WS128 The UK multicentre teledermatology study I

Workshops

systems, ‘DNA-chip’ technology and combinatorial chemistry. Industry now has an unprecedented opportunity to develop novel therapeutic strategies for the treatment of human disease which embrace small molecule drug discovery, protein therapeutics and gene therapy. Intelligent utilisation of these platform technologies will result in customization of treatment regimens and monitoring as well as more effective semi-ethical medicines and a move towards disease prevention.

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Telemedicine

accessed using HTTP to achieve better performance and avoid the overhead involved by starting common gateway interface processes. For the user, only a WWW browser is required. The acceptance of our WWW-server is surprisingly high. Nowadays we register over 15,000 accesses to our Dermatology on-line atlas per day from all over the world.

Still image-based dermatological diagnosis in a semi-rural setting

WS127

P.V. Harrison. Queen

Telemedicine WS125

Telemedicine - An overview

R. Wootton. Institute University,

Belfast

of Telemedicine BT9 TAB, UK

and Telecare,

QueenS

Telemedicine can be defined as medicine practised at a distance. Historically, much of telemedicine has been “high tech” and centred on hospitals. For example, teleradiology and telepathology. However, there are currently great opportunities for telemedicine in the primary care sector, partly because of the continuing fall in the cost of the technology. Teledermatology is an obvious area for primary care telemedicine. There are a number of potential benefits in terms of improved access etc, and also some potential drawbacks. Despite much teledermatology activity - for example, in the USA-there is little scientific evidence for its cost-effectiveness. There are two fundamentally different approaches to teledermatology, depending on whether the information is prerecorded and then sent to the dermatologist for subsequent evaluation (so called store-and-forward telemedicine), or whether the evaluation is done interactively (i.e. real-time telemedicine). The information transmitted can also vary, usually being either still pictures or video. A number of groups around the world have teledermatology research trials in progress and evidence of efficacy is beginning to emerge. However, it is not yet clear which technique or techniques are preferable, or even whether teledermatology has significant advantages over conventional dermatology in the primary care sector. Given the current fashion for “evidence-based medicine” there is little chance of the NHS adopting teledermatology without formal proof of cost-effectiveness.

WSI 26 On-line atlas as a tool for teledermatology T.L. Diepgen, J. Bauer, M. Simon, A. Bittorf. Dept. Dermatology Germany

Friedrich-Alexander-University,

Victoria

Hospital,

Morecambe

LA4 5NN,

UK

of Erlangen,

The World Wide Web (WWW) is becoming the major way of acquiring information in all scientific disciplines as well as in business. It is very well suitable for fast distribution and up to date teaching resources. However, to date most teaching applications on the Web do not use its full power by integrating interactive components. We have set up a computer based training (CBT) framework for Dermatology which consists of dynamic lecture scripts, case reports, an atlas and a quiz system. All these components heavily rely on an underlying image database that permits the creation of dynamic documents. We used a demon process that keeps the database open and can be

Increasing dermatological referrals, within a diverse geographical area in the Morecambe Bay region, have led to local difficulties in waiting list management. Previous work has indicated the usefulness of conventional photographic images in screening for various dermatological problems, particularly skin tumours (1). and we have also illustrated the benefit of a mobile telemedicine system for managing dermatological referrals (2, 3). As a prelude to an ISDN-based still image system, we have utilised conventional photographic images as a waiting list management module over a 6 month period. Two hundred and ten patients (92 males and 118 females), were managed from high resolution photographic images, eliminating in most individuals a need for an initial dermatological clinic visit. Patient satisfaction was good, diagnoses accurate, and the waiting list was reduced by over 75% within the study period. On the basis of this work, we are introducing a digital system in the Morecambe Bay area to improve speed of data transfer and reduce running costs of the system. References [ 11 Harrison P V and Lyon C C. Telemed 96, London [2] Lyon C C and Harrison P V. Telemed 96, London. [3] 3 Lyon C C et al. BAD 1997, Harrogate WS128

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The UK multicentre teledermatology study1

H.E. Gore. Dermatology Hospital

Group

Trust,

Department, Craigavon Portadown, UK

Area

I will discuss the results to date of the UK Multicentre Teledermatology Study. The primary aim of the study is to evaluate the diagnostic accuracy of teledermatology. Videoconferencing equipment was used in three Health Centres and three Hospitals. Dermatological patients were referred for a consultation with a remote dermatologist by videolink, followed by a (conventional) face to face consultation. Comparison of diagnosis was made. To date 348 patients have been included, with 422 dermatological conditions. There was accurate diagnostic correlation between the two types of consultation in 65% of cases. In 6% of cases a wrong diagnosis was obtained by teleconsultation. In the other cases, diagnosis by teleconsultation was differential, or not possible, or a condition was missed. When a video camera of higher quality was used accuracy rates improved. Telemedicine requires rigorous evaluation before it can be widely introduced as a tool for health care. I suggest that there

