Accuracy of Store-and-Forward Teledermatology for the Diagnosis of Skin Cancer: The Nouvelle-Aquitaine Experience

Background In Nouvelle-Aquitaine (a French region with a population of almost 6 million), the density of dermatologists is less than 3.8/100,000 inhabitants. This lack of dermatological care is delaying diagnosis and management, especially for skin cancer. The SmartDerm Project is a store-and-forward (SAF) teledermatology platform for primary care in Nouvelle-Aquitaine providing dermatological counselling to general practitioners (GPs). Objective The main objective was to determine the concordance between the diagnosis of skin cancer made by dermatologists and the pathologists’ diagnosis. Methods GPs in 3 pilot departments of Nouvelle-Aquitaine (Lot-Et-Garonne, Deux-Sèvres, Creuse) sent their dermatology requests using their smartphone, via an app called PAACO/Globule; dermatologists at the University Hospital of Bordeaux answered within 48-72 hours. Consecutive cases of skin cancer suspected by the referent dermatologists during the intervention were included, if the result of biopsy interpreted by a certified pathologist was available at the time of the study. Results Among the 1727 requests, 163 (9%) concerned a possible diagnosis of skin cancer and were eligible. For 61 cases, the histopathological findings were not available. Eventually, 93 patients with a total of 102 skin lesions were included. Median age was 75 years (range 26-97 years), with 53% women. The skin lesions had progressed for 8 months on average (range 0.5-36 months). The median response time was 1 day (range 0-61 days); 65 days (range 1-667 days) elapsed on average between the SAF opinion and the histological sample. Histopathology diagnosed 83 malignant lesions (57 basal cell carcinomas, 69%; 18 squamous cell carcinomas, 22%; 6 melanomas, 7%; 1 cutaneous lymphoma, 1%; 1 secondary location of a primary cancer, 1%), 1 precancerous lesion, and 18 benign lesions. The concordance between the opinion of the referent dermatologist and the final pathological finding was 83% for nonmelanocytic lesions and 67% for melanocytic lesions. Conclusions This study showed the reliability of SAF teledermatology in the diagnosis of skin cancer, comparable to literature data in the absence of dermatoscopy. The median delay of about two months between request and histology was an improvement compared to the delay of usual appointments in the intervention area. The lack of data for 61 patients showed that SAF telemedicine requires better coordination and follow-up, especially for the management of skin cancer. With this reservation in mind, teledermatology offers an alternative answer for the triage of patients with skin cancer residing in areas with low medical density. Conflicts of Interest None declared.

Exploration and Identification of Potential Therapeutic Targets and Biomarkers for Docetaxel Resistant Prostate Cancer

Background: Prostate cancer has become the third most common cancer, and the death rate of advanced patients due to metastasis and invasion is high. Approximately 40% to 50% of castration resistant prostate cancer responding to docetaxel did not show a substantial and sustained prostate specific antigen decline, and the median response duration was limited to 6 to 9 months.Objective: To understand the pathogenesis of docetaxel-resistant prostate cancer (DRPC), and to search for prognostic markers and new therapeutic targets.Methods: RNA sequencing data of GSE36135 and GSE33455 from the Gene Expression Synthesis Database were used to search for co-expressed genes. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors, which were validated by expression and survival analyses. Subsequently, their ability to jointly predict patient prognosis was evaluated. Then, the lasso Cox regression model was established to evaluate the correlation of DEGs with immune score, ferroptosis, methylation, and OCLR score. And predicted for targeted small molecule drugs and validated the effect of small molecule drugs.Results: EZH2 and SRC were identified as potential therapeutic targets and effective prognostic markers for docetaxel-resistant prostate cancer, and were found to be significantly associated with the immune score, ferroptosis, methylation, and OCLR score. Targeted small molecule drugs were predicted and validated for EZH2 and SRC.Conclusions: This study helps to fully explain the mechanism of docetaxel-resistant prostate cancer formation and provides new immune-related therapeutic targets and biomarkers for it. Preliminary exploration of the effects of docetaxel in combination with urapidil or roxithromycin in prostate cancer cells

