The remote assessment of melanocytic skin lesions: a viable alternative to face-to-face consultation.

BACKGROUND: The incidence of melanoma continues to rise in the Western world, prompting health care professionals to search for novel tools that may increase rates of early detection. Here we focus on one such tool: remote specialist diagnosis of melanocytic lesions utilising mobile-phone camera patient-generated clinical images. OBJECTIVE: We aim to test the hypothesis that patient-generated clinical images utilising mobile phones are of acceptable quality, and that digital image diagnostic outcomes are comparable with face-to-face (FTF) diagnostic outcomes. METHODS: Study participants were asked to photograph, using their mobile-phone camera any number of their own melanocytic naevi, and then upload these clinical images to a central server. Diagnostic accuracy of the management decision based on assessing these digital images was tested by comparing results from digital image assessment with results from FTF assessments. RESULTS: We provide evidence that suggests potential patients are capable of uploading good quality clinical images of melanocytic lesions for diagnostic purposes, and we show that good concordance rates can be achieved with respect to digital image and FTF diagnostic outcomes. With respect to the latter, exact agreement was found in 116 of 167 assessable lesions (69%). CONCLUSIONS: This work suggests that specialist remote diagnosis of patient-generated clinical images of melanocytic lesions utilising mobile-phone cameras may be a viable alternative to traditional FTF assessments.

Clinical dietetics changes due to cost-reduction activities in healthcare systems.

OBJECTIVE: This study was designed to assess changes in clinical dietetics due to cost-reduction activities in healthcare systems. SUBJECTS: 1,200 ADA members who indicated that they were employed by acute care hospitals in ADA Area 2 states. DESIGN: A questionnaire about changes in clinical dietetics staffing and clinical dietitians' activities and responsibilities was developed based on qualitative research. Descriptive statistics, t tests, analysis of variance, chi2 tests, and correlations were calculated. RESULTS: A total of 342 usable questionnaires (28.5%) were returned. More than one third (37.9%) of respondents reported reductions in the number of clinical dietitians, and 32.2% reported increases in the number of part-time clinical dietitians. Most respondents indicated that they were more involved with high-risk patient interventions, had limited time for inpatient instruction, and experienced an increased patient caseload. Although 45.4% of respondents reported diminished job satisfaction due to recent changes in healthcare systems, some changes, such as increased high-risk patient intervention and referrals, were positively correlated with perceived job satisfaction. DISCUSSION: Thorough review of current clinical dietetics activities/responsibilities and planning before cost-reduction, restructuring activities may maximize staff utilization without decreased job satisfaction of clinical dietetics staff.