9(a) DERMLIST
G. Leal
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
Robin Travers
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
Michael Binder
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
Abhijit Bidaye
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
Amanda Oakley
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
Eliot Mostow
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
Dan Siegel
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
Yoshiki Taniguchi
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.
Ahsan Abdulghani
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
Rhett Drugge
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.
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