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Solomons telepathology

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  • 1. Solomon Islands
  • 2. Solomon Islands
  • 3. Solomon IslandsSolomon IslandsCapital: HoniaraPopulation: 450‘000Islands: ~1000Independence: 1978
  • 4. Solomon IslandsSolomon Islands National Referral HospitalCapital: HoniaraPopulation: 450‘000Islands: ~1000Independence: 1978
  • 5. Solomon IslandsSolomon Islands National Referral HospitalCapital: Honiara Doctors: 15 - 30Population: 450‘000 Radiologists: 1Islands: ~1000 Pathologists: 0Independence: 1978 Dermatologists: 0
  • 6. Limitations in Developing Countries  Shortage of general practitioners - many rural clinics are run by nurses only  Shortage of medical specialists - many countries have no dermatologists, pathologists, ophthalmologists, radiologists, etc.  Limited access to current information - medical libraries have no current material, no continuing medical education (CME)
  • 7. Limitations in Developing Countries  Limited Transportation
  • 8. Limitations in Developing Countries  Limited Communication Infrastructure Example: many islands in Solomons have no telephone – communication only my VHF radio. Existing telephones are often slow and too unreliable for stable internet access.  Limited financial resources
  • 9. Implications Patients - cannot afford to visit hospital - visit hospital late Doctors - no access to specialist knowledge - no advise for patient management - no experience with rare diseases - no communication with patient (unless at hospital)
  • 10. Solomon Islands Pathology  Problem for Pathology Services: – Specimen sent to Brisbane (AU) by air – Time until diagnosis: 60 days!  Patients do not return: – No communication infrastructure – Limited transport
  • 11. Suggested solutionTelemedicine: Access to advice and diagnosis from remote specialists with the help of telecommunication technologies.
  • 12. Solomon IslandsTelepathology:Phase 1: Histology Lab - September 2001Phase 2: Establishing remote diagnostics - 2001-2003Phase 3: Routine diagnostics - 2003 - ....
  • 13. Phase 1: Histology LabNeeds for Histology Lab: Operational under local conditions: - frequent power cuts - high temperature and humidity Sustainable - locally available spare parts
  • 14. Phase 1: Histology Lab Tissue Processing
  • 15. Phase 1: Histology Lab Tissue Processing Preparing blocks
  • 16. Phase 1: Histology Lab Tissue Processing Preparing blocksCutting
  • 17. Phase 1: Histology Lab Tissue Processing Preparing blocksCutting Staining
  • 18. Phase 1: Histology Lab Tissue Processing Preparing blocksCutting Staining Histology slides
  • 19. Phase 2: Remote consultationsStep 1:Selected images captured with digitalcamera (Nikon CoolPix 990) andsubmitted to server in Basel via email Step 2: Cases are reviewed by a group of 7 pathologists (Switzerland, Germany and South Africa)
  • 20. Phase 2: Remote consultations Results:  360 cases submitted and diagnosed  turn-around time 10 days (1-3 days for diagnosis)  Quality of diagnosis (preliminary results, n=80)*: 80% identical diagnosis 23% minor discrepancies 7% major discrepancies** * Full report in preparation ** Includes two cases of sampling errors (false negative needle biopsies)