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BACKGROUND: Damage biomarkers are helpful in early identification of patients who are at risk of developing acute kidney injury (AKI). Investigations are ongoing to identify the optimal role of stress/damage biomarkers in clinical practice regarding AKI risk prediction, surveillance, diagnosis, and prognosis. OBJECTIVE: To determine the impact of utilizing a clinical decision support system (CDSS) to guide stress biomarker testing in intensive care unit (ICU) patients at risk for drug-induced acute kidney injury (D-AKI). METHODS: A protocol was designed utilizing a clinical decision support system (CDSS) alert to identify patients that were ordered 3 or more potentially nephrotoxic medications, suggesting risk for progressing to AKI from nephrotoxic burden. Once alerted to these high-risk patients, the pharmacist determined if action was needed by ordering a stress biomarker test, tissue inhibitor of metalloproteinase-2-insulin-like growth factor-binding protein 7 (TIMP-2â¢IGFBP7). If the biomarker test result was elevated, the pharmacist provided nephrotoxin stewardship recommendations to the team. Pharmacists recorded the response to the clinical decision support alert, ordering, and interpreting the TIMP-2â¢IGFBP7, and information regarding clinical interventions. An alert in conjunction with TIMP-2â¢IGFBP7 as a strategy for AKI risk prediction and stimulant for patient care management was assessed. In addition, barriers and solutions to protocol implementation were evaluated. RESULTS: There were 394 total activities recorded by pharmacists for 345 unique patients. Ninety-three (93/394; 23.6%) actionable alerts resulted in a TIMP-2â¢IGFBP7 test being ordered. Thirty-one TIMP-2â¢IGFBP7 results were >0.3 (31/81; 38.3%), suggesting a high-risk of progression to AKI, which prompted 191 pharmacist/team interventions. On average, there were 1.64 interventions per patient in the low-risk patients, 3.43 in high-risk patients, and 3.75 in the highest-risk patients. CONCLUSION AND RELEVANCE: Stress biomarkers can be used in conjunction with CDSS alerts to affect therapeutic decisions in ICU patients at high-risk for D-AKI.
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Injúria Renal Aguda , Sistemas de Apoio a Decisões Clínicas , Humanos , Inibidor Tecidual de Metaloproteinase-2 , Biomarcadores , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnóstico , Unidades de Terapia IntensivaRESUMO
BACKGROUND: An understanding of the prevalence patterns of skin diseases in children in Botswana is needed to guide national dermatological policy development, training, and resource allocation to improve patient care. OBJECTIVE: To describe local skin disease patterns in children aged 0-18 years presenting for dermatologic care in Botswana. METHODS: A retrospective review of records from 1st January 2011 to 31st December 2016 was conducted at the outpatient dermatology clinic of Princess Marina Hospital (PMH) in Gaborone, Botswana and outreach clinic sites. RESULTS: There were 4413 pediatric visits constituting 18.6% of all dermatology visits. There was a slight male predominance of 1.2:1. The majority of disorders were noninfectious 80.1% (3537/4413) versus infectious 14.6% (645/4413), with 5.2% (231/4413) unclassified. In the noninfectious category, two-thirds were inflammatory, followed by disorders of nails, skin appendages, and pigmentary disorders. Atopic dermatitis was the most common inflammatory disorder. Over half of infectious skin diseases were viral, followed by fungal and bacterial disorders. In the HIV-related disorders, the majority were verrucae 94% (108/115) followed by Kaposi sarcoma. The nine most common skin diagnoses accounted for close to 70% of all skin diseases seen at the clinic, and these included atopic dermatitis (almost half of all cases), followed by verruca, acne, and vitiligo. CONCLUSION: There is a high burden of skin disorders in children in Botswana. In our cohort, a small number of skin conditions made up the vast majority of pediatric diagnoses. This information can be used to guide dermatology training and resource allocation to better manage these common diseases.
