scholarly journals Diagnostic Concordance in Tertiary (Dermatologists-to-Experts) Teledermoscopy: A Final Diagnosis-Based Study on 290 Cases

2020 ◽  
pp. e2020071 ◽  
Author(s):  
Anne Marchetti ◽  
Stephane Dalle ◽  
Delphine Maucort Boulch ◽  
Mona Amini-Adl ◽  
Sébastien Debarbieux ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Real Life ◽  
Final Diagnosis ◽  
Skin Lesions ◽  
Real Life Setting ◽  
Retrospective Nature ◽  
Pigmented Skin Lesions ◽  
Diagnostic Concordance ◽  
Difficult Cases

Background: Teledermoscopy (TDS) improves diagnostic accuracy and decreases the number of unnecessary consultations. Objectives: To determine the diagnostic concordance in tertiary (dermatologist-to-experts) TDS with histopathology/follow-up–based diagnosis. Methods: A descriptive retrospective cohort study including 290 requests. Results: Perfect diagnostic concordance was found in 202 (69.7%) cases and partial agreement in 29 (10%). Disagreement was found in 59 (20.3%) cases. Perfect concordance on the benign/malignant nature of the lesion was found in 227 (78.3%) cases and disagreement in 63 (21.7%). In onychology, diagnostic concordance was perfect in 43 (76.8%) cases, partial in 7 (12.5%), and there was disagreement in 6 (10.7%). Final concordance on the benign/malignant nature of the lesion was perfect in 48 (85.7%) and there was disagreement in 8 (14.3%) nail cases. For pediatric requests, diagnostic concordance was perfect in 29 (65.9%) cases, partial in 5 (11.4%), and there was disagreement in 10 (22.7%). Final concordance on the benign/malignant nature of the lesion was observed in 34 (77.3%) cases, disagreement in 10 (22.7%). Conclusions: This study confirms that tertiary TDS improves diagnostic accuracy of pigmented skin lesions. Moreover, it shows encouraging results in unusual conditions such as ungual and pediatric skin tumors. The main limitation was the retrospective nature and the “real-life” setting of our study that could have created a selection bias toward inclusion of the most difficult cases.

scholarly journals POS0693 EFFICACY AND SAFETY OF BELIMUMAB IN PATIENTS WITH LUPUS NEPHRITIS IN REAL-LIFE SETTING: RESULTS FROM A LARGE, NATIONWIDE, MULTICENTRIC, PROSPECTIVE COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 594-595
Author(s):  
F. Saccon ◽  
M. Gatto ◽  
M. Zen ◽  
M. Fredi ◽  
F. Regola ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Independent Predictor ◽  
Rescue Therapy ◽  
Real Life ◽  
Multivariate Logistic Regression Analysis ◽  
Class Iii ◽  
Baseline Serum ◽  
Renal Response ◽  
Real Life Setting

Background:LN is still a severe manifestation of Systemic lupus erythematosus (SLE) and multitarget therapy is needed to control the disease especially in refractory cases.Objectives:To evaluate renal response in SLE patients with glomerulonephritis (GN) treated with Belimumab in real-life setting.Methods:Patients with proteinuria >0.5 g/24 h and/or active sediment at baseline enrolled in a multicentre Italian cohort of SLE patients (BeRLiSS study), treated with monthly iv Belimumab 10 mg/kg plus standard of care were considered in this study. Complete renal response (CRR) was defined as proteinuria <0.5 g/24 h, estimated glomerular filtration rate (eGFR)≥90ml/min/1.73m2 and no rescue therapy. Primary efficacy renal response (PERR) was defined as proteinuria ≤0.7 g/24 h, eGFR ≥60ml/min/1.73m2 and no rescue therapy. Prevalence and predictive factors of CRR and PERR at 12 and 24 months after Belimumab initiation were analyzed by multivariate logistic regression analysis.Results:A total of 91 patients were considered in this study, 79 female, mean age 40.51±9.03 years, mean disease duration 12.18±8.15 years, median follow-up time after Belimumab initiation 22 months. Twenty patients had baseline proteinuria ≥0.5 <1 g/day, 17 ≥1 <2 g/day, 13 ≥2 g/day. Belimumab was started at GN onset in 20 (22%) patients and at the time of a renal flare in all other cases. Seventy-five patients underwent a renal biopsy: 1 class I, 4 class II, 14 class III, 47 class IV and 9 class V. Baseline serum creatinine was 82.44±29.26 umol/L; 15 patients showed eGFR<60ml/min/1.73m2 at baseline. Immunosuppresants were taken by 70 (76.9%) patients: 47 micofenolate, 15 azathioprine and 5 ciclosporine. Sixty patients (65.9%) were on antimalarials. During follow-up 34 (37.4%) patients achieved CRR. Among them 5 (14.7%) patients relapsed and 29 (85.3%) patients maintained remission. Mean time to achieved CRR was 9.71±5.91 months.High levels of baseline proteinuria were a negative independent predictor of CRR and PERR at 6 months (OR 0.044 CI95% 0.006-0.320 p=0.002 and OR 0.232 CI95% 0.091-0.596 p=0.002) and 12 months (OR 0.029 CI95% 0.002-0.556 p=0.019 and OR 0.056 CI95% 0.009-0.327 p=0.001). High levels of baseline creatinine were a negative independent predictor of renal response. Renal response at 6 months was a strong predictive factor of renal response at 12 and 24 months.Conclusion:Belimumab is an effective add-on therapy in the treatment of GN in real-life practice setting.Disclosure of Interests:None declared

