Yiannias, James A.

Background: The study objective was to investigate the willingness to pay (WTP) for teledermoscopy services among students at a university health center. The hypothesis was that WTP for teledermoscopy among students would exceed the costs for traditional consultation. Methods: Between November 2013 and May 2014, students at a university health center were surveyed for their perceptions of teledermoscopy. One set of responses was collected from students visiting the health center for any reason (anonymous sample). An additional set of responses was collected from students visiting for dermatologic lesions (in-person sample). A contingent valuation method with a maximum likelihood estimation procedure was used to estimate the WTP distribution. Results: A total of 214 surveys were collected for the anonymous sample and 41 responses for the in-person sample. The mean (standard deviation [SD]) WTP for the anonymous sample was $55.27 ($39.11; 95% confidence interval [CI]: $49.99-$60.55). The mean (SD) WTP for the in-person sample was $52.37 ($26.56; 95% CI: $43.99-$60.75). Median WTP for the 2 samples was similar: $48.84 and $48.01. Conclusions: We conclude that students would be willing to pay for teledermoscopy services that would provide the potential for significant system cost savings. This may be especially true in college health or similar settings where dermatology services may not be available.

Background Patch-test readings after day 5 have previously been used to identify delayed reactions to metals and topical antibiotics. Objective The aims of this study were to identify allergens for which late readings (beyond day 5) would be most valuable and to compare our results with our previous study on delayed patch-test readings. Methods This was a retrospective study of 298 patients who underwent metal and corticosteroid series patch testing from January 1, 2007, through December 31, 2013. Patch-test readings were conducted on days 3 and 5 and at least once sometime between days 7 and 14. All reactions were examined at each reading. Conclusions These results were concordant with our previous findings that additional readings after day 7 are particularly useful for identifying reactions to metals (gold, cobalt, beryllium, palladium), specific preservatives (dodecyl gallate, propolis), and the topical antibiotic neomycin. New delayed reactions to bacitracin, p -phenylenediamine, and topical corticosteroids were not seen in this cohort.

AbstractBackgroundMayo Clinic developed an internal iOS‐based, point‐of‐care clinical image capture application for clinicians. We aimed to assess the adoption and utilization of the application at Mayo Clinic.MethodsMetadata of 22,784 photos of 6417 patients taken by 606 users over 8040 clinical encounters between 3/1/2015 and 10/31/2015 were analyzed. A random sample of photos from 100 clinical encounters was assessed for quality using a five‐item rubric. Use of traditional medical photography services before and after application launch were compared.ResultsThe largest group of users was residents/fellows, accounting for 31% of users but only 18% of all photos. Attending physicians accounted for 29% of users and 30% of photos. Nurses accounted for 14% of users and 28% of photos. Surgical specialties had the most users (36% of users), followed by dermatology (14% of users); however, dermatology accounted for 54% of all photos, and surgery accounted for 26% of photos. Images received an average of 91% of possible points on the quality scoring rubric. Most frequent reasons for missing points were the location on the body not clearly being demonstrated (19% of encounters) and the perspective/scale not being clearly demonstrated (12% of encounters). There was no discernible pre‐post effect of the application's launch on use of traditional medical photography services.ConclusionsPoint‐of‐care clinical photography is a growing phenomenon with potential to become the new standard of care. Patient and provider attitudes and the impact on patient outcomes remain unclear.

Background Benzalkonium chloride (BAK), a detergent and preservative found in health care and household products, is an established irritant, yet BAK is seldom considered to cause allergic contact dermatitis. We have, however, observed positive patch test reactions more often than is typically reported. From 2001 through 2005 and 2006 through 2010, BAK was among the top 10 most frequent allergens in our standard series. Objective The aim of this study was to review the Mayo Clinic experience from 2000 to 2012 with patch testing to BAK. Methods An electronic patch test database was used to acquire results of patients who underwent patch testing for BAK 0.1% aqueous after it was introduced to the standard series in 2000 until 2012. Previous reports (1998–2000, 2001–2005, 2006–2010) from our institution were also reviewed. Conclusions Our study showed BAK to be an allergen of increasing importance. From 1998 through 2000, 2001 through 2005, and 2006 through 2010, the rate of allergic patch test results to BAK increased. More than half of the reactions in each period studied were graded as macular erythema, with at least one third of all reactions deemed to be relevant. Irritancy rates were consistently low.

AbstractBackgroundWe aimed to determine whether patients and providers were satisfied with teledermoscopy consultation for skin lesions.MethodsFrom 2010 to 2011, patients with clinically suspicious lesions were referred for teledermoscopy by internal medicine physicians. Lesions were digitally photographed using a dermatoscope accessory lens. Images were interpreted by an on‐call dermatologist. We conducted same day surveys of providers and patients after the evaluations.ResultsThe survey response rate was 100%. Of the 20 patients surveyed, all agreed that a teledermoscopic consult was convenient and helpful. Nineteen patients (95%) strongly agreed that teledermoscopy potentially was a cost‐saving tool. All providers thought the evaluations were helpful. Ninety‐five percent of providers and patients reported satisfaction with the ease of use of this technology.ConclusionsTeledermoscopy may give primary care providers the ability to consult with dermatologists when seeing patients in remote or medically underserved areas. This can streamline the referral process and decrease the number of referrals for benign lesions.

Background Current evaluation of suspected allergic contact dermatitis to lanolin includes patch testing to lanolin alcohol (30% in petrolatum). Using this method, the prevalence of lanolin allergy is low (1.8%–2.5%). Objective The objective of this study was to determine whether patch testing to a single lanolin derivative results in underdiagnosis compared with patch testing to 12 lanolin derivatives. Methods Patients were prospectively patch tested to (1) lanolin alcohol (30% in petrolatum) in our standard allergen series; (2) Amerchol L101 (50% in petrolatum) in our cosmetic series; and (3) 10 lanolin derivatives (using concentrations and vehicles recommended in the literature) in a supplemental series. Results Of 286 patients, the overall prevalence of positive reactions to lanolin in at least 1 of the 3 patch test series was 6.29% (95% confidence interval [CI], 3.48%-9.11%) (n = 18). The prevalence rates of lanolin allergy using the standard, cosmetic, and supplemental series were 1.05% (95% CI, 0%–2.23%), 3.85% (95% CI, 1.62%–6.07%), and 3.85% (95% CI, 1.62%–6.07%), respectively. Amerchol L101 was associated with increased reaction rates compared with the standard (odds ratio, 3.81; P = 0.007) and supplemental (odds ratio, 8.85; P < 0.001) series, whereas reaction rates were similar for the standard and supplemental series ( P = 0.78). Conclusions Amerchol L101 and patients’ own products should be added to a standard patch testing allergen series to adequately identify lanolin allergy.