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Dermatite Atópica , Dermatologia , Dermatopatias , Criança , Masculino , Humanos , Feminino , Pacientes Ambulatoriais , Botsuana/epidemiologia , Dermatopatias/epidemiologia , Dermatopatias/diagnósticoRESUMO
BACKGROUND: Representative images of pathology in patients with skin of color are lacking in most medical education resources. This particularly affects training in dermatology, which relies heavily on the use of images to teach pattern recognition. The presentation of skin pathology can vary greatly among different skin tones, and this lack of representation of dark skin phototypes challenges providers' abilities to provide quality care to patients of color.In Botswana and other countries in sub-Saharan Africa, this challenge is further compounded by limited resources and access to dermatologists. There is a need for improved and accessible educational resources to train medical students and local medical providers in basic skin lesion description and diagnosis. OBJECTIVES: We examined whether online Perceptual and Adaptive Learning Modules (PALMs) composed of representative dark skin images could efficiently train University of Botswana medical students to more accurately describe and diagnose common skin conditions in their community. METHODS: Year 4 and 5 medical students voluntarily completed PALMs that teach skin morphology, configuration, and distribution terminology and diagnosis of the most common dermatologic conditions in their community. Pre-tests, post-tests and delayed-tests assessed knowledge acquisition and retention. RESULTS: PALMs training produced statistically significant (P < .0001) improvements in accuracy and fluency with large effect sizes (1.5, 3.7) and good retention after a 12.5-21-week median delay. Limitations were a self-selected group of students, a single institution, slow internet connections, and high drop-out rates. CONCLUSIONS: Overall, population-specific PALMs are a useful tool for efficient development of pattern recognition in skin disease description and diagnosis.
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Dermatologia/educação , Educação de Graduação em Medicina/organização & administração , Dermatopatias/diagnóstico , Pigmentação da Pele , Botsuana , Currículo , HumanosRESUMO
A two-year-old boy presented with a large, non-healing ulceration on his left buttock, which was originally noted as a brown patch present at birth. Punch skin biopsy was performed and histopathology revealed an atypical, pleomorphic, spindled proliferation in whorled fascicles replacing the dermis and trapping fat in the subcutis, consistent with a diagnosis of congenital/infantile fibrosarcoma. No evidence of metastatic spread was seen on imaging. The tumor was initially deemed unresectable owing to extent of local invasion. Neo-adjuvant chemotherapy caused significant tumor shrinkage and the patient underwent complete resection.
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Fibrossarcoma/congênito , Neoplasias Cutâneas/congênito , Úlcera Cutânea/etiologia , Nádegas , Pré-Escolar , Fibrossarcoma/complicações , Fibrossarcoma/patologia , Humanos , Masculino , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia , Úlcera Cutânea/patologiaAssuntos
Infecções Oportunistas Relacionadas com a AIDS , Prestação Integrada de Cuidados de Saúde , Infecções por HIV/complicações , Sarcoma de Kaposi/patologia , Neoplasias Cutâneas/patologia , África Subsaariana , Biópsia , Botsuana , Dermatologia , Saúde Global , Humanos , Quênia , Nigéria , Encaminhamento e Consulta , Sarcoma de Kaposi/diagnóstico , Neoplasias Cutâneas/diagnósticoRESUMO
Neutrophilic panniculitis is a rare adverse effect of therapy with selective BRAF inhibitors. We report a case of neutrophilic panniculitis in a 15-year-old girl receiving treatment with vemurafenib for a brainstem glioma. Clinicians should be aware of this rare but important side effect of vemurafenib. This is the first report of neutrophilic panniculitis in a child treated with vemurafenib.
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Antineoplásicos/efeitos adversos , Indóis/efeitos adversos , Neutrófilos/patologia , Paniculite/induzido quimicamente , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Sulfonamidas/efeitos adversos , Adolescente , Neoplasias do Tronco Encefálico/tratamento farmacológico , Feminino , Glioma/tratamento farmacológico , Humanos , Paniculite/patologia , VemurafenibRESUMO
OBJECTIVE: The primary objective of this study was to evaluate the students' choice of activities and perception of a cocurricular program (CCP). Attitude and skill development and areas for program improvement were also assessed. METHODS: Data were evaluated from 2 sources: a student survey administered to all Doctor of Pharmacy students to determine student perceptions of the CCP and barriers to success and student activity reporting data from postexperience submissions to evaluate the CCP. Data were stratified by student demographics to identify trends. A comparison of data was conducted from both sources on the students' perception of learning value. RESULTS: Data for 405 students were available for analysis. The highest preference overall from students for hosts of activities were professional student organizations; the highest preference of location was online, asynchronous. The most meaningful benefits were learning information about a new subject (n = 258, 63.7%), ability to extend learning from the classroom to real life (n = 247, 61%), and networking opportunities (n = 218, 53.8%). The top barriers for completion of the program included scheduling challenges (n = 296, 73.1%), lack of time (n = 249, 61.5%), and lack of interest (n = 187, 46.2%). Subpopulations identified different benefits and barriers to completion. CONCLUSION: Students have overall positive perceptions of the CCP and its value for skill development. Findings were applied to adjust the CCP at the institution, including a reduction in total hours required. The continuous evaluation of CCPs is important to optimize student learning and address curricular overload.
