliness) and factors within the outer setting (e.g., reimbursement and legal considerations) were the most commonly reported barriers. No existing studies use a comprehensive implementation framework to identify factors influencing teledermatology implementation. Many included studies have a risk of bias in at least two of the five study quality indices evaluated. Summary: This systematic review is the first study to summarize the existing teledermatology implementation literature into well-defined constructs from a comprehensive implementation science framework. Findings suggest future studies would benefit from the use of an implementation framework to reduce study bias, improve result comprehensiveness, facilitate comparisons across studies, and produce evidence-based resolutions to implementation barriers. Tools, resources, and recommendations to facilitate the use of an implementation framework in future studies are provided. Supplementary Information: The online version contains supplementary material available at 10.1007/s13671-020-00323-0.

A retrospective study of 51,781 adult oral and maxillofacial biopsies.

BACKGROUND: Few studies have compared patient and anatomic characteristics across the broad scope of oral and maxillofacial disease seen in dental clinics. The authors conducted a study to make these comparisons by surveying a large sample of histologically diagnosed oral and maxillofacial lesions in a US adult population. METHODS: A total of 51,781 specimens biopsied from 51,781 adult patients were received by an oral pathology service over 13 years (2001-2015) and analyzed. A description of patients' sex and age at diagnosis, as well as the anatomic site of biopsy was given for diagnoses of 10 oral disease types, including malignant neoplasm, benign neoplasm, infectious, reactive, potentially malignant, developmental, healthy tissue, immune dysfunction, physical trauma, and other. RESULTS: The authors reported reactive lesions were the most prevalent disease type found in the sample (74.9%). Malignant diagnoses comprised 1.97% of all biopsies. The 3 most prevalent diagnoses in this study included benign keratosis, chronic apical periodontitis, and radicular cyst. Different anatomic sites, patient age groups, and sexes show different distributions of disease. CONCLUSIONS: Certain disease types and diagnoses were found to have a higher prevalence by sex, among particular age groups, and in certain anatomic sites. PRACTICAL IMPLICATIONS: This information provides clinicians with a detailed and broad scope of the variety of oral and maxillofacial lesions processed at an oral pathology service and may assist practitioners in forming clinical impressions and differential diagnoses.

Pediatric Oral Pathology: A Retrospective Survey of 4,554 Biopsies.

PURPOSE: The purposes of this study were to: (1) report patient age, gender, and anatomical information on a large number of pediatric oral biopsies in the United States; and (2) highlight differences in recent pediatric oral lesions compared to past pediatric studies and an adult population. METHODS: A total of 4,554 pediatric biopsies received over the past 13 years (2001-2015) were surveyed. Patient's age, gender, anatomical site of biopsy, and diagnosis were described under 10 diagnostic categories: (1) malignant neoplasm; (2) benign neoplasm; (3) infectious; (4) reactive; (5) precancerous; (6) developmental; (7) healthy tissue; (8) immune dysfunction; (9) physical trauma; and (10) other. RESULTS: A gradual increase in the number of biopsies with age was noted. The most common diagnosis observed was mucocele, consisting of 28 percent of all biopsies. Biopsies across pathological categories were most commonly obtained from the mandible. CONCLUSIONS: Biopsies received from a pediatric population are largely reactive in nature. Compared to an adult population, the pediatric population has a significantly lower rate of malignant and precancerous lesions but a higher rate of developmental diagnosis. A diverse array of pathoses was seen in the gingiva and mandible, whereas palatal mucosa and the floor of the mouth exhibited more variation.