Accuracy of Store-and-Forward Teledermatology for the Diagnosis of Skin Cancer: The Nouvelle-Aquitaine Experience (Preprint)

BACKGROUND In Nouvelle-Aquitaine (a French region with a population of almost 6 million), the density of dermatologists is less than 3.8/100,000 inhabitants. This lack of dermatological care is delaying diagnosis and management, especially for skin cancer. The SmartDerm Project is a store-and-forward (SAF) teledermatology platform for primary care in Nouvelle-Aquitaine providing dermatological counselling to general practitioners (GPs). OBJECTIVE The main objective was to determine the concordance between the diagnosis of skin cancer made by dermatologists and the pathologists’ diagnosis. METHODS GPs in 3 pilot departments of Nouvelle-Aquitaine (Lot-Et-Garonne, Deux-Sèvres, Creuse) sent their dermatology requests using their smartphone, via an app called PAACO/Globule; dermatologists at the University Hospital of Bordeaux answered within 48-72 hours. Consecutive cases of skin cancer suspected by the referent dermatologists during the intervention were included, if the result of biopsy interpreted by a certified pathologist was available at the time of the study. RESULTS Among the 1727 requests, 163 (9%) concerned a possible diagnosis of skin cancer and were eligible. For 61 cases, the histopathological findings were not available. Eventually, 93 patients with a total of 102 skin lesions were included. Median age was 75 years (range 26-97 years), with 53% women. The skin lesions had progressed for 8 months on average (range 0.5-36 months). The median response time was 1 day (range 0-61 days); 65 days (range 1-667 days) elapsed on average between the SAF opinion and the histological sample. Histopathology diagnosed 83 malignant lesions (57 basal cell carcinomas, 69%; 18 squamous cell carcinomas, 22%; 6 melanomas, 7%; 1 cutaneous lymphoma, 1%; 1 secondary location of a primary cancer, 1%), 1 precancerous lesion, and 18 benign lesions. The concordance between the opinion of the referent dermatologist and the final pathological finding was 83% for nonmelanocytic lesions and 67% for melanocytic lesions. CONCLUSIONS This study showed the reliability of SAF teledermatology in the diagnosis of skin cancer, comparable to literature data in the absence of dermatoscopy. The median delay of about two months between request and histology was an improvement compared to the delay of usual appointments in the intervention area. The lack of data for 61 patients showed that SAF telemedicine requires better coordination and follow-up, especially for the management of skin cancer. With this reservation in mind, teledermatology offers an alternative answer for the triage of patients with skin cancer residing in areas with low medical density.

Evaluation of A Breastfeeding Promotion Film Among A Racially Minoritized Sample

Background: In Los Angeles County (LAC), disparities in breastfeeding rates vary by race and region. Black persons are more affected by social and environmental factors than other racial/ethnic groups, leading to lower breast/chestfeeding rates. This study aims to evaluate the community’s knowledge, perceptions, experiences, barriers, and solutions regarding breast/chestfeeding among Black persons. Methods: Participant responses were collected anonymously through an online survey (via QR code) pre-and post-viewing with open- and closed-ended questions. There were 15 pre-screening questions and 24 post-screening questions. Questions included four main areas in breast/chestfeeding: current/past experiences, support, awareness of laws, and solutions. Central tendency, variance, and paired differences were calculated from evaluation responses. Results: There were 185 participants who completed the pre-screening evaluation and 57 participants who completed the post-screening evaluation. Racial/ethnic differences were found for stated reasons for attendance, and perceptions of breastfeeding being challenging after viewing the video. Most participants felt the video was relevant (median response = “2-relevant”; IQR = “3-neutral”, “1-very relevant”), learned something new (81.4%) and knew how to access breast/chestfeeding support after viewing the video (93.2%). Conclusions: Current media is a way to alter perceptions and opinions, and provides information. Additionally, it can be a way of increasing awareness of issues that Black breast/chestfeeding persons encounter. Strategic marketing efforts for future film screenings may increase attendance from those that can gain insight into breast/chestfeeding support (youth/young adults and males). Supportive breast/chestfeeding environments can also be a reality with a readily accessible, unified, and encouraging personal and professional networks.

