Waikato Teledermatology: a pilot project for improving access in New Zealand.

INTRODUCTION: Teledermatology can improve access to specialist dermatological advice. We describe a retrospective review of the first 12 months of Waikato Teledermatology (WT), a low-cost, secure, website-based, store-and-forward teledermatology network using the Collegium Telemedicus platform. METHODS: We determined specialist response time, referral metrics, patient diagnosis and progress reports from the network's database. The programme's value was evaluated by post-pilot online surveys of referrers and specialist dermatologists. RESULTS: WT was used by 31 referring doctors for 309 consultations with four dermatologists between July 2013 and June 2014. Mean and median specialist response time was 2.07 hours (range: 0.13-5.64 hours). The researchers categorized the referrals as tumours (56.8%) and rashes (43.2%), including inflammatory dermatoses (51.9%), infection (18.1%), uncertain (16.5%), miscellaneous (7.5%), and of environmental origin (6%). Thirty tumours were biopsied, including nine melanomas and three basal cell carcinomas. A total of 158 progress reports and 35 survey responses were received. Reported advantages included decreased delay, improved accuracy of diagnosis and treatment compared to that made without specialist input, decreased unnecessary procedures such as biopsies of undiagnosed conditions, and increased appropriate referrals for face-to-face assessment, thus leading to cost savings for the patient and the health care system. The major disadvantages were the time burden for clinicians to complete consultations, the lack of integration with the patients' usual electronic medical record and absence of funding. DISCUSSION: WT proved an effective and acceptable approach to improving patient access to dermatologic services.

Patients' educational needs about topical treatments for psoriasis.

BACKGROUND: Topical medications are a mainstay of psoriasis treatment. Many patients lack education about topicals. This may contribute to low adherence with long-term disease management. OBJECTIVE: We sought to describe educational needs concerning topical treatment for patients with psoriasis. METHODS: Patients' questions regarding topical therapy were collected from a National Psoriasis Foundation webcast on topical medications. The prebroadcast question responses and the postwebcast survey responses were categorized into common themes and ranked by frequency. RESULTS: Thirty percent asked about side effects, with a major emphasis on topical steroids; 16% asked about proper use; and 11% asked about efficacy. Popular new and useful education concerned specific medication facts and information on medication (especially steroid) safety, the need for treatment adherence, and the variety of options available in topical form. LIMITATIONS: The study population consisted of online users expressing interest in the National Psoriasis Foundation educational material, not the general population of patients with psoriasis. CONCLUSIONS: Patient needs can be better met by providing information regarding side effects, proper use, and efficacy of topical medications. Communication regarding treatment changes and adherence to the treatment regimen should also occur.

Feasibility of a clearing house for improved cooperation between telemedicine networks delivering humanitarian services: acceptability to network coordinators.

BACKGROUND: Telemedicine networks, which deliver humanitarian services, sometimes need to share expertise to find particular experts in other networks. It has been suggested that a mechanism for sharing expertise between networks (a 'clearing house') might be useful. OBJECTIVE: To propose a mechanism for implementing the clearing house concept for sharing expertise, and to confirm its feasibility in terms of acceptability to the relevant networks. DESIGN: We conducted a needs analysis among eight telemedicine networks delivering humanitarian services. A small proportion of consultations (5-10%) suggested that networks may experience difficulties in finding the right specialists from within their own resources. With the assistance of key stakeholders, many of whom were network coordinators, various methods of implementing a clearing house were considered. One simple solution is to establish a central database holding information about consultants who have agreed to provide help to other networks; this database could be made available to network coordinators who need a specialist when none was available in their own network. RESULTS: The proposed solution was examined in a desktop simulation exercise, which confirmed its feasibility and probable value. CONCLUSIONS: This analysis informs full-scale implementation of a clearing house, and an associated examination of its costs and benefits.

Who shall coordinate the coordinators? Facilitating the work of telemedicine networks which provide humanitarian services.

Telemedicine networks for humanitarian purposes have evolved over the last decade or so in a largely autonomous way. Communication between them has been informal and relatively limited in scope. This situation could be improved by developing a comprehensive approach to the collection and dissemination of information. We propose the formation of a central 'clearing house' which would allow networks to exchange information and cases where appropriate. In order for a network to belong to the clearing house, it would need to conform to certain guidelines, which would ensure that safe and satisfactory standards would be maintained. We propose that a coordinators' conference should be held to discuss who would operate the clearing house and how it would be resourced. The creation of a central clearing house would facilitate the operation of the networks, particularly during periods of heavy workload, and lead to improved sustainability, thereby benefiting individual patients. We believe that more can be achieved by the networks acting together than by them acting independently.

Glucocorticoids may trigger attacks in several types of periodic paralysis.

Hypokalemic periodic paralysis is a rare disorder characterized by episodic attacks of muscle flaccidity associated with low serum potassium levels. We report twelve patients with normokalemic and hypokalemic periodic paralysis due to various mutations who developed hypokalemic paralytic episodes following a single dose or short-term administration of glucocorticoids. We hypothesize that glucocorticoids cause hypokalemia due to their stimulation of the Na(+)-K(+) ATPase mediated by insulin and amylin and due to their side effect of insulin resistance resulting in hyperglycemia. This report adds to the clinical description of glucocorticoids as a trigger of attacks of hypokalemic periodic paralysis indicating that glucocorticoids should be administered with caution in patients with periodic paralysis.