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Randomized comparison of virtual microscopy and glass microscopy among dermatology and pathology residents during a simulated in-training examination
3804
3880
Multistrategic therapy for hypertrophic burn scars in Mexican children Alfonsina Avila Romay, MD, Gea Gonzalez, Mexico City, Mexico; Fabiola Arvizu, MD, Medica Sur, Mexico City, Mexico; Vielka Sarmiento Mujica, MD, Medica Sur, Mexico City, Mexico; Virginia Nu~ nez Luna, MD, Medica Sur, Mexico City, Mexico; Juliana Tellez, MD, Medica Sur, Mexico City, Mexico; Abril Martinez-Velasco, MD, Medica Sur, Mexico City, Mexico
Resident-driven educational videos in patient counseling Ardalan Minokadeh, MD, PhD, Tulane University, New Orleans, LA, United States; Azeen Sadeghian, MD, Tulane University, New Orleans, LA, United States; Andrea Murina, MD, Tulane University, New Orleans, LA, United States Patient counseling outside of the brief patient encounter is helpful to emphasize important points that can help manage chronic skin conditions. We have found at follow-up encounters that patients often do not recall significant details of counseling for conditions such as dry skin care and proper application of topical retinoids. This makes compliance more difficult and often delays improvement given that there are often large intervals between follow-up visits. Patients are increasingly able to access information through online sources. Having a video reference allows patients to have access to counseling tips at any time from any device. This has become especially important and unique in our resident-run clinics as the clinicians in the videos are the same providers they encounter in our clinic.
Michou y Mau, I.A.P, is a nonprofit organization devoted to the prevention and assistance of Mexican children who suffer burn injury, nowadays it treats about 8000 patients with burn injury sequelae. Assist the pediatric patient with burn injury sequelae, so that we can provide a better quality of life for them and their families. Our mission is to provide a multidisciplinary treatment with the highest standard of quality, ethic and responsibility, giving our patients the most effective and scientific proved treatments, no matter their economic situation. Vision: To expand our program so that more children and teenagers can benefit a multistrategic treatment nonprofit clinic which provides the state of the art treatment for burns. Our main purpose is to improve children’s quality of life. We have made a commitment with the children suffering burn sequelae in our country.
Commercial support: None identified.
Specific objectives: Reduce the height, pigmentation, and erythema of the hypertrophic scars, reduce the pain and itching, and improve pliability of scars and minify the contracture of the involved areas. Intervention: We treat children between 6 and 18 years old who suffer from hypertrophic burn scars. Our intervention consist in pressure garments, ultrasound, intralesional drugs (triamcinolone and 5-fluorouracil), pulsed dye laser, erbium fractional laser and CO2 fractional laser as well as plastic and reconstructive surgery This project started in 2010 and today we have treated 197 children. We perform 6 session a year. We also provide makeup workshops to cover to teach children how to cover the scars. This clinic is formed by a laser specialist dermatologist, plastic surgeons, pediatricians, and an anesthesiologist. Cases: A 9-year-old female with an hypertrophic burn scar. Initial Vancouver scar scale: 11 points. After 9 sessions with intralesional triamcinolone, pulsed dye laser and erbium fractional laser she got a Vancouver scar score of 4 points. A 14-year-old male with an initial Vancouver scar scale of 7 points. After 3 sessions with pulsed dye laser and triamcinolone he got a Vancouver scar score of 4. Commercial support: None identified.
