Dermatology Online Journal
Abstracts of the Internet Dermatology Society meeting
Abstracts of the Internet Dermatology Society Meeting
New Orleans, March 18 1999
Rhett Drugge, Editor
Dermatology Online Journal 5(1): 9
Dermlist is an electronic mailing list that connects portuguese-speaking dermatologists from Brazil and other countries. It was started in February of 1997, and now has more than 220 participants, from 10 countries. It runs on a daily basis,and there is no charge for participation. It is divided into four areas starting with Editorial which serves as an index for the day. The next area is Contributions which contains materials sent by the participants focused on dermatology related subjects, including clinical cases with or without pictures. These texts undergo edition (which eliminates irrelevant and unnecessary lines such as repetition of the whole text of the previous day, that comes along with some contributions). The next section is the reposting of Questions, placed by a participant. We allow a specific question to remain exposed for five days, so the question gets more attention from the whole group.Finally, there is an Informal section, where other subjects unrelated to clinical dermatology are analyzed, such as discussions involving medical fees, jokes, etc. A question is also allowed to remain in this informal section for 5 days. The text is sent simultaneously either in html format as well as regular e-mail text. At the end of this text, in the body of the message, there is the blue line characterizing the html; when clicked, it will automatically display that latter format.
9(b) A live teledermatology session with Switzerland using DERMANET
G.Burg, L.Gilli, A. Haffner, L. Kuhnis, L.Milesi. T. Rufli, P.Schmid
A teledermatology conference between various participants in Switzerland was performed live at the Internet Dermatology Society Meeting in order to demonstrate the functionality of the Dermanet system used for teledermatology in Switzerland. Dermatologists in private practice and university based departments of dermatology discussed clinical and histological images, demonstrating the many features of the program used. This program operates according to the highest security standards. It is easy to use, flexible and meets the specific dermatologic requirements of its clients. Information on software prices and hardware requirements will be given.
9(c) DERMANET: A teledermatology consultation and information system in Switzerland: Preliminary results
L.Milesi,G.Burg, L.Gilli, A Haffner, L.Kuhnis, T.Rufli, P.Schmid
Dermanet is the result of three years of interdisciplinary teledermatological development. It has been tested primarily in the target areas for which it was designed. During the development of this tool, the main emphasis was placed on quality, user-friendliness and practicality, with much effort going into making it a modular, expandable, forward-looking and open system, affordable for everybody. The system is being evaluated by means of questionnaires addressed to physicians using it and to their patients. The points emphasized in the questionnaires are the degree of acceptance of the system and its effectiveness, its effect on access to know-how, care and quality improvements as well as its educational value. The information collected clearly indicates that Dermanet makes the users' workflow smoother and increases their patients' trust in their work. These preliminary results should be corroborated in further investigations.
9(d) Continuing Medical Education on-line
The need for dermatologists to be life-long learners arises out of our ethical responsibility as physicians, the explosive nature of the biomedical information base, and the need to fulfill credentialling criteria for continued medical licensure and board certification/recertification. Physician use of the internet, in general, and the WWW, in specific, is increasing. Recent survey data reveal increasing interest in continuing medical education delivered through online media. These same surveys demonstrate that physician information needs are not currently being met.
ACCME accreditation processes for Category I online CME enduring materials will be reviewed in the historical context of online CME development. Opportunities for Category II credit will also be reviewed. Dermatologic efforts will receive particular attention.
Social forces, regulatory pressures, and technological advances that may be expected to impact the content of online CME will be outlined. Models of online CME delivery will be reviewed, including didactic, interactive, disease state management, evidence based medicine (EBM), and hybrid EBM structures. Barriers to the use of electronic media for obtaining CME credit will be discussed, including familiarity, quality issues, and critical mass. Trends in online CME will be discussed, including educational technologies, outcome analyses, and global educational strategies.
9(e) Digital epiluminescence microscopy of pigmented skin lesion
Cutaneous melanoma(CM)represents an important health problem among the white-skinned population around the world. Early recognition of CM is widely accepted as a substantial issue to reduce the probability of metastasis. Long-term survival after early melanoma is greater than 95%. Epiluminescence microscopy (ELM) as a non invasive clinical technique makes subsurface structures of the skin accessible for in vivo examination and thus provides additional criteria for the early diagnosis of pigmented skin lesions (PSL). Recently, digital ELM (DELM) systems have been developed. The potential advantages in using these digital instruments rather than simple handheld microscopes are as follows: (1) images of PSL can be stored and retrieved easily, (2) digital images allow a more objective comparison during follow-up, (3) digital images can be transferred easily to expert centers for the purpose of a second opinion and (4) digital images represent a basis for electronic feature extraction and mathematical analysis.