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Educação em Farmácia , Estudantes de Farmácia , Humanos , Estudantes de Farmácia/psicologia , Educação em Farmácia/métodos , Masculino , Feminino , Aprendizagem , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Adulto , Comportamento de Escolha , Currículo , Adulto Jovem , Avaliação EducacionalRESUMO
The American Association of Colleges of Pharmacy Council of Faculties commissioned a task force during the 2021-2022 academic year to examine the problem of curricular overload. As a result of this task force and the Academy-wide discussions around curricular overload, a consensus has formed around the significance of defining and addressing this challenge. Many institutions have begun work on identifying solutions to curricular overload. This theme issue will identify and describe current solutions to curriculum overload that can be implemented at the course, curricular, or Academy level. Future directions are also described. This introduction provides an overview of the theme issue.
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Educação em Farmácia , Assistência Farmacêutica , Farmácias , Farmácia , Humanos , Academias e InstitutosRESUMO
OBJECTIVE: Recently, there have been calls to action to address curricular expansion, including modifying standards, using curricular analytics, and optimizing interdisciplinary collaboration, all of which focus on program-level changes. The primary objective of this study was to describe how the process of backward design can be used as a strategy to reduce curricular expansion at the individual course level while maintaining student performance and decreasing student and coordinator stress. METHODS: Backward design was applied to a large, interdisciplinary, team-taught pharmacotherapy course to identify opportunities to reduce content volume and align assessment content with course objectives. Didactic content hours were measured and compared with historical controls. Student performance on examinations was measured and compared with previous years. Student feedback on examination alignment and other course-related stressors was gathered via semester-end course evaluations and compared with previous years. Course coordinator reflections before and after implementation were described. RESULTS: The amount of didactic content hours delivered to students decreased by over 37 hours (33%), allowing space for the expansion of application-based practice, study time, and wellness breaks. Student performance on examinations was maintained, while student stress with examination content and the course design was decreased. Coordinators noted less stress and time spent negotiating didactic content time and examination content and alignment with individual instructors. CONCLUSION: Using backward design as a framework to intentionally evaluate didactic content volume and assessment alignment can address curricular expansion while maintaining student learning and decreasing student and instructor stress.
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Educação em Farmácia , Humanos , Estudos Interdisciplinares , Exame Físico , EstudantesRESUMO
BACKGROUND: In resource-limited countries, access to specialized health care services such as dermatology is limited. Clinical decision support systems (CDSSs) offer innovative solutions to address this challenge. However, the implementation of CDSSs is commonly associated with unique challenges. VisualDx-an exemplar CDSS-was recently implemented in Botswana to provide reference materials in support of the diagnosis and management of dermatological conditions. To inform the sustainable implementation of VisualDx in Botswana, it is important to evaluate the intended users' perceptions about the technology. OBJECTIVE: This study aims to determine health care workers' acceptance of VisualDx to gauge the feasibility of future adoption in Botswana and other similar health care systems. METHODS: The study's design was informed by constructs of the Technology Acceptance Model. An explanatory, sequential, mixed methods study involving surveys and semistructured interviews was conducted. The REDCap (Research Electronic Data Capture; Vanderbilt University) platform supported web-based data capture from March 2021 through August 2021. In total, 28 health care workers participated in the study. Descriptive statistics were generated and analyzed using Excel (Microsoft Corp), and thematic analysis of interview transcripts was performed using Delve software. RESULTS: All survey respondents (N=28) expressed interest in using mobile health technology to support their work. Before VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants' survey responses showed their confidence in VisualDx (18/19, 95%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (330/681, 48.5% of total uses) or using the artificial intelligence feature to analyze skin conditions (150/681, 22% of total uses). Overall, 61% (17/28) of the survey respondents were also interviewed, and 4 thematic areas were derived. CONCLUSIONS: Participants' responses indicated their willingness to accept VisualDx. The ability to access information quickly without internet connection is crucial in resource-constrained environments. Selected enhancements to VisualDx may further increase its feasibility in Botswana. Study findings can serve as the basis for improving future CDSS studies and innovations in Botswana and similar resource-limited countries.
