The majority of skin lesions in pediatric primary care attention could be managed by Teledermatology.

BACKGROUND: Teledermatology is a tool that provides accurate diagnosis and has been gaining more emphasis over time. It can be used for triage in primary care attention to address skin conditions improving access and reducing time to treatment for surgical, severe or even lethal diseases. OBJECTIVES: Our main goal was to evaluate the proportion of pediatric patient's lesions that could be managed using teledermatology in primary care attention. Secondly, we wanted to assess the ten most frequent skin conditions, the most common treatments and the referrals made by the teledermatologists to biopsy, in-presence dermatologist or kept at primary care attention. METHODS: A cross-sectional retrospective study involving 6,879 individuals and 10,126 lesions was conducted by store-and-forward teledermatology during one year in the city of Sao Paulo, Brazil. If the photographs taken had enough quality, teledermatologist would diagnose, treat and orient each lesion (if possible), and choose one of three options for referral: direct to biopsy, in-presence dermatologist or kept at primary care attention. RESULTS: Teledermatology managed 62% of the lesions to be kept at primary care attention, 37% were referred to dermatologists and 1% to biopsy, reducing the mean waiting time for an in-presence visit in 78%. In patients 0-2 years old, lesions related to eczema and benign congenital lesions predominated. From 3-12 years old, eczema was still a major cause of complaint, as well as warts and molluscum. From 13-19 years old, acne was the most significant problem, followed by atopic dermatitis, nevi and warts. The most frequent treatment was emollient. CONCLUSION: Teletriage addressed 63% of the lesions without the need for an in-presence visit, suggesting that teledermatology can manage common diseases and optimize dermatological appointments for the most serious, surgical or complex skin illnesses, reducing the mean waiting time for them.

[Avances recientes en dermatología comunitaria 2016-2017. Teledermatología, un modelo de enseñanza y asistencia en atención primaria a la salud].

INTRODUCTION: Community dermatology (CD) is integrated by dermatologists, epidemiologists and interested people. It has 27 years of experience at the Guerrero State. Due to unsafety issues, the teaching and medical attention model had to be changed from presential to virtual trough telemedicine. METHOD: Transversal, descriptive, observational and analytic study, in which results from teaching-learning of the health personal that was capacitated throughout the telemedicine network at the Guerrero State were evaluated, during nine courses that reached 35 telemedicine centers. RESULTS: 2465 health workers were capacitated in basic dermatology, which were evaluated in their general knowledge of dermatology before and after every course. The utility of this modality of teaching was statistically evaluated with a random simple in 611 attendees with satisfactory results. DISCUSSION: Teaching through telemedicine network, represents an improvement for CD by reaching a higher number of attendees to several reception centers simultaneously, minimizing transportation expenses and improving the safety of the participants at the activities, with the advantage of allowing continuity of the CD purposes.

INTRODUCCIÓN: La dermatología comunitaria (DC) está integrada por dermatólogos, epidemiólogos y personal afín. Tiene 27 años de existencia en el Estado de Guerrero. Por condiciones de inseguridad se cambió el modelo presencial de enseñanza y atención dermatológica a la forma virtual, a través de teledermatología. OBJETIVO: Determinar la utilidad de la capacitación y enseñanza virtual a través de la telemedicina en DC. MÉTODO: Estudio transversal, descriptivo, observacional y analítico, en el que se evaluaron los resultados de la enseñanza-aprendizaje en el personal de salud capacitado por la red de telemedicina mediante nueve cursos que llegaron a 35 centros de telemedicina en el Estado de Guerrero. RESULTADOS: Se capacitó en dermatología básica a 2465 trabajadores de la salud, evaluando sus conocimientos antes y después de cada curso. Se validó estadísticamente la utilidad de esta modalidad de enseñanza con una muestra al azar de 611 asistentes, con resultados satisfactorios. DISCUSIÓN: La enseñanza a través de la red de telemedicina representa un avance en DC al llegar a un mayor número de asistentes en varios centros de recepción en forma simultánea, minimizando los gastos de transporte y salvaguardando la integridad de los participantes, con la ventaja de dar continuidad a los propósitos de DC.