3605 Randomized comparison of virtual microscopy and glass microscopy among dermatology and pathology residents during a simulated intraining examination William Berger, Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT, United States; Monica Townsend, University of Connecticut School of Medicine, Farmington, CT, United States; Michael Murphy, MD, University of Connecticut Health Center, Department of Dermatology, Farmington, CT, United States; Zendee Elaba, MD, Hartford Hospital, Department of Pathology, Hartford, CT, United States Introduction: Virtual microscopy is increasingly being used in medical education. However, relatively few studies exist to compare diagnostic accuracy using virtual microscopy with that of traditional glass slide microscopy. Objective: The purpose of this study was to determine whether examination scores of residents would be equivalent when tested using the two image formats. Additionally, the opinions of examinees regarding the two techniques were assessed. Methods: Twenty-two residents and fellows in dermatology and pathology were given an examination consisting of a randomized combination of 24 dermatopathology cases, with 12 provided as virtual slides and 12 as glass slides. Following completion of the examination, participants were asked to provide their opinions regarding the two microscopy formats by completing a questionnaire. Results: Residents performed similarly using the two methods, with mean number correct [SD] out of a possible 12 found to be 8.00 [1.90] and 8.64 [1.79] for virtual and glass slide microscopy, respectively. The 95% confidence interval for the difference in mean scores was determined to be -0.14 to 1.42. The test of the null hypothesis that a difference in scores greater than 2 exists between methods was rejected (t-test, P ¼ .0008), indicating that no meaningful difference in diagnostic accuracy was found. On a scale of 1-5 (1 ¼ poor, 2 ¼ fair, 3 ¼ good, 4 ¼ very good, 5 ¼ excellent), participants evaluated the ease of viewing glass slides (mean ¼ 4.2 [1.1]) as greater than that for virtual slides (3.3 [0.9]) (Wilcoxon signed rank P ¼ .012). No examinee reported difficulty in use of the glass slides. However, 65% of participants described problems viewing the virtual slides, with slow loading times and internet browser crashes being the most commonly reported. Overall, 75% of examinees stated that they would prefer glass slide microscopy to be used for histology instruction during residency training, while 25% favored the virtual format. However, many participants provided comments stating that with improved image loading speeds, they would be interested in using virtual microscopy in the future. Conclusions: The ability of residents to accurately diagnose dermatopathology cases was similar when tested using virtual microscopy and glass slide microscopy, despite their overall preference for the latter. Commercial support: None identified.
MAY 2016
2730 Teledermatology: A model of feasibility in rural Haiti Lauren Cutler, Keck School of Medicine of USC, Los Angeles, CA, United States; Katherine Ross, Keck School of Medicine of USC, Los Angeles, CA, United States; Melvin Chiu, MD, MPH, University of California, Los Angeles, Westlake Village, CA, United States; David Cutler, MD, University of California, Los Angeles, Santa Monica, CA, United States Background: Dermatological ailments in Haiti contribute significantly to the health complaints of local Haitians, but much of the dermatological care in Haiti has been provided by transient international aid groups. Teledermatology projects have been completed in numerous international sites, but this is the first to our knowledge to be performed in Haiti. Objective: Our aim is to see if concordance rates between teledermatologists and primary care practitioners (PCPs) provides adequate diagnostic acumen in a reasonable time frame as a proof of concept for implementing teledermatology into a rural Haitian clinic to help increase access to dermatological care. Study design: At a rural Haitian clinic, patients with dermatological issues were recruited by community health care workers, radio advertisements and word of mouth and consecutively enrolled into the study. Patients received a free skin examination and treatment plan from PCP that completed their intake evaluation. Photos of the lesion were then taken on an iPhone 6 and uploaded into an encrypted Google documents folder with the intake evaluation and named with a deidentified patient code. Dermatologists in the U.S. completed a consultation form indicating their diagnosis and treatment plan and uploaded that into the patient folder. Clinical and teledermatological diagnoses were reviewed and final diagnoses were reported to local Haitian physicians to carry out any changes in treatment. Results: Out of 100 patients, the average concordance value between teledermatologists and PCPs was 75.09%. The average time from patient intake to ‘‘case closed’’ was 1.67 days. Conclusion: The concordance between teledermatologists and PCPs has not been published, but was within the 41-89% range of concordance between face-to-face dermatologists and teledermatologists. The time from patient intake to ‘‘case closed’’ was within turnaround times listed in previous studies, which ranged from two hours to one week, and could be improved by assigning specific cases to each dermatologist. Future directions could include developing a more user-friendly platform or implementing a self-training guide for using the software. In Haiti there is an unmet need for dermatology services. Until infrastructure, transportation, and number of dermatologists improve, teledermatology is a viable option to provide care to rural patients. Commercial support: None identified.