Abstract 9873: Comparing Base Locations for Drone-Delivered Defibrillators

Introduction: Drone-delivered defibrillators may improve response for out-of-hospital cardiac arrest (OHCA). Prior studies have assumed that drones may be stationed at any police, fire, or paramedic station; however, cross-service implementation may not be logistically feasible. We sought to compare estimated response times by drone base location type. Methods: We included OHCAs (Jan. 2014 to Dec. 2020) in southern Vancouver Island, British Columbia, Canada where OHCA response includes fire and paramedic services. We created four models with candidate drone base locations at: police stations, fire stations, paramedic stations, and on a grid with 1 km sides as an optimistic model. We used mathematical optimization to select 1-5 drone bases for each model. Assuming a drone system had been in place during the study period and accounting for drone availability, we estimated 9-1-1 call-to-defibrillator intervals (measured to either drone, paramedic, or fire arrival) and calculated the proportion of OHCAs where a drone would arrive prior to fire and paramedic for each model. Median response times were compared to historical response using one-sided sign tests. Results: We included 1,610 OHCAs with a median historical response time of 6.4 mins (IQR 5.0-8.6). We identified 21 police stations, 59 fire stations, 21 paramedic stations, and 7,008 grid locations in the study area. Median 9-1-1 call-to-defibrillator intervals ranged from 4.3-5.3 mins for police, 4.3-5.3 mins for fire, 4.5-5.4 mins for paramedic, and 4.2-5.4 mins for grid locations (all P<0.001). Drones arrived prior to fire and paramedics in 36.6-65.4% of cases for police, 38.1-66.2% for fire, 37.3-63.2% for paramedic, and 35.7-66.8% for grid locations. Conclusion: Locating drone bases at different types of emergency service stations significantly decreases 9-1-1 call-to-defibrillator intervals, while resulting in similar response intervals to those achieved using optimistic grid-optimal locations.

Integrating Telemedicine in Assisting Poison Center Service: Line Application

Objective: To characterize Line, a mobile chat application, usage in Ramathibodi Poison Center (RPC) for further improvement of toxicological consultation services. Materials and Methods: Retrospective data were retrieved from Line messages together with concurrently recorded cases in the RPC database for six months, between November 16, 2018 and May 15, 2019. Time of consultation, time to response, types of toxins, reasons for consultation, and delivered content were recorded. Results: Over six months, 12,686 consultations were made via the hotline with 1,181 cases that used Line as an adjunct with 1,301 conversations. Median response time was three minutes. The most common poisonings were pesticides with 525 contacts (40.4%), followed by pharmaceutical agents and animal toxins. Most requests were for treatment suggestions with 731 contacts (56.2%), followed by notifying case progression and substance or animal identification. Among 1,030 files sent by consultees, the most common were photos of substances and animals for identification. Among 997 responses, most RPC staff used Line as an adjunct for treatment suggestions at 659 times (66.1%), followed by substance or animal identification and providing diagnoses. Overall, 602 protocols were delivered. Conclusion: Ten percent of all consultations were accompanied by Line usage. Most contacts were about pesticides and for appropriate treatment. RPC also used Line to effectively deliver diagnoses and treatment and increase coverage nationally. Keywords: Telemedicine, Line, Application, Poison center

What Are the Opinions of New Zealand Public Library Staff on Ebooks?