Implementación de la gestión de riesgo en los procesos misionales de la Sección de Dermatología de la Universidad de Antioquia (Medellín, Colombia) siguiendo las directrices de la norma ISO 9001: 2015 / Implementation of Risk Management in the Mission Processes of the Dermatology Section of the Universidad de Antioquia (Medellín, Colombia) Following the ISO 9001: 2015 Guidelines / Implementação de gestão de risco em processos missionais da Seção de Dermatologia da Universidade de Antioquia (Medellín, Colômbia) seguindo diretrizes da norma ISO 9001: 2015

Resumen La gestión de riesgos en los servicios de atención en salud es un proceso que considera la planeación y aplicación de estrategias orientadas a controlar posibles efectos adversos que surjan durante la atención a los usuarios, la calidad en el servicio y la seguridad del paciente. En el presente artículo se reporta el desarrollo del sistema de gestión del riesgo de los procesos misionales de la Sección de Dermatología de la Universidad de Antioquia, así como los principales resultados obtenidos a la fecha y la manera como el Sistema de Gestión de Calidad bajo la norma ISO 9001 sirvió de complemento y apoyo al sistema de gestión del riesgo implementado. Se identificaron cinco riesgos inherentes para el Laboratorio de Dermatopatología, seis para Otros Procesos Dermatológicos y ocho para la Unidad de Fotodermatología, los cuales fueron analizados y evaluados, luego de lo cual se implementaron los controles pertinentes.

Abstract Risk management in health care services is a process that takes into account the planning and implementation of strategies aimed at controlling possible adverse effects that arise during the attention to users, quality of service, and patient safety. This article reports on the development of the risk management system for the mission processes of the Dermatology Section of the Universidad de Antioquia, as well as on the main results obtained to date and the way in which the Quality Management System (under the ISO 9001 standard) worked as a complement and support to the implemented risk management system. Five inherent risks were identified for the Dermatopathology Laboratory, six for Other Dermatological Procedures, and eight for the Photodermatology Unit, all of which were analyzed and evaluated; the relevant controls were implemented afterwards.

Resumo A gestão de riscos nos serviços de atenção em saúde é um processo que considera o planejamento e aplicação de estratégias orientadas a controlar possíveis efeitos adversos que surgirem durante o atendimento a utentes, a qualidade no serviço e a segurança do paciente. No presente artigo relata-se o desenvolvimento do sistema de gestão de riscos dos processos missionais da Seção de Dermatologia da Universidade de Antioquia, bem como os principais resultados obtidos a hoje e a maneira como o Sistema de Gestão de Qualidade sob a norma ISO 9001 serviu de complemento e apoio ao sistema de gestão do risco implementado. Cinco riscos inerentes ao Laboratório de Dermatopatologia foram identificados, seis para outros Processos Dermatológicos e oito para a Unidade de Fotodermatologia, os quais foram analisados e avaliados, após disso implementaram-se os controles pertinentes.

Brazilian Society of Dermatology against leprosy.

The Brazilian Society of Dermatology promoted a national campaign against leprosy in 2012, involving their State Regional, Accredited Services of Dermatology and Referral Services in Leprosy. Consisted of clarification to the population about the disease and a day of medical voluntary service. Ninety services (57 Accredited Services and 33 Reference Services) participated, distributed in 23 states. The campaign examined 3,223 people and 421 new cases were diagnosed, 54,4% female, 74,3% between 19 and 64 years and 8,3% in children under 15 years. Of the 217 classified cases, 58,5% was paucibacillary and 41,5% was multibacillary. The results were posted on the Brazilian Society of Dermatology website.

Building a global teledermatology collaboration.

Skin disease is common in low-resource countries and is associated with significant morbidity. The disease burden is often heightened by lack of access to adequate diagnosis and treatment. Teledermatology is a growing healthcare delivery modality that allows access to subspecialty care at a distance. This article describes how a low-cost teledermatology program was launched through collaboration between the Medical College of Wisconsin and Hillside Healthcare International. Several factors are required for a teledermatology program to be successful, beginning with a partnership between two entities that targets a locally identified need and is mutually beneficial to invested partners. The program should utilize the expertise of each partner, be based on an agreed upon process with clearly defined objectives, and protect patient privacy. After a program is implemented, adaptation to address challenges and best meet the needs of all parties involved will allow for continued success and sustainability. This process can serve as a model for other programs desiring to establish similar teledermatology partnerships in an academic setting.

