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• W2100034202 abstract "To the Editor: The availability of dermatopathology services varies across the world. Developing countries have limited to no access to dermatologists, pathologists, or histology and laboratory services. To address healthcare needs in underserved areas, medical specialists are increasingly providing patient care in remote areas, either through establishing local clinics or through telemedicine.1Rao B. Lombardi 2nd, A. Telemedicine: current status in developed and developing countries.J Drugs Dermatol. 2009; 8: 371-375PubMed Google Scholar, 2Schmid-Grendelmeier P. Masenga E.J. Haeffner A. Burg G. Teledermatology as a new tool in sub-Saharan Africa: an experience from Tanzania.J Am Acad Dermatol. 2000; 42: 833-835Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Expanding clinical services creates a need for histologic assessment of diseases requiring clinicopathologic correlations for diagnosis. Proposed strategies include shipment of wet tissue for processing, or “virtual dermatopathology” through the electronic transfer of photomicrographs, scanned slides, or live interactive telepathology.3Kayser K. Kayser G. Radziszowski D. Oehmann A. New developments in digital pathology: from telepathology to virtual pathology laboratory.Stud Health Technol Inform. 2004; 105: 61-69PubMed Google Scholar, 4Leong A.S. Leong F.J. Strategies for laboratory cost containment and for pathologist shortage: centralised pathology laboratories with microwave-stimulated histoprocessing and telepathology.Pathology. 2005; 37: 5-9Crossref PubMed Scopus (28) Google Scholar, 5Piccolo D. Soyer H.P. Burgdorf W. Talamini R. Peris K. Bugatti L. et al.Concordance between telepathologic diagnosis and conventional histopathologic diagnosis: a multiobserver store-and-forward study on 20 skin specimens.Arch Dermatol. 2002; 138: 53-58Crossref PubMed Google Scholar We seek to characterize the presence of histology and dermatopathology services in sub-Saharan Africa, where many patients are evaluated clinically but laboratory services are scarce. Forty-one countries south of the Sahara desert were included. We searched international professional databases, queried local physicians and the Ministries of Health to identify individuals and organizations with insight into the availability of dermatology and pathology services. Internet and PubMed searches performed between June 15 and August 14, 2008 used the following key words: dermatology, pathology, dermatopathology, hospital, university, Ministry of Health, department, medicine, and each country name. Each individual received an e-mail in English explaining the study aims and questions to answer voluntarily (Fig 1). Residents of French-speaking countries received an additional e-mail in French. One of the authors (M.W.T.) collected all responses by country. For discordant aggregate responses, the majority response of those surveyed represented the country's response. For cases with no clear majority, the longest time interval represented a country's response time. For dichotomous values, any “yes” response represented a final “yes” for that country. The survey had a 51% response rate. Because the search parameters failed to identify individuals in 34% of countries, surrogates in other parts of Africa, Europe, and the United States were solicited in these cases. Contacts in seven countries had undeliverable e-mail addresses. Countries in which data could not be collected remain white in Fig 2. Histology processing services and a pathologist are available in 86% of countries (Fig 2, A). In almost one-third of countries, it takes longer than 1 month for both sample processing and a pathologist's read. A trained dermatopathologist or specialized trained dermatologist is available in only 14% of countries (Fig 2, B). Interest in consult services was nearly unanimous (95%). The single “no” response arguably codes “yes” because his interest was contingent upon dermatopathology training for physicians in his nation (Senegal). All responding nations expressed interest in telemedicine as an adjunct to current clinical practice (Table I).Table IAggregate responses to availability of a dermatopathologist, histology services, and interest in teledermatopathology consultation servicesAggregate country informationNo.%No. of countries surveyed41—No. of countries responding21—Dermatopathologist available314%Histology service available1886% Same day211% <1 week317% <1 month844% >1 month528%Histology services unavailable314%Pathologist read available1886% Same day211% <1 week317% <1 month739% >1 month633%Pathologist read unavailable314%Countries sending specimens out524%Teledermatology would be useful2095%Interest in teledermatology21100% Open table in a new tab South Africa deserves special mention for the only respondents not interested in teledermatopathology. While these private practice physicians had processing and dematopathologist reports available within 24 hours, an understaffed general hospital reported waiting times similar to the remainder of sub-Saharan Africa. The availability of dermatopathology services in sub-Saharan Africa is limited. While physicians have access to histology in the majority of countries surveyed, long wait times impede reliance on this diagnostic tool. Those surveyed showed overwhelming interest in teledermatology and teledermatopathology services, but recognized fundamental challenges—lack of infrastructure, political bureaucracy, and cost—that must be addressed before expanding access to dermatology and dermatopathology through telemedicine. Digital imaging and mobile telecommunications offer one possible immediate and cost-effective method to shorten times to diagnosis. Specifically, digitalized images of processed slides may be electronically sent to dermatopathologists anywhere in the world for interpretation, and results could be retuned via telephone or e-mail. This system would use existing histology services, bypass delays caused by lack of ground transportation and local infrastructure, and bring remote expertise to underserved regions of Africa." @default.
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• W2100034202 title "Global access to dermatopathology services: Physician survey of availability and needs in sub-Saharan Africa" @default.
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