J AM ACAD DERMATOL
AB113
3880
Multistrategic therapy for hypertrophic burn scars in Mexican children Alfonsina Avila Romay, MD, Gea Gonzalez, Mexico City, Mexico; Fabiola Arvizu, MD, Medica Sur, Mexico City, Mexico; Vielka Sarmiento Mujica, MD, Medica Sur, Mexico City, Mexico; Virginia Nu~ nez Luna, MD, Medica Sur, Mexico City, Mexico; Juliana Tellez, MD, Medica Sur, Mexico City, Mexico; Abril Martinez-Velasco, MD, Medica Sur, Mexico City, Mexico
Resident-driven educational videos in patient counseling Ardalan Minokadeh, MD, PhD, Tulane University, New Orleans, LA, United States; Azeen Sadeghian, MD, Tulane University, New Orleans, LA, United States; Andrea Murina, MD, Tulane University, New Orleans, LA, United States Patient counseling outside of the brief patient encounter is helpful to emphasize important points that can help manage chronic skin conditions. We have found at follow-up encounters that patients often do not recall significant details of counseling for conditions such as dry skin care and proper application of topical retinoids. This makes compliance more difficult and often delays improvement given that there are often large intervals between follow-up visits. Patients are increasingly able to access information through online sources. Having a video reference allows patients to have access to counseling tips at any time from any device. This has become especially important and unique in our resident-run clinics as the clinicians in the videos are the same providers they encounter in our clinic.
Michou y Mau, I.A.P, is a nonprofit organization devoted to the prevention and assistance of Mexican children who suffer burn injury, nowadays it treats about 8000 patients with burn injury sequelae. Assist the pediatric patient with burn injury sequelae, so that we can provide a better quality of life for them and their families. Our mission is to provide a multidisciplinary treatment with the highest standard of quality, ethic and responsibility, giving our patients the most effective and scientific proved treatments, no matter their economic situation. Vision: To expand our program so that more children and teenagers can benefit a multistrategic treatment nonprofit clinic which provides the state of the art treatment for burns. Our main purpose is to improve children’s quality of life. We have made a commitment with the children suffering burn sequelae in our country.
Commercial support: None identified.
Specific objectives: Reduce the height, pigmentation, and erythema of the hypertrophic scars, reduce the pain and itching, and improve pliability of scars and minify the contracture of the involved areas. Intervention: We treat children between 6 and 18 years old who suffer from hypertrophic burn scars. Our intervention consist in pressure garments, ultrasound, intralesional drugs (triamcinolone and 5-fluorouracil), pulsed dye laser, erbium fractional laser and CO2 fractional laser as well as plastic and reconstructive surgery This project started in 2010 and today we have treated 197 children. We perform 6 session a year. We also provide makeup workshops to cover to teach children how to cover the scars. This clinic is formed by a laser specialist dermatologist, plastic surgeons, pediatricians, and an anesthesiologist. Cases: A 9-year-old female with an hypertrophic burn scar. Initial Vancouver scar scale: 11 points. After 9 sessions with intralesional triamcinolone, pulsed dye laser and erbium fractional laser she got a Vancouver scar score of 4 points. A 14-year-old male with an initial Vancouver scar scale of 7 points. After 3 sessions with pulsed dye laser and triamcinolone he got a Vancouver scar score of 4. Commercial support: None identified.