<p>RESEARCH OBJECTIVE: The purpose of this study was to discover the opinions of New Zealand public library staff on ebooks. While there are studies on opinions on ebooks, there is less emphasis on public library staff. Ebooks are becoming more and more popular and how libraries implement them will impact on the future of libraries. The aim of this study was to discover what library staff liked and disliked about ebooks and how they feel about ebooks in public libraries. METHODOLOGY: Invitations to participate in a survey about ebooks were posted on two email discussion lists, PUBSIG, for New Zealand public library staff, and NZ-Libs, for New Zealand library staff. Additionally, an invitation was emailed to all staff members of Wellington City Libraries. Data were collected using an online survey consisting mainly of Likert-type statements that respondents indicate their level of agreement to. These statements were adapted from previous studies done on ebooks. Respondents were not required to answer every question. RESULTS: There were 202 responses. 63% (127) of New Zealand public library staff surveyed have read at least one ebook in the past year. 93% (188) Agree or Strongly Agree with the statement that it is important for public libraries to offer ebooks. 57% (105) Agree or Strongly Agree with the statement “I enjoy helping patrons with technical questions about ebooks or ereaders”. Respondents think that the portability of ebooks and the ability to customise ebooks is useful. Most library staff surveyed think the increasing popularity of ebooks is good for libraries. The median response to “My library has a great stock of ebooks” was Neither Agree nor Disagree, with the majority of respondents agreeing that ebook licensing terms restricts the stock of ebooks available at their library. IMPLICATIONS: Library staff think that offering ebooks is important for libraries. However, libraries implementing ebooks need to ensure staff are ready to help patrons with ebooks. Ebook licensing terms are perceived as restricting libraries’ ebook stock, for libraries to be successful at offering ebooks the licensing situation may need to change.</p>

What Are the Opinions of New Zealand Public Library Staff on Ebooks?

<p>RESEARCH OBJECTIVE: The purpose of this study was to discover the opinions of New Zealand public library staff on ebooks. While there are studies on opinions on ebooks, there is less emphasis on public library staff. Ebooks are becoming more and more popular and how libraries implement them will impact on the future of libraries. The aim of this study was to discover what library staff liked and disliked about ebooks and how they feel about ebooks in public libraries. METHODOLOGY: Invitations to participate in a survey about ebooks were posted on two email discussion lists, PUBSIG, for New Zealand public library staff, and NZ-Libs, for New Zealand library staff. Additionally, an invitation was emailed to all staff members of Wellington City Libraries. Data were collected using an online survey consisting mainly of Likert-type statements that respondents indicate their level of agreement to. These statements were adapted from previous studies done on ebooks. Respondents were not required to answer every question. RESULTS: There were 202 responses. 63% (127) of New Zealand public library staff surveyed have read at least one ebook in the past year. 93% (188) Agree or Strongly Agree with the statement that it is important for public libraries to offer ebooks. 57% (105) Agree or Strongly Agree with the statement “I enjoy helping patrons with technical questions about ebooks or ereaders”. Respondents think that the portability of ebooks and the ability to customise ebooks is useful. Most library staff surveyed think the increasing popularity of ebooks is good for libraries. The median response to “My library has a great stock of ebooks” was Neither Agree nor Disagree, with the majority of respondents agreeing that ebook licensing terms restricts the stock of ebooks available at their library. IMPLICATIONS: Library staff think that offering ebooks is important for libraries. However, libraries implementing ebooks need to ensure staff are ready to help patrons with ebooks. Ebook licensing terms are perceived as restricting libraries’ ebook stock, for libraries to be successful at offering ebooks the licensing situation may need to change.</p>

Azacytidine Treatment in Patients with Acute Myeloid Leukemia/High-Risk Myelodysplastic Syndrome: Day-Hospital Management Compared to Home Care Setting