We report on the results from a clinical study from 8244 PSL which have been sampled with a commercially available DELM system during a period of two years. The prevalence of CM in the data set was 1.8%. The image quality of the digital images was compared with conventional photos in 100f the sample. All lesions have been analyzed with clinical scoring systems as well as with automated digital feature extraction. A comparison of clinical features and digitally extracted data will be presented.
9(f) Digital imaging for facial wrinkles evaluation
The goal of the study is to determine if digital imaging can be used to evaluate changes in fine facial wrinkles following application of a facial cream formulation useful in reducing the number of facial wrinkles. Twenty subjects were imaged before and after treatment with two facial creams, a test compound and a placebo compound, applied randomly to one side of the face or the other. The duration of the study was eight weeks. Using an Agfa 1280 digital camera, facial images were obtained before and following treatment. The image of the face was divided into left and right halves and then in four sections defined by the Forehead, Eyes, Cheek, and Chin. Statistical comparisons were made using the t-test for active sides versus placebo sides before and after the treatment. At the end of the study, both the active compound side and the placebo side showed decreased number of facial wrinkles. These changes in the aggregate wrinkle score were statistically significant from the baseline numbers. There was no statistical difference in the facial wrinkle score at the end of the study between the active and placebo sides. A separate analysis of the fine facial wrinkle count showed similar results as the aggregate score.
Quantitative changes in the number of facial wrinkles were documented with both the test compound and the placebo compound. A visual examination of the digital images also shows a slightly lower number of fine wrinkles at the end of treatment period. Digital imaging and high pass filtering appear to work well for evaluation and documenting changes in facial wrinkling.
9(g) On-line patient information
This paper describes how to assess and find on-line information that is suitable for patients with skin disease. The oral PowerPoint presentation will be supplemented by a comprehensive web page.
I will compare on-line information with conventional sources of information. Some of the most suitable and comprehensive sites for patients with skin diseases will be identified. The internet has more than 10,000 health-related web sites of variable size and quality. Few are specifically for patients with skin disease - the best will be listed.
The quality of health sites on the Internet should be carefully evaluated before uncritically recommending them to patients. A useful guide is the draft White Paper, "Criteria for Assessing the Quality of Health Information on the Internet, 1997". The criteria discussed include credibility, content, disclosure, design and interactivity.
Patients can access the same information as their medical adviser including image banks, dermatological texts and Medline searches. On-line sources of information to the patient include professional sites (organisations, academic departments and specific on-line general health resources), commercial sites, and self-help sites. Several lists of resources are available which improve the chance of finding specific information.
9(h) Telemedicine for wound care
Telemedicine can be used as an important adjunct in the care of patients with chronic wounds. Reduced costs and improved quality of life are two outcomes we are studying in our pilot project at The Wound Clinic of Akron General Medical Center. Our multidiscipinary wound care clinic sees over 100 outpatients per week and is staffed by 5 physicians and one nurse practitioner.
The obvious advantage of telemedicine is that transportation costs can be reduced or eliminated. Utilizing digital images sent as email attachments is a simple approach that can be used by nursing homes and home health agencies to triage new patients to the most appropriate wound care specialist and follow patients after their initial visit in our clinic.
The development of our program will be discussed with the intent of helping others address specific issues related to wound clinics, limitations of digital images, security, and medical record storage. Reimbursement issues will also be addressed.
9(i) On-line pearls
The WWW is a valuable educational tool for dermatologists. Unfortunately, both physical (couch potato syndrome) and mental (boredom while waiting for downloads) illness can be engendered by its use. There are a number of ways to avoid these problems and optimize your online experiences.
UP ON YOUR HEELS, DOWN ON YOUR TOES. Surf the WWW while working out on a Nordic Trak, Stepmaster or exercycle. Commercially available reading stands make this easy to do.
A DAY AT THE RACES, A NIGHT AT THE OPERA. The majority of surfing is done with Navigator and Explorer, the two most popular browsers. Unfortunately, both of these have their slow moments. If you want to browse faster (faster downloads of graphics being most critical) try the Opera browser from www.operasoftware.com A small (1.2 meg) download, this browser will coexist well with both of the big boys on your hard drive.
A ROSE IS A ROSE IS A ROSE. Waiting for downloads on any browser can be a nuisance. Why not open multiple browser windows simultaneously? Although this will have a net effect of slowing all downloads, if some pages are less graphically intense or less popular than others, these may download first, allowing you to do something while the other page(s) download.