scholarly journals AB0369 EFFICACY AND SAFETY OF RITUXIMAB ORIGINATOR AND BIOSIMILAR IN PRIMARY SJÖGREN’S SYNDROME IN A REAL-LIFE SETTING

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1485.3-1485
Author(s):  
F. Carubbi ◽  
A. Alunno ◽  
P. Cipriani ◽  
V. Pavlych ◽  
C. DI Muzio ◽  
...  
Keyword(s):  
Disease Activity ◽  
Real Life ◽  
Primary Sjögren’S Syndrome ◽  
Efficacy And Safety ◽  
Research Support ◽  
Treatment Groups ◽  
Real Life Setting ◽  
Patient Reported ◽  
Time Point

Background:Over the last 2 decades rituximab (RTX) has been widely used, albeit off-label, in primary Sjögren’s syndrome (pSS). Several studies reported that B-lymphocyte depletion with RTX is effective in this disease not only by reducing disease activity but also by affecting the inflammation and the lymphoid organization that occur in target tissues. With the recent release of several RTX biosimilars (bRTX) on the market, the demonstration of their interchangeability with RTX originator (oRTX) is required.Objectives:To compare efficacy and safety of oRTX and bRTX in pSS patients in a real-life setting.Methods:Clinical records of pSS patients referring to a tertiary rheumatology clinic were retrospectively evaluated. Patients having received at least 2 courses of either oRTX or bRTX (1000 mg IV infusion, repeated after 2 weeks -1 course- and the course repeated after 24 weeks) with complete data at baseline and after 3, 6, 9 and 12 months of treatment were enrolled. Disease activity was assessed with the EULAR SS disease activity index (ESSDAI) and its clinical version without the biological domain (ClinESSDAI). Patient-reported symptoms were assessed with the EULAR SS Patient Reported Index (ESSPRI).Results:Seven patients that received oRTX and 7 patients that received bRTX were enrolled. Baseline clinical features, including ESSDAI and ESSPRI were similar in the 2 treatment groups. Both compounds significantly reduced ESSDAI and ESSPRI as early as 3 months and no difference between the groups was observed at any time point (Figure 1). Of interest, ESSDAI slowly decreased until month 6 when the most pronounced reduction was observed. Conversely, ESSPRI dropped to its lowest values already at month 3. With regard to safety, at 12 months of follow-up no adverse event was observed in any of the treatment groups.Conclusion:At 12 months of follow-up, oRTX and bRTX display similar efficacy and safety profiles. The improvement of patient reported outcomes is faster than the improvement of disease activity with both compounds. Our data support interchangeability of oRTX and bRTX in pSS.References:[1]Carubbi F et al. Arthritis Res Ther. 2013;15(5):R172[2]Carubbi F et al. Lupus. 2014;23(13):1337-49Figure 1 ESSDAI and ESSPRI values at every time point in the 2 treatment groups. Asterisks indicate p values <0.05 compared to the other treatment group at the same time pointDisclosure of Interests:Francesco Carubbi Speakers bureau: Francesco Carubbi received speaker honoraria from Abbvie and Celgene outside this work., Alessia Alunno: None declared, Paola Cipriani Grant/research support from: Actelion, Pfizer, Speakers bureau: Actelion, Pfizer, Viktoriya Pavlych: None declared, claudia di muzio: None declared, Roberto Gerli: None declared, Roberto Giacomelli Grant/research support from: Actelion, Pfizer, Speakers bureau: Abbvie, Roche, Actelion, BMS, MSD, Ely Lilly, SOBI, Pfizer

Store-and-forward teledermatology based on photographs taken with a smartphone by a general practitioner in case of suspicion of melanoma: evaluation of management concordance among dermatologists (Preprint)

