Effect of real-time teledermatology on diagnosis, treatment and clinical improvement.

We assessed the effect of real-time teledermatology consultations on diagnosis and disease management, patients' quality of life and time- and cost-savings. All consecutive patients with skin diseases attending teledermatology clinics at two rural hospitals in Jordan were included in the study. Patients were interviewed at their initial visit and again after eight weeks. Various questionnaires and forms, including quality of life questionnaires, were used to collect the data. Ninety teledermatology consultations were performed for 88 patients between September 2013 and January 2014. A diagnosis was established as part of the teledermatology consultation in 43% of patients and changed from that of the referring provider in 19% of patients. The treatment plan was established for 67% of patients and changed for 9% patients. The mean SF-8 score increased significantly (P < 0.005). The mean DLQI score decreased significantly (P < 0.005) indicating that there had been an improvement in the patients' quality of life since baseline. Most patients perceived that the visit to the teledermatology clinic required less travel time (96%), shorter waiting time (83%) and less cost (96%) than a visit to the specialist clinic at the main hospital. The patients' mean satisfaction score was 90.5 (SD 8.5), indicating a high level of satisfaction. Teledermatology resulted in changes in the patients' diagnosis and treatment plan, and was associated with improved health state and quality of life.

Telecardiology application in jordan: its impact on diagnosis and disease management, patients' quality of life, and time- and cost-savings.

Objectives. To assess the impact of live interactive telecardiology on diagnosis and disease management, patients' quality of life, and time- and cost-savings. Methods. All consecutive patients who attended or were referred to the teleclinics for suspected cardiac problems in two hospitals in remote areas of Jordan during the study period were included in the study. Patients were interviewed for relevant information and their quality of life was assessed during the first visit and 8 weeks after the last visit. Results. A total of 76 patients were included in this study. Final diagnosis and treatment plan were established as part of the telecardiology consultations in 71.1% and 77.3% of patients, respectively. Patients' travel was avoided for 38 (50.0%) who were managed locally. The majority of patients perceived that the visit to the telecardiology clinic results in less travel time (96.1%), less waiting time (98.1%), and lower cost (100.0%). Telecardiology consultations resulted in an improvement in the quality of life after two months of the first visit. Conclusions. Telecardiology care in remote areas of Jordan would improve the access to health care, help to reach proper diagnosis and establish the treatment plan, and improve the quality of life.

The use of the 308-nm excimer laser for the treatment of psoriasis.

OBJECTIVE: The objective was to study the effectiveness of the 308-nm excimer laser for the treatment of various forms of localized stable psoriasis. BACKGROUND: Recent reports show that 308-nm excimer laser may be an effective and safe method for the treatment of localized stable psoriasis. METHODS: A retrospective chart review was performed of a population-based group of 98 patients with various forms of localized stable psoriasis treated with excimer laser. Of these, 41 were male, and 57 were female patients. Ages ranged from 10 to 84 years (mean, 51.4 years). Patients who completed at least 10 sessions were included unless they had achieved >70% improvement in PASI scores before 10 treatments. The initial dose was determined by the MED (minimal erythema dose), and the dose was raised gradually in a stepwise fashion. RESULTS: Significant improvement (≥70%) was achieved by 59 (60.2%) patients; they needed an average cumulative dose of 6.46 J/cm(2), and an average of 17 sessions. Twenty-four (24.5%) patients achieved good improvement (50% to 70%); the average cumulative dose needed was 5.36 J/cm(2), and the average number of sessions required was 12. Side effects were limited to sunburn-like reaction. CONCLUSION: The 308-nm excimer laser is an effective and safe modality for the treatment of psoriasis, with good results achieved in a relatively short time.

A five-patient satisfaction pilot study of calcium hydroxylapatite injection for treatment of aging hands.

BACKGROUND: The process of skin aging is not limited to the face but involves every part of the body, including the hands. A common manifestation of aging of the hands is the loss of volume, which occurs as the skin loses its subcutaneous fat. Injectable dermal fillers have surfaced as a popular method to address such deficiencies. OBJECTIVES: To report the use of calcium hydroxylapatite (CaHA) to address lost volume. METHODS: Five female subjects with soft tissue deficiency of the dorsa of the hands were enrolled at Mount Sinai Medical Center. A solution of CaHA with 2% lidocaine in amounts of 0.3 to 1.0 mL was injected interdigitally at each of three to five insertion sites; the sites were massaged and molded up to three times to ensure an optimal cosmetic end point. Subjects were seen for a follow-up visit after 1, 4, 16, and 24 weeks. RESULTS: With a single injection, all subjects reached their correction goals without requiring any touch-ups. At the 24-week visit, the subjects retained the filling effect, with no adverse events and high patient satisfaction. CONCLUSION: CaHA, a new, easily injectable, safe dermal filler, has emerged as an excellent option for soft tissue augmentation in aging hands.