S106

Workshops

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Genitoanal

Dermtoses

Genitoanal Dermatoses

is sufficient degree of accuracy to allow the technique to be useful in some situations. WS131

WSI 29 The UK teledermatology Elizabeth Gilmour. Section Manchesteq

Mancehstel;

study II

of Germatology, UK

University

M.A. Waugh. Leeds General Infirmary, of

The UK Teledermatology Study was designed to assess the diagnostic accuracy of consulations with a dermatologist over a video-conferencing (ISND2) link compared to a face to face consultation; to explore patient and doctor satisfaction with the teleconsultation and to outline management plans. Overall diagnostic concordance proved to be 65% and is discussed in detail elsewhere. Management plans from both consultations were broadly similar in 67% of cases, however, in 20% of cases the teledermatologist was unable to offer a management plan after the teleconsultations and in 8% the management plan was considered to be less than optimum. There was no difference in the number or type of investigations requested following the consultation. While follow up rates generated by the two types of consultation were almost identical, different patients were recommended for outpatient follow-up after each type ogf consultation. GPs found 75% of consultations to be of educational benefit and were satisfied with 98%. Dermatologists reported high levels of satisfaction (~80%) in terms of patients response to the consultation although satisfaction with the system with the quality of sound (66%) and vision (61%) was poorer. Patients reported high levels of satisfaction with the system. This study demonstrates the potentials of low cost telemedicine. Once the problem of image quality has been addressed, issues of cost-effectiveness and potential changes in health service usage will require further evaluation.

WSI 30 Real time teledermatology R. Suhonen. Mikkeli

Central

Hospital,

Mikkeli,

Genital dermatoses - Introduction

using ISDNG Finland

A trial between a health center (GP), Mikkeli Central Hospital and Kuopio University Hospital revealed the benefits and problems of the real time teleconsultation. The bandwidth of 384 kbit/s allows rather good real time moving or still pictures in teledermatology. For a GP the possibility for immediate consultation is an optimal form of teledermatology. For a busy dermatology clinic the unscheduled telecontacts proved intolerable, however. In spite of the high standard of telecommunication in Finland, the synchronous use of 6 ISDN lines was not without technical problems. The teleconference type video equipment is not very well suited for the close up pictures needed in accurate teledermatology. We planned and made an own modification of video camera mount with light sources. Real time teledermatology with 6 ISDN lines is useful, if it is scheduled, the camera is modified for the needs of dermatology and the illumination is proper. So far also the billing is an unresolved matter - who pays and for what - for time used or per contact? It is not the technique or costs but the suspicious attitudes to build the major obstacle for teledermatology.

England

I write this introduction as a foreword to the Workshop with great joy as in a way genital dermatoses link the themes of the 6th EADV Congress, Dermatology and Venereology. All of us, in practice, see many patients with genital dermatoses. These require skilled history taking, excellent description and up to date work up often including histology. Localised dermatological conditions of the genitalia need excluding, i.e. balanitis xerotica et obliterans. Generalised dermatoses often have genital components, i.e. dermatitis, drug eruptions, lichen planus, psoriasis. These are often great sources of anxiety to the patient. Neoplasia have always been frequent in the ano-genital area. Infections, not always sexually transmitted, i.e. filariasis, may cause genital problems. STDs are many and frequent and a whole specialty. The manifestations of HIV often occur in the genital region. All the laboratory aspects of medicine are required for diagnosis. Lastly, we must not forget our predecessors in dermatology, from Hebra and Kaposi to Hugh Wallace and Darrell Wilkinson, who have done so much for the understanding of genital dermatoses. WS132

Genitoanal lesions as manifestation of generalized dermatoses

P.K. Kohl. Dept. of Dermatology Hospital,

12351

Berlin,

and Venereology, FR Germany

Neukiilln

The workshop on genitoanal dermatoses encompasses different aspects of skin diseases of the genital and perianal area, which are relevant for the practicing physician. Examination of genitoanal skin and mucosa is an important part of the every day occupation of genito-urinary medicine specialists, sexual health physicians, gynaecologists, obstetricians, urologists and dermato-venereologists. Besides specific dermatoses of the genitoanal area also skin and mucosal changes may be present which point to dermatoses involving the entire body surface. Careful examination and classification of the observed types of skin lesions may lead to the correct diagnosis. Thus generalized dermatoses like bullous diseases, Darier’s disease, drug eruption, erythema exsudativum multiforme, lichen planus, lupus erythematodes, lupus vulgaris, psoriasis vulgaris (flexural psoriasis), Reckling-hausen’s disease, varicella, vasculitis and vitiligo may be diagnosed solely by examination of the genitoanal area. This lecture will support this vue with ample visual material. WSI 33

Genitoanal lesions in Adamantiades-Behqet’s

Ch.C. Zouboulis. Department Medical Center Benjamin Berlin, Berlin, Germany

disease

of Dermatology, Franklin, The Free

University University

of

Recurrent genital ulcers constitute one of the major criteria for diagnosis of Adamantiades-Behcet’s disease. They mainly