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PURPOSE: Traditional methods used to evaluate changes in kidney function to identify acute kidney injury (AKI) have significant limitations. Damage biomarkers can identify patients at risk for AKI prior to changes in kidney function. While clinical trials have shown that biomarker-guided treatment can improve outcomes, whether these biomarkers can influence providers' choice of treatment strategy for risk prediction, surveillance, or diagnostic evaluation in clinical practice is uncertain. SUMMARY: This case series describes 4 patients at an academic medical center whose care was informed by kidney biomarker utilization in conjunction with a clinical decision support system (CDSS). Though each patient's clinical presentation was unique, kidney biomarkers were successfully employed as clinical tools in evaluating the risks and benefits of nephrotoxic medications. CONCLUSION: This case series demonstrates 4 scenarios in which a kidney injury biomarker used in conjunction with CDSS and consideration of the patients' clinical presentation informed treatment strategies with the intent to prevent AKI.
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Injúria Renal Aguda , Conduta do Tratamento Medicamentoso , Humanos , Biomarcadores , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnósticoRESUMO
We present the case of an 8-year-old girl who presented with distal extremity necrosis of the hands, feet, nose, and ears as an acute manifestation of cutaneous polyarteritis nodosa (CPAN). She was emergently managed with intravenous steroids, nifedipine, sildenafil, pentoxifylline, nitroglycerin paste, aspirin, low-molecular-weight heparin, and intravenous gamma globulin. The necrosis was controlled, and reperfusion was attained to salvage the extremities. It is important for clinicians to be aware that acute distal extremity necrosis can be a manifestation of CPAN in children. Etiology is often not clear on presentation, but once infection is excluded, acute management with systemic steroids and systemic vasodilators is indicated regardless of the cause. Iloprost and bosentan may represent options for adjunctive vasodilators. More studies are needed to create guidelines for the acute and long-term management of these children. Close follow-up of children with CPAN, especially with a history of vaso-occlusive symptoms, is important to allow prompt intervention in the event of distal extremity infarction.
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Poliarterite Nodosa/patologia , Poliarterite Nodosa/terapia , Úlcera Cutânea/patologia , Úlcera Cutânea/terapia , Doença Aguda , Criança , Extremidades , Feminino , Gangrena/patologia , Gangrena/terapia , Humanos , Necrose/patologia , Necrose/terapiaRESUMO
People with albinism (PWA) in Africa suffer many challenges, including higher risk of skin cancers and deeply embedded stigma. We conducted interviews with PWA to determine factors influencing their quality of life (QOL) in Botswana. Physical concerns expressed included skin/eye health issues and limited access to health care. Psychosocial concerns included stigma/discrimination and myths/superstitions. Environmental concerns included barriers to personal development of education and employment, safety concerns, financial insecurity, and disability rights issues. Pervasive difficulty in obtaining equal rights to physical, psychosocial, and environmental health affected QOL. Education around albinism and disability rights are needed to improve QOL for PWA.
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Albinismo Oculocutâneo/fisiopatologia , Albinismo Oculocutâneo/psicologia , Pessoas com Deficiência , Qualidade de Vida , Neoplasias Cutâneas/prevenção & controle , Queimadura Solar/prevenção & controle , Protetores Solares/uso terapêutico , Transtornos da Visão/fisiopatologia , Adulto , Idoso , Botsuana , Educação , Emprego , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Pesquisa Qualitativa , Discriminação Social , Estigma Social , Adulto JovemRESUMO
The authors reviewed outpatients in a tertiary dermatology clinic in Botswana to expand knowledge on patterns of skin disease in this population with a high prevalence of human immunodeficiency virus (HIV). Approximately one-third of new and follow-up patients were HIV positive. Common dermatologic conditions included eczematous eruptions, viral and fungal infections, malignant neoplasms, vascular disorders, disorders of pigmentation, and mechanical/physical injury-related disorders. HIV has impacted patterns of dermatologic disease in Botswana, with Kaposi sarcoma being the most frequently biopsied condition. Given the shortage of dermatology specialists, resources should be allocated toward education and management of these most prevalent skin conditions.