Introduction Treatment with Hypometilating Agents (HMA) of unfit patients (pts) with Acute Myelogenous Leukemia (AML) and High-Risk Myelodysplastic Syndromes (HR-MDS) is often difficult in the standard Day-Hospital (DH) setting, due to the number of hospital admissions required and the frail clinical conditions of pts. In the Viterbo province, accounting for 3612 Km 2 divided into 60 municipalities, is operative an Unit of Domiciliary Hematologic Care (UDHC) for clinical assistance to frail pts with hemopathies. Aims To evaluate the role of the UDHC compared to standard DH setting in the active frontline treatment with HMA +/- venetoclax (VTX) of pts with AML/HR-MDS. Methods All pts with newly diagnosed AML/HR-MDS unfit for intensive care and treated frontline with HMA from 1/2010 to 4/2021 were analysed. Results In this study period, 112 pts (62 AML/50 HR-MDS) received HMA (azacytidine in 105 cases and decitabine in 7 cases): six pts added VTX to HMA. As concern therapy management, 69 pts (61.6%) were treated in a standard DH setting and 43 (38.4%) were followed by UDHC: pts were allocated to DH or home care setting by responsible physician based on clinical conditions, comorbidities, caregiver availability and distance from hospital. The main features at baseline of HMA in the whole cohort and according to management are reported in the Table 1. Median interval from diagnosis to HMA initiation was 0.9 months (IQR 0.5 - 3.0). Median number of HMA cycles administered was 9 (IQR 4 - 16). The overall response rate (ORR), including complete response, partial response and hematologic improvement, was 43.7% (48/112 pts) in the whole cohort, without differences according to management [29/69 (42.0%) in DH vs 19/43 (44.1%) in home care, p=0.797]. Infections were also equally reported [46/69 pts (66.6%) in DH vs 31/43 (72.0%) in home care setting had at least 1 infection, p=0.362]. Median response duration of the whole cohort was 10.0 months (95%CI 5.7 - 14.2), without differences according to management [8.7 months (95%CI 7.0 - 10.3) in DH vs 13.0 months (95%CI 8.3 - 17.6) in home care, p=0.460]. Median Overall Survival (OS) of the whole cohort was 13.0 months (95%CI 9.7 - 16.2): median OS of pts treated in DH was 13.7 months (95%CI 9.9 - 17.4) compared to 13.0 months (95%CI 6.7 - 19.3) of pts managed by UDHC (p=0.753) (Figure 1). Conclusions Home care management of HMA for unfit AML/HR-MDS pts is feasible and effective, with results similar to those achievable in a standard DH setting: this approach is thus adequate to offer active therapies in a fraction of frail pts with AML/HR-MDS considered up to now ineligible. Figure 1 Figure 1. Disclosures Latagliata: Novartis: Honoraria; Pfizer: Honoraria; BMS Cellgene: Honoraria.

P.216 Improving access to neurosurgeons through an electronic consultation service

Background: Timely access to neurosurgeons for clinical advice is limited depending on region and other social factors. An eConsult service providing access to neurosurgeons in Ontario, Canada may influence primary care provider (PCP) course of action and referral behaviours. Methods: The Champlain BASE (Building Access to Specialist Care via eConsult) service allows PCPs to access specialist care in lieu of traditional face-to-face referrals. We conducted a cross-sectional study of eConsult cases submitted to neurosurgeons by PCPs between Jan 1, 2017 and Dec 31, 2018. Usage data and PCP responses to a mandatory closeout survey were analyzed. Results: A total of 432 eConsults were submitted. Specialist median response time was 2.29 days with 86.8% of responses occurring within 7 days. PCPs received a new or additional course of action in 53% of cases. An unnecessary face-to-face referral was avoided in 57% of all eConsults, and 50% of cases where the PCP initially contemplated requesting a referral. Over 86% of cases were rated at least 4 out of 5 in value for PCPs and their patients. Conclusions: The use of eConsult improves access to neurosurgeons by providing timely, highly-rated practice-changing clinical advice while reducing the need for patients to attend face-to-face office visits.