2021 ◽  
Author(s):  
Edmond Démoulins ◽  
Heloïse Schmeltz ◽  
Aurélie Gaultier ◽  
Jean Michel Nguyen ◽  
Gaëlle Quereux ◽  
...  
Keyword(s):  
General Practitioner ◽  
Care Management ◽  
Real Life ◽  
Skin Lesions ◽  
Care Process ◽  
Additional Information ◽  
Life Context ◽  
Pigmented Skin Lesions ◽  
Store And Forward ◽  
Attending Physician

BACKGROUND The incidence of melanoma is increasing worldwide. The effectiveness of treatment is associated with diagnostic and therapeutic delays. In this context, teledermatology (TD), especially store-and-forward TD, is a promising technology, as it can accelerate the care process. However, several studies indicate that the efficiency and reliability of this practice in cases of pigmented skin lesions is not proven and call for further work. OBJECTIVE The main objective of this study was to evaluate management concordance among teledermatologists concerning the appropriate consultation delay when reviewing photographs of suspicious pigmented skin lesions taken with a smartphone by a general practitioner (GP). METHODS Methods: We conducted management concordance analysis among different teledermatologists with experience in TD. The teledermatologists determined the consultation delay to propose to 110 patients with suspicious pigmented skin lesions viewed online based on 241 photographs taken by GPs in a real-life context. The practitioners had to decide among 4 possibilities for care management: 1. urgent need for consultation, 2. nonurgent need for consultation, 3. no need for consultation, and 4. impossible to assess: request for additional information or photographs from the GP. "Major" discordance was defined as follows: one teledermatologist decided that the patient had to receive a consultation within 15 days, while another teledermatologist decided that it was not necessary to see the patient ("simple letter to the attending physician"). RESULTS This study revealed poor agreement among dermatologists when they assessed photographs taken by a GP using a smartphone. The interrater agreement was poor regardless of the analysis modality used. The 2-to-2 interdermatologist management concordance revealed a low Cohen's kappa (between 0.11 and 0.43). Overall agreement was low (Fleiss’ kappa 0.24). We observed major discordance regarding care management for 42 clinical cases (38% of patients). CONCLUSIONS This study is in line with recent studies calling for postponement of the development of store-and-forward TD for the management of skin cancers until additional studies have been carried out.

scholarly journals Introducing teledermoscopy of possible skin cancers in general practice in Southern Denmark

2020 ◽  
Vol 37 (4) ◽  
pp. 513-518
Author(s):  
Tine Vestergaard ◽  
Sumangali C Prasad ◽  
Annette Schuster ◽  
Rasa Laurinaviciene ◽  
Anette Bygum ◽  
...  
Keyword(s):  
General Practice ◽  
Diagnostic Accuracy ◽  
Health Care Systems ◽  
Final Diagnosis ◽  
Skin Lesions ◽  
University Hospital ◽  
Predictive Values ◽  
Face To Face ◽  
Skin Cancers ◽  
Care Systems

Abstract Background The increasing incidence of skin cancers poses a burden to health care systems. General practitioners (GPs) play an important role in triaging these diseases and referring relevant patients to specialists. It is challenging to distinguish benign from malignant skin lesions, and GPs may benefit from diagnostic support from teledermoscopy (TD). Objectives To assess whether the introduction of TD in general practice was feasible and might reduce the number of unnecessary referrals to specialists and to assess the diagnostic accuracy and confidence of participating GPs. Methods Fifty general practices in Southern Denmark participated. Adult patients presenting to their GP with suspected skin cancer could be included. Images including dermoscopy were taken by the GP and sent for evaluation by specialized dermatologists at a university hospital. Patients were simultaneously referred for a face-to-face evaluation at the university hospital. Diagnoses proposed by the GPs and by TD were compared to the final diagnoses obtained by histopathology or, if not available, face-to-face evaluation. Results Five hundred and nineteen patients with 600 suspected skin cancers were included. The final diagnosis was benign in 72.3%. The photo quality was good or fair in 90.5%. GPs reported uncertainty about their diagnoses in 41.5% of cases. The GPs’ positive predictive values for any malignancy and for malignant melanoma were 49.5% and 26.3%, respectively. On evaluation by TD, 31.5% of lesions did not need further in-person assessment. Conclusion Useful images of suspicious skin lesions were obtained from general practice, and GPs could benefit from TD to improve their diagnostic accuracy and confidence.