Teledermatology in Tijuana, Mexico.

The Health Frontiers in Tijuana (HFiT) clinic is a binational partnership between the University of California, San Diego School of Medicine (San Diego, California); the Universidad Autónoma de Baja California School of Medicine (Tijuana, Mexico); and Desayunador Salesiano Padre Chava, a community grassroots organization in Tijuana, Mexico. Health Frontiers in Tijuana provides accessible quality health care for the underserved in Tijuana's Zona Norte. This article is a narrative meant to share my clinical experience as a dermatology resident who worked with HFiT to establish teledermatology services at this clinic.

Dermatologists in the Emergency Department: A 6-Year Retrospective Analysis.

OBJECTIVE: There are few studies documenting dermatological consultations in the emergency setting. The aim of this study was to evaluate the nature, purpose, and diagnostic accuracy of emergency care physicians in all the dermatology consults evaluated by the Department of Dermatology of the University of Puerto Rico School of Medicine. METHODS: A retrospective analysis of all the consultation reports pertaining to patients evaluated at 4 emergency departments served from July 1, 2007, to June 30, 2013. The data collected from each consultation report consisted of the demographic information of the patient, the name of the consulting hospital, the initial diagnostic impression, the diagnostic impression of a dermatologist, and the procedures, if any, performed by that dermatologist. RESULTS: A total of 429 patients were evaluated (53% men, 47% women) from July 2007 through June 2013. The most common diagnosis was infectious process (37%), followed by eczema (14%) and drug-induced skin reactions (12%). Seventeen percent (17%) of the cases for which consultations were sought were considered true dermatological emergencies. Forty-six percent of cases resulted in no diagnostic impression from the consulting physician. Of the cases that did result in diagnoses, these diagnoses were later changed by a dermatologist in 34% of the cases. CONCLUSION: This study suggests that the role of the dermatologist in the emergency department is very important. In addition, better education in the management of common skin disorders and the identification of true dermatological emergencies should be stressed during medical school and in residency training programs of specialties such as emergency medicine and those that offer primary care.

Eventos adversos en la terapia farmacológica de la enfermedad inflamatoria intestinal / Adverse events associated with the treatment of inflammatory bowel disease

Background: The purpose of inflammatory bowel disease (IBD) treatment is to achieve resolution of symptoms and remission of disease with a minimum of adverse events (AE). Aim: To report AE of different prescriptions used for the treatment of IBD. Material and Methods: Analysis of a registry of patients with IBD held at a private clinic from 1976 to 2013. All used medications, the occurrence and severity of AE were recorded. Results: The records of 346 patients aged 16 to 86 years, 74% with ulcerative colitis, were analyzed. The most commonly type of medications prescribed were 5-aminosalicylates (5-ASAs) in 329 patients (92%), followed by adrenal steroids in 218 (61%). Forty nine AE were recorded in the same number of patents (14%). These were more common in patients with Crohn disease (n = 19, 21%). An univariate analysis, demonstrated that extra-intestinal manifestations, hospitalizations secondary to IBD crisis, requirement of surgery and treatment with steroids, immunosuppressants or biologic agents were significantly associated with the presence of AE. AEs were more common with immunosuppressants, followed by 5-ASAs and steroids. Discontinuation of therapy was required in 79, 100 and 43% of patients taking these medications, respectively. Twenty percent of AEs were severe. Leukopenia and pancytopenia along with alopecia were the most common AEs attributable to azathioprine. Conclusions: The occurrence of AEs in patients with IBD is uncommon. Even inmunosuppressants or biologic agents have a low rate of AE and most of them mild.

The path to modernity: a personal testimony to the restructuring of the Department of Dermatology, Vargas Hospital, Caracas, Venezuela.