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Dermatite/epidemiologia , Infecções por HIV/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Dermatopatias Vasculares/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Adulto , Idoso , Biópsia/estatística & dados numéricos , Botsuana/epidemiologia , Criança , Pré-Escolar , Dermatite/diagnóstico , Dermatite/terapia , Dermatite Atópica/diagnóstico , Dermatite Atópica/epidemiologia , Dermatite Atópica/terapia , Feminino , Humanos , Lactente , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Discoide/epidemiologia , Lúpus Eritematoso Discoide/terapia , Masculino , Pessoa de Meia-Idade , Neurodermatite/diagnóstico , Neurodermatite/epidemiologia , Neurodermatite/terapia , Prevalência , Estudos Retrospectivos , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/epidemiologia , Sarcoma de Kaposi/terapia , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/terapia , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/terapia , Dermatopatias Vasculares/diagnóstico , Dermatopatias Vasculares/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Centros de Atenção Terciária , Verrugas/diagnóstico , Verrugas/epidemiologia , Verrugas/terapia , Adulto JovemRESUMO
BACKGROUND: Oculocutaneous albinism is disproportionately prevalent in Africa; however, the medical and psychosocial characteristics of people living with albinism (PWA) in Botswana have not been studied. OBJECTIVE: To characterize the demographics, health-related factors, sun-protective behaviors, and psychosocial challenges of PWA in Botswana. METHODS: Overall, 50 PWA and 99 patients without albinism (non-PWA) were recruited and surveyed. RESULTS: Higher proportions of PWA lived in rural villages compared with non-PWA (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.26-5.34). PWA reported limited access to health care more frequently compared with non-PWA (OR, 2.72; 95% CI, 1.11-6.62). High proportions of PWA adopted sun-protective measures, including sunscreen, clothing, and sunlight avoidance. Despite high rates of feeling accepted by family and peers, PWA had increased odds of feeling unaccepted by their community (OR, 15.16; 95% CI, 5.25-31.81), stigmatized by society (OR, 9.37; 95% CI, 3.43-35.62), and affected by stigma in social interactions (OR, 2.21; 95% CI, 1.08-4.54) compared with non-PWA. Three-quarters of PWA had witnessed mistreatment of PWA. LIMITATIONS: Study limitations include the small sample size, convenience sampling, and a non-validated survey instrument. CONCLUSION: PWA faced increased medical and psychosocial challenges compared with non-PWA in Botswana. Our findings can begin to inform public health strategies aimed at promoting improved health care, education, and social inclusion for this population in Botswana and other regions in Africa.
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BACKGROUND: People with albinism (PWA) are at increased risk of photodamage and skin cancer. In many parts of Africa, there is a significant lack of knowledge regarding albinism which can lead to societal stigma, discrimination, and persecution from an early age. In the Democratic Republic of Congo (DRC), there is limited clinical data on PWA and skin cancer. We aim to better understand sociodemographics, risk factors, clinical features, and outcomes of this population. METHODS: Patients with a diagnosis of albinism and skin cancer presenting to Kisangani Albino Clinic were enrolled. RESULTS: Of 205 PWA, 61 patients were diagnosed with skin cancer with a mean age of 26.5 years. Common occupations were student (45.6%) or unemployed (26.4%). Discrimination was experienced from close contacts (24.4%) and society (67.4%). A majority (88.5%) had never used sunscreen, only 4.9% used fully sun protective clothing, and 90.2% spent 4 or more hours in the sun daily. Skin cancers had a mean size of 3.8 cm and were most commonly located on the face (47.7%). Squamous cell carcinoma was the most common histopathological diagnosis. Most patients underwent excision, and 90.2% had clinical clearance of tumors at a mean follow-up of 5.7 months. CONCLUSION: People living with albinism in the DRC experience a high rate of nonmelanoma skin cancers at a young age and additionally face a number of psychosocial challenges. This study represents the first attempt to analyze a cohort of patients with albinism from the DRC and serves to increase awareness of this vulnerable population.
