Marchell Richard, Locatis Craig, Burges Gene, Maisiak Richard, Liu Wei-Li, Ackerman Michael
1 Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina , Charleston, South Carolina.
2 National Library of Medicine, National Institutes of Health , Bethesda, Maryland.
Telemed J E Health. 2017 Mar;23(3):213-218. doi: 10.1089/tmj.2016.0093. Epub 2016 Oct 5.
There is little teledermatology research directly comparing remote methods, even less research with two in-person dermatologist agreement providing a baseline for comparing remote methods, and no research using high definition video as a live interactive method.
To compare in-person consultations with store-and-forward and live interactive methods, the latter having two levels of image quality.
A controlled study was conducted where patients were examined in-person, by high definition video, and by store-and-forward methods. The order patients experienced methods and residents assigned methods rotated, although an attending always saw patients in-person. The type of high definition video employed, lower resolution compressed or higher resolution uncompressed, was alternated between clinics. Primary and differential diagnoses, biopsy recommendations, and diagnostic and biopsy confidence ratings were recorded.
Concordance and confidence were significantly better for in-person versus remote methods and biopsy recommendations were lower. Store-and-forward and higher resolution uncompressed video results were similar and better than those for lower resolution compressed video.
Dermatology residents took store-and-forward photos and their quality was likely superior to those normally taken in practice. There were variations in expertise between the attending and second and third year residents.
The superiority of in-person consultations suggests the tendencies to order more biopsies or still see patients in-person are often justified in teledermatology and that high resolution uncompressed video can close the resolution gap between store-and-forward and live interactive methods.
几乎没有远程皮肤病学研究直接比较远程方法，甚至更少研究有两名皮肤科医生现场会诊作为比较远程方法的基线，且没有研究使用高清视频作为实时交互方法。
比较现场会诊与存储转发及实时交互方法，后者有两个图像质量级别。
进行了一项对照研究，患者分别通过现场检查、高清视频和存储转发方法接受检查。患者体验方法的顺序以及住院医师分配方法是轮换的，不过主治医生始终进行现场检查。各诊所交替使用较低分辨率压缩或较高分辨率未压缩的高清视频类型。记录主要和鉴别诊断、活检建议以及诊断和活检置信度评分。
现场会诊与远程方法相比，一致性和置信度显著更好，活检建议更少。存储转发和较高分辨率未压缩视频的结果相似且优于较低分辨率压缩视频。
皮肤科住院医师拍摄存储转发照片，其质量可能优于实际操作中通常拍摄的照片。主治医生与二、三年级住院医师之间的专业水平存在差异。
现场会诊的优越性表明，在远程皮肤病学中，倾向于进行更多活检或仍然进行现场看诊往往是合理的，并且高分辨率未压缩视频可以缩小存储转发和实时交互方法之间的分辨率差距。