DOUBLE YOUR PLEASURE, DOUBLE YOU FUN. You use more than one browser but would like to easily move your bookmarks and favorite places back and forth. A number of freeware, shareware and commercial applications will let you do this.
HOME IS WHERE THE HEART IS. Don't like the home page chosen by your browser or ISP? Edit/Preferences/Navigator in Navigator and View/Internet Options/General in Explorer will let you define your own homepage, such as that of the IDS (www.telemedicine.org) or use a local HTML file on your computer as your home page.
RIGHT ON, BROTHER! The right button on your mouse has lots of uses while browsing, including point and click capture of bookmarks/favorite places, saving of files and capture of graphics as files or as desktop wallpaper.
MIGHTY MOUSE! The standard mouse is not for everyone. A variety of other pointing devices, including touchpads, trackball and stylus devices are available, some in wireless forms. All are programmable for those with physical limitations.
SLAYING THE DRAGON. Voice recognition has made great strides over the last year. Unfortunately, voice control of your WWW browser in anything other than a very, very quiet room is not here yet.
DON'T BACK DOWN. You don't store your money in a can in your backyard (I hope). Why store your data in the same place? Remote backup may be the norm someday. You can try it for free now at www.freedrive.com
PICTURE PERFECT. Do you like what you see on the WWW? Do you want to capture it for posterity on a 35mm slide without spending a fortune? Easy approaches with camera and tripod will be elaborated upon.
9(j) J Derm mailing list and its activities
J Derm mailing list initiated in June 1995, has now more than 160 members and more than 1700 postings by December 1998. Although there have been several mailing lists in the Internet for dermatologists, this dermatology mailing list was created to discuss clinical problems and comments on the daily dermatological cases in Japanese. The members of the mailing list have been selected among the applicants who send an e-mail requesting subscription to the administrator of the mailing list, because the mailing list provides members professional discussion without security problems. The mailing list has been also the discussion site for on-line clinico-pathological-conferences which has linked to the World Wide Web server at Mie university.
9(k)Application of computer assisted video image analysis in assessment of immunohistological markers in psoriasis.
Psoriasis is a common, chronic inflammatory papulosquamous skin disorder with well-validated pharmacodynamic markers of immune mediation and epidermal activation. In this report we demonstrate the application of a video image analyzer in assessment of these immunohistologic markers of active psoriatic plaques. An image analysis system used in our application consists of a special color video camera connected to a light microscope. The images acquired by the camera are captured by the computer with a capture card and these images can be displayed, adjusted and stored as image files on the computer. Using the image analysis program, Image-Pro Plus (Media Cybernetics, Silver Spring, MA), the number of positively stained cells were quantified using monoclonal antibodies to Ki 67 (epidermal proliferation) and CD 3+ cells (T lymphocytes). The parameters set to quantify positively stained cells included the selection of color intensity, range of area, roundness, and aspect of the positively immunostained cells. Epidermal area and thickness were measured after spatial scale calibration of the system. The image analyzer was shown to be a time efficient system tool that can be used to accurately count positively stained cells and measure epidermal thickness and area with great advantages over conventional methods of histological assessments of images. In conclusion we find that this tool can also be applied in the field of dermatology for analyzing the ultrastructure of the skin or in preparation of high-resolution histological images.
9(l) The Internet Dermatology Society, past, present and future
Language Solutions to E-mail Lists
Over a five-year period, the Internet Dermatology Society Membership Database has collected data on approximately 1,200 applicants with 650 accepted members. The membership form included 96 fields. As the e-mail list activity increased to large proportions, there was a need to control the signal to noise ratio. Using a spreadsheet, the data in the "interests" field was sorted according to unique words and multilingual synonyms, the prepositions and irrelevant parts of speech were eliminated and then the e-mail lists were exported into this spreadsheet to create distribution lists of 100 categories and word groups. Categories with fewer than five participants were consolidated into other groups. Similarly, the "geographic" field data which included states and countries was organized into 100 countries or regions and 42 US States. This is a useful construct for imposing finer granularity on communications among dermatologists. Future work in this area will include work establishing channel security, automation of list updating and evaluation of usage patterns.
Large Format Imaging in Telemedicine
The commercial availability of new large format image acquisition and display devices has set the stage for applications of this technology in dermatology. Image capture, processing and display technologies will be reviewed with a special eye towards understanding the emerging role of new large format systems and their potential role in dermatology. Image capture device strategies will be reviewed including line scanners, area scanners, and video capture. Image registration, image size requirements and three dimensional mapping required to create diagnostic total body images will be discussed. Ergonomics and cost of various imaging strategies will be delineated.