3605 Randomized comparison of virtual microscopy and glass microscopy among dermatology and pathology residents during a simulated intraining examination William Berger, Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT, United States; Monica Townsend, University of Connecticut School of Medicine, Farmington, CT, United States; Michael Murphy, MD, University of Connecticut Health Center, Department of Dermatology, Farmington, CT, United States; Zendee Elaba, MD, Hartford Hospital, Department of Pathology, Hartford, CT, United States Introduction: Virtual microscopy is increasingly being used in medical education. However, relatively few studies exist to compare diagnostic accuracy using virtual microscopy with that of traditional glass slide microscopy. Objective: The purpose of this study was to determine whether examination scores of residents would be equivalent when tested using the two image formats. Additionally, the opinions of examinees regarding the two techniques were assessed. Methods: Twenty-two residents and fellows in dermatology and pathology were given an examination consisting of a randomized combination of 24 dermatopathology cases, with 12 provided as virtual slides and 12 as glass slides. Following completion of the examination, participants were asked to provide their opinions regarding the two microscopy formats by completing a questionnaire. Results: Residents performed similarly using the two methods, with mean number correct [SD] out of a possible 12 found to be 8.00 [1.90] and 8.64 [1.79] for virtual and glass slide microscopy, respectively. The 95% confidence interval for the difference in mean scores was determined to be -0.14 to 1.42. The test of the null hypothesis that a difference in scores greater than 2 exists between methods was rejected (t-test, P ¼ .0008), indicating that no meaningful difference in diagnostic accuracy was found. On a scale of 1-5 (1 ¼ poor, 2 ¼ fair, 3 ¼ good, 4 ¼ very good, 5 ¼ excellent), participants evaluated the ease of viewing glass slides (mean ¼ 4.2 [1.1]) as greater than that for virtual slides (3.3 [0.9]) (Wilcoxon signed rank P ¼ .012). No examinee reported difficulty in use of the glass slides. However, 65% of participants described problems viewing the virtual slides, with slow loading times and internet browser crashes being the most commonly reported. Overall, 75% of examinees stated that they would prefer glass slide microscopy to be used for histology instruction during residency training, while 25% favored the virtual format. However, many participants provided comments stating that with improved image loading speeds, they would be interested in using virtual microscopy in the future. Conclusions: The ability of residents to accurately diagnose dermatopathology cases was similar when tested using virtual microscopy and glass slide microscopy, despite their overall preference for the latter. Commercial support: None identified.
MAY 2016
2730 Teledermatology: A model of feasibility in rural Haiti Lauren Cutler, Keck School of Medicine of USC, Los Angeles, CA, United States; Katherine Ross, Keck School of Medicine of USC, Los Angeles, CA, United States; Melvin Chiu, MD, MPH, University of California, Los Angeles, Westlake Village, CA, United States; David Cutler, MD, University of California, Los Angeles, Santa Monica, CA, United States Background: Dermatological ailments in Haiti contribute significantly to the health complaints of local Haitians, but much of the dermatological care in Haiti has been provided by transient international aid groups. Teledermatology projects have been completed in numerous international sites, but this is the first to our knowledge to be performed in Haiti. Objective: Our aim is to see if concordance rates between teledermatologists and primary care practitioners (PCPs) provides adequate diagnostic acumen in a reasonable time frame as a proof of concept for implementing teledermatology into a rural Haitian clinic to help increase access to dermatological care. Study design: At a rural Haitian clinic, patients with dermatological issues were recruited by community health care workers, radio advertisements and word of mouth and consecutively enrolled into the study. Patients received a free skin examination and treatment plan from PCP that completed their intake evaluation. Photos of the lesion were then taken on an iPhone 6 and uploaded into an encrypted Google documents folder with the intake evaluation and named with a deidentified patient code. Dermatologists in the U.S. completed a consultation form indicating their diagnosis and treatment plan and uploaded that into the patient folder. Clinical and teledermatological diagnoses were reviewed and final diagnoses were reported to local Haitian physicians to carry out any changes in treatment. Results: Out of 100 patients, the average concordance value between teledermatologists and PCPs was 75.09%. The average time from patient intake to ‘‘case closed’’ was 1.67 days. Conclusion: The concordance between teledermatologists and PCPs has not been published, but was within the 41-89% range of concordance between face-to-face dermatologists and teledermatologists. The time from patient intake to ‘‘case closed’’ was within turnaround times listed in previous studies, which ranged from two hours to one week, and could be improved by assigning specific cases to each dermatologist. Future directions could include developing a more user-friendly platform or implementing a self-training guide for using the software. In Haiti there is an unmet need for dermatology services. Until infrastructure, transportation, and number of dermatologists improve, teledermatology is a viable option to provide care to rural patients. Commercial support: None identified.
J AM ACAD DERMATOL
AB113