The First Unprovoked Seizure in Typically Developing Children: A Real-Life Setting in Southern Brazil

2020 ◽  
pp. 155005942096539
Author(s):  
Mayara de Rezende Machado ◽  
Isac Bruck ◽  
Luciano de Paola ◽  
Mônica Nunes Lima Cat ◽  
Sérgio Antonio Antoniuk ◽  
...  
Keyword(s):  
Risk Factor ◽  
Recurrence Rate ◽  
Real Life ◽  
Typically Developing ◽  
Southern Brazil ◽  
Seizure Recurrence ◽  
Typically Developing Children ◽  
Unprovoked Seizure ◽  
Real Life Setting

Aim To describe the first unprovoked seizure in typically developing children, its clinical characteristics, recurrence rate, and possible risk factors in a real-life setting in Southern Brazil. Method In this retrospective cohort study, medical records of typically developing children aged 28 days to 14 years who had a first unprovoked seizure in a single tertiary care center were reviewed, in a 10-year period (2006-2016). Results Seventy-four children were included, 41 males and 33 females. The most frequent age group of the first seizure was 5 to 10 years and seizure main type was focal (50%). Most seizures occurred while children were awake (70%). All patients underwent an electroencephalogram (EEG), which was normal in 44.6%. Neuroimaging was performed in 81%, in 2 cases the etiology was considered structural, the remaining was classified as unknown. Median follow-up period was 32.5 months. Seizure recurrence rate was 56.7% and age younger than 5 years was a possible risk factor. Interpretation In the subpopulation of Brazilian typically developing children with a first unprovoked epileptic seizure there is a high recurrence rate. An abnormal EEG was a common finding, although it was not associated with a higher risk of seizure recurrence. A possible risk factor was age younger than 5 years, which may suggest a more rigorous follow-up of these patients.

scholarly journals Occurrence of adverse events in patients with JIA receiving biologic agents: long-term follow-up in a real-life setting

Rheumatology ◽  
2014 ◽  
Vol 54 (7) ◽  
pp. 1170-1176 ◽  
Author(s):  
Maarit Tarkiainen ◽  
Pirjo Tynjälä ◽  
Paula Vähäsalo ◽  
Pekka Lahdenne
Keyword(s):  
Adverse Events ◽  
Real Life ◽  
Biologic Agents ◽  
Real Life Setting ◽  
Long Term Follow Up

Computer aided follow-up of pigmented skin lesions

1997 ◽  
Vol 7 (Supplement 1) ◽  
pp. S57 ◽  
Author(s):  
M Binder ◽  
H Kittler ◽  
H Pehamberger ◽  
K Wolff
Keyword(s):  
Skin Lesions ◽  
Computer Aided ◽  
Pigmented Skin Lesions

Analysis according to prognostic factors in patients (pts) treated with first-line bevacizumab (BEV) combined with paclitaxel (PAC) for HER2-negative metastatic breast cancer (mBC) in a routine oncology practice study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1077-1077 ◽  
Author(s):  
Iris Schrader ◽  
Frank Gerhard Foerster ◽  
Andreas Schneeweiss ◽  
Matthias Geberth ◽  
Lars Hahn ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Real Life ◽  
Metastatic Breast ◽  
Progression Free Survival ◽  
Real Life Setting ◽  
Long Term Follow Up ◽  
Practice Study ◽  
Oncology Practice

1077 Background: 1st-line BEV combined with weekly PAC significantly improves progression-free survival (PFS) and response rate (RR) vs PAC alone in HER2-negative mBC, as shown in E2100. We analyzed data from a German routine oncology practice study of 1st-line BEV–PAC according to prognostic factors. Methods: Pts who had received no prior chemotherapy for mBC received BEV–PAC according to the European label. Efficacy and safety were documented for up to 1 y (or until progression, death, or BEV discontinuation if earlier) with additional long-term follow-up. Efficacy was analyzed in clinically important subgroups. Results: Efficacy data were available for 818 pts. The median duration of follow-up was 11.4 mo. The composition of the pt population with respect to the subgroups below was generally similar to the population treated in E2100, except for a higher proportion of pts with visceral disease or metastases in <3 organs. RR was very similar across all subgroups analyzed. Differences in median PFS and OS were generally in line with the differing prognoses according to clinical characteristics. Conclusions: These data suggest that 1st-line BEV–PAC is typically associated with median PFS >9 mo in the real-life setting, irrespective of baseline characteristics. [Table: see text]

Adherence to osteoporosis therapy in a real life setting with a long follow-up

Bone ◽  
2009 ◽  
Vol 44 ◽  
pp. S434-S435 ◽  
Author(s):  
F.F.L. Giardina ◽  
A.A.D.F. de Flaviis ◽  
M.M.M. Mammì ◽  
L. Pietrogrande
Keyword(s):  
Real Life ◽  
Osteoporosis Therapy ◽  
Real Life Setting
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