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Albinismo , Neoplasias Cutâneas , Adulto , Albinismo/epidemiologia , República Democrática do Congo/epidemiologia , Humanos , Neoplasias Cutâneas/epidemiologia , Protetores Solares/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: Primary cutaneous lymphoma (PCL) represents a heterogeneous collection of non-Hodgkin lymphomas originating in the skin. Our study describes the clinical and histological findings of cutaneous lymphoma within Botswana to expand the paucity of data on this rare disease in sub-Saharan Africa. METHODS: We conducted a retrospective review from the dermatology clinic at Princess Marina Hospital (Gaborone, Botswana) of patients evaluated by skin biopsy for cutaneous lymphoma between 2008 and 2017. Patients with initial diagnostic suspicion for cutaneous lymphoma had biopsies re-reviewed by experienced dermatopathologists and were given a final diagnosis of either (i) cutaneous lymphoma, (ii) atypical lymphocytic infiltrate (ALI), or (iii) a reactive cutaneous process. RESULTS: Thirty-eight cases were identified with a mean age of 50.0 years and a male:female (M:F) ratio of 13:6. Final diagnoses included: 27 cases of cutaneous lymphoma, eight cases of ALI, and three cases of reactive cutaneous processes. Subtypes of cutaneous lymphoma diagnosed included: mycosis fungoides (MF) (81.5%), plasmablastic lymphoma (7.4%), Epstein-Barr virus-positive T-cell lymphoma (3.7%), subcutaneous panniculitis-like T-cell lymphoma (3.7%), and peripheral T-cell lymphoma, not otherwise specified (3.7%). The most common immunohistochemical staining profile in MF cases was CD8 predominance over CD4. CONCLUSIONS: Primary cutaneous lymphoma causes significant morbidity and mortality globally. Given the limited resources in sub-Saharan Africa, it is essential to educate providers on the manifestations and histology of PCL. This study is an important step towards understanding the demographics, clinical presentation, histologic features, and mortality of patients diagnosed with PCL in Botswana and similar low-resource settings.
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Linfoma não Hodgkin/diagnóstico , Neoplasias Cutâneas/diagnóstico , Botsuana , Feminino , Humanos , Imuno-Histoquímica , Linfoma não Hodgkin/terapia , Masculino , Estudos Retrospectivos , Neoplasias Cutâneas/terapiaRESUMO
Telemedicine is well established as a means of providing high-quality healthcare at a distance, particularly to patients in underserved populations. Technologies in teledermatology can be used to complement traditional methodologies of clinical trials, expanding accessibility of trials to people typically unable to participate in research. Tools of communication technology may enhance many aspects of clinical trials in dermatology, from recruitment and retention of participants to collection of real-time data. Clinical trials can be made completely virtual or incorporate aspects of virtual technologies at any stage of research. Virtual clinical trials are considered highly patient-centered, as the ability of participants to engage with research staff from their own home often supplants the need for many or all on-site clinic visits. As technological advances influence every aspect of modern life, clinical trials will also evolve to incorporate these tools, meeting participant expectations and overcoming traditional challenges of conducting research. Virtual clinical trials come with specific issues pertaining to analysis of data, technology, and oversight. As more virtual trials are conducted, advantages and limitations of using such technology in research will become clearer and regulatory guidelines will be more firmly established.
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Ensaios Clínicos como Assunto/métodos , Dermatologia/métodos , Projetos de Pesquisa , Dermatopatias/terapia , Telemedicina/métodos , Ensaios Clínicos como Assunto/normas , Dermatologia/normas , Humanos , Guias de Prática Clínica como Assunto , Telemedicina/normasRESUMO
PURPOSE: Kaposi sarcoma (KS) is an HIV-associated skin cancer that is highly prevalent in Botswana and associated with significant morbidity and mortality. Histopathology-confirmed diagnosis is required for chemotherapeutic interventions in Botswana, which creates barriers to care because of limited biopsy and pathology services. We sought to understand the role a dermatology specialist can play in improving KS care through quality improvement (QI) initiatives to reduce histologic turnaround times (TATs) for KS. METHODS: Employment of a dermatology specialist within a public health care system that previously lacked a local dermatologist generated quality improvements in KS care. Retrospective review identified patients diagnosed with KS by skin biopsy in the predermatology QI interval (January 1, 2015, to December 31, 2015) versus the postdermatology QI interval (January 1, 2016, to November 31, 2017). Histology TATs and clinical characteristics were recorded. A t test compared the median histology TATs in the pre- and post-QI intervals. RESULTS: A total of 192 cases of KS were diagnosed by skin biopsy. Nearly all (98.4%) were HIV-positive; and 52.8% of patients were male with a median age of 39 years. Median TAT in the postdermatology QI interval was 11 days (interquartile range, 12-23 days) compared with 32 days in the predermatology QI interval (interquartile range, 24-56 days; P < .00). CONCLUSION: Dermatology-led QI initiatives to improve multispecialty care coordination can significantly decrease histology TATs for KS. The reduction of diagnostic delays is a key first step to decreasing the morbidity and mortality associated with this cancer in resource-limited settings.