In the late 1950s and early1960s, there was a concerted effort to modernize teaching, training, and patient care in the Vargas Hospital of Caracas, Venezuela. The above included the development of research in the frame of postgraduate training. This effort was to be helped by USA funds and institutions but could only be achieved by the work of Venezuelans, sharing a vision of progress. Dermatology spearheaded this initiative, and the fruit of this was the exponential development of Venezuelan Dermatology and the creation of the National Institute of Dermatology on the grounds of the Vargas Hospital. The purpose of this contribution is to review these events that happened more than half a century ago from my own perspective. I sincerely hope that these lines could serve as an inspiration to the younger generations that toil today under less-than-favorable conditions.

Organizing a dermatology service mission.

BACKGROUND: There are few published guidelines that describe the forethought and logistical considerations needed to create a dermatology-specific medical mission. OBJECTIVE: To report the experience of planning and executing a successful medical mission to an underserved community in Puerto Rico. METHODS: We identified an area of need and projected the volume of patients and diseases to be treated. After recruiting medical staff, pharmaceutical and surgical supplies were collected. Important concerns included establishing the scope of medical and educational services to be rendered, advertising the clinic, arranging for biopsy processing, ensuring follow-up, and selecting a method for medical documentation. We tracked the number of patients seen, diagnoses made, and materials used to prepare for future missions. RESULTS: We recruited 12 physicians and 25 ancillary (i.e. nonlicensed physician) staff members, including: six dermatologists, four internists, one pathologist, one psychiatrist, 23 medical students, and two medical assistants. We secured 12 examination rooms in an existing medical facility. Two pharmaceutical companies and two pathology companies provided the medications and surgical supplies with the remainder coming from the volunteer physicians' offices. Three thousand dollars were raised and used toward purchasing additional supplies. Advertising via public announcements resulted in the attendance of 166 patients during the 1-day clinic. A total of 41 procedures were performed, including 14 biopsies, five excisions, three incisions and drainage, and 19 electrodessications and curettage. CONCLUSION: Proper planning is critical in creating a successful dermatology mission. Documenting the care given and supplies used helps to identify needs and optimize limited resources for future missions. The goal of a self-sustaining public health service starts with patient education and coordination with the local healthcare providers.

Teledermatology via a social networking web site: a pilot study between a general hospital and a rural clinic.

Teledermatology via a free public social networking Web site is a practical tool to provide attention to patients who do not have access to dermatologic care. In this pilot study, a general practitioner sent consults to a dermatology department at a general hospital via Facebook(®). Forty-four patients were seen and treatment was installed. We identified both simple-to-treat, common skin diseases and rare congenital diseases that require genetic counseling and more complex treatment. The majority of patients (75%) benefited with the diagnoses and treatments offered, thus avoiding unnecessary expenses or transportation to urban areas.

Teledermatología: ¿qué, cuándo y cómo?: [revisión] / Teledermatology: what, when and how?: [review]

La telemedicina es un campo con un alcance enorme, el que se ha expandido en los últimos años. Particularmente las especialidades gráficas, como por ejemplo la Dermatología, tienen un papel crucial en este terreno. La teledermatología tiene enormes beneficios como son: permitir el acceso a consultas especializadas de poblaciones remotas y con pocos recursos, realizar interconsultas entre expertos para casos complicados, brindar educación médica continua; no obstante se deben conocer sus limitaciones y obstáculos.

Telemedicine is an area with enormous potential that has expanded greatly in the last few years. Particularly specialties that rely on images, like Dermatology, have an important role in the field. Teledermatology brings on a lot of benefits, such as bringing specialty care to remote populations without resources, allowing experts to exchange ideas on difficult cases, continuing medical education; but it also has limitations and obstacles that need to be acknowledged.

The dermatologist in military operations.

The military dermatologist has a specific and significant role in military operations--in time of war as well as in peace. Many dermatologists are unfamiliar with the impact that our specialty and cutaneous disease has upon the ability of the military to fulfill the missions, duties, and responsibilities assigned by our government. This article highlights a few of the recent or ongoing types of military operations in which our specialty plays a prominent part.