Classification and design of teledermatology practice: what dermatoses? Which technology to apply?

Dermatologists are mostly confined to urban regions and rural population is deprived of specialist care. Teledermatology Practice (TDP) is a solution to overcome this global problem. Tools for TDP includes video conference, store and forward, hybrid, mobile, satellite communication, integration model, nurse-led teledermatology, teledermatology focusing on difficult-to-manage cases, teledermoscopy, and teledermatopathology with combined applications. This article reviews the feasibility studies focusing teledermatology tools and analyses the possible options in designing TDP. Categorizing dermatoses for TDP depends on the purpose and types of technology. The dermatoses presenting from a remote geographic regions requires any of the following approaches (i) only TDP, (b) initial TDP followed by face-to-face, (iii) initial face-to-face followed by TDP and (iv) only face-to-face examination. The technology should suit the dermatoses, meet the purpose, be cost-effective and provide better management with follow-up care. We recommend store and forward as a basic TDP model as most dermatoses are diagnosed and follow-up care is delivered. Leprosy, pigmented skin lesions, leg ulcers, HIV and endemic dermatoses require screening and triage services using mobile teledermatology. Counselling and education require videoconference. Rural dermatology's camps require satellite communication mounted on a vehicle. Objective assessment (vitiligo and leg ulcer) after treatment requires integration model at a tertiary centre. Difficult-to-manage cases require second opinion using hybrid/store and forward TDP. Lower rural centre are provided with mobile/ store and forward teledermatology services. Selected or major community centre should be equipped with hybrid teledermatology and linked to a tertiary centre. This process helps healthcare administration to plan a TDP to cover all dermatoses, utilizing the available health care professional (HCP) and technology with minimum budget investment.

Journal club: screen, select, probe & evaluate.

Postgraduate dermatology training programs like seminars, panel discussions, and case presentations help residents to acquire knowledge. Journal club (JC) exercises help residents to update themselves with the current literature. What article a resident should choose and how a resident should evaluate and analyze an article or critically appraise a topic are issues that are most relevant for the success of a JC. Little guidance is available in the biomedical literature on how to deal with such issues. The objective of this article is to provide guidance to neophytes on dealing with JC exercises in a way that helps them in learning the critical appraisal skills. A review of the literature and of the author's experience in JC exercises will be presented. Knowing the methodology of rapid screening of articles along with the art of evaluating them, coupled with a sound knowledge of epidemiology and bio-statistics, helps a resident to select appropriate articles and discard poorly conceived or designed topics that may not generate interest in JC attendees. Hence, such an approach helps the resident in acquiring new knowledge in the shortest time. Choosing the right topic and then applying the newly obtained information to clinical practice, participants succeed in making the JC a valuable learning experience. Further, such well-formatted JCs help residents to improve the quality of health care delivered to patients.