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JMIR Dermatology
Technologies, devices, apps, and informatics applications for patient education in dermatology, including preventative interventions, and clinical care for people with dermatological conditions
Background: Clinical practice guidelines are evidence based recommendations used by dermatologists to improve patient care. These guidelines provide the physician with an assessment of the benefits and harms of a treatment and its alternatives. Therefore, it is essential that the clinical practice guidelines be based on the strongest available evidence. Numerous studies in a variety of different fields of medicine have demonstrated that recommendations supported by weak evidence are a common theme in clinical practice guidelines. A clinical guideline based solely on weak evidence has the capability to reduce the quality of care provided by dermatologists. Objective: Our primary objective is to evaluate the levels of evidence supporting the recommendations constituting the American Academy of Dermatology clinical practice guidelines. Methods: Using a cross-sectional study design, investigators SM and RO located all current clinical practice guidelines from the American Academy of Dermatology website on June 10, 2017 and December 11, 2019. Each recommendation and its corresponding evidence rating were extracted in a duplicate and blinded fashion. A consensus meeting was planned a priori to resolve disagreements in extractions or stratifications. Results: Six clinical guidelines and their subsections were screened and 899 recommendations were identified. Our final data included 841 recommendations, as 58 of the recommendations contained no level of evidence and were excluded from calculations. The majority of the recommendations were supported by a moderate level of evidence and therefore received a B rating (346/841, 41.1%). Roughly one-third of the recommendations were supported by a strong level of evidence and were given an A rating (307/841, 36.5%). The clinical practice guideline with the highest overall strength of evidence was regarding the treatment of acne, which had 17 of 35 (48.6%) recommendations supported by strong evidence and only two (2/35, 5.7%) supported by weak evidence. The clinical practice guideline with the least amount of recommendations supported by strong evidence was melanoma (13/63, 20.6%). Conclusions: Clinical practice guidelines that lack strong supporting evidence could negatively affect patient care, and dermatologists should be mindful that not all recommendations are supported by the strongest level of evidence. Increased quantity and quality of research needs to be performed in the field of dermatology to improve the evidence supporting the American Academy of Dermatology clinical practice guidelines.
Journal Description
JMIR Dermatology (JDerm) is a new sister journal of JMIR (the leading open-access journal in health informatics), focusing on technologies, medical devices, apps, engineering, informatics applications for patient education in dermatology, including preventative interventions (e.g. skin cancer prevention) and clinical care for people with dermatological conditions.
As an open access journal, we are read by clinicians and patients alike and have (as with all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).
During a limited period of time, there are no fees to publish in this journal. Articles are carefully copyedited and XML-tagged, ready for submission in PubMed Central.
Background: Research impact has traditionally been measured using citation count and impact factor (IF). Academics have long relied heavily on this form of metric system to measure a publication’s impact. A higher number of citations is viewed as an indicator of the importance of the research and a marker for the impact of the publishing journal. Recently, social media and online news sources have become important avenues for dissemination of research, resulting in the emergence of an alternative metric system known as altmetrics.
Objective: We assessed the correlation between altmetric attention score (AAS) and traditional scientific impact markers, namely journal IF and article citation count, for all the dermatology journal and published articles of 2017.
Methods: We identified dermatology journals and their associated IFs available in 2017 using InCites Journal Citation Reports. We entered all 64 official dermatology journals into Altmetric Explorer, a Web-based platform that enables users to browse and report on all attention data for every piece of scholarly content for which Altmetric Explorer has found attention.
Results: For the 64 dermatology journals, there was a moderate positive correlation between journal IF and journal AAS (rs=.513, P<.001). In 2017, 6323 articles were published in the 64 dermatology journals. Our data show that there was a weak positive correlation between the traditional article citation count and AAS (rs=.257, P<.001).
Conclusions: Our data show a weak correlation between article citation count and AAS. Temporal factors may explain this weak association. Newer articles may receive increased online attention after publication, while it may take longer for scientific citation counts to accumulate. Stories that are at times deemed newsworthy and then disseminated across the media and social media platforms border on sensationalism and may not be truly academic in nature. The opposite can also be true.
Background: Skin cancers are caused by the development of abnormal cells that can invade or spread to other parts of the body. The countries whose authors contribute the most amount of articles on skin cancer to academia is still unknown.
Objective: The objectives of this study are to apply an author-weighted scheme (AWS) to quantify the credits for coauthors on an article byline and allocate the author weights to the country-level credits in articles.
Methods: On July 20, 2019, we obtained 16,804 abstracts published since 1938, based on a keyword search of “skin cancer” in PubMed. The author names, countries/areas, and journals were recorded. International author collaborations on skin cancer were analyzed based on country-level credits in articles. We aimed to do the following: (1) present country distribution for the first authors and the most popular journals, (2) show choropleth maps to highlight the most influential countries, and (3) draw scatter plots based on the Kano model to characterize the features of country-level research achievements. We programmed Excel Visual Basic for Applications (Microsoft Corp) routines to extract data from PubMed. Google Maps was used to display graphical representations.
Results: Our results suggest that researchers in the United States have published most frequently, accounting for 30.37% (5103), while Germany accounts for 7.34% (1234), followed by Australia (997, 5.93%). The top three continents for the proportion of published articles are North America, Europe, and Asia, accounting for 32.29%, 31.71%, and 10.41%, respectively.
Conclusions: This study offers an objective picture of the representativeness and evolution of international research on the topic of skin cancer. The research approaches used here have the potential to be applied to other areas besides skin cancer.
Background: Skin cancer is the most common cancer in the United States, disproportionately affecting young women. Since many young adults use Twitter, it may be an effective channel to communicate skin cancer prevention information.
Objective: The study aimed to assess the reach of the National Council on Skin Cancer Prevention (NCSCP)’s 2018 Don’t Fry Day Twitter campaign, categorize the types of individuals or tweeters who engaged in the campaign, and identify themes of the tweets.
Methods: Descriptive statistics were used, and a content analysis of Twitter activity during the 2018 Don’t Fry Day campaign was conducted. The NCSCP tweeted about Don’t Fry Day and skin cancer prevention for 14 days in May 2018. Twitter contributors were categorized into groups. The number of impressions (potential views) and retweets were recorded. Content analysis was used to describe the text of the tweets.
Results: A total of 1881 Twitter accounts, largely health professionals, used the Don’t Fry Day hashtag, generating over 45 million impressions. These accounts were grouped into nine categories (eg, news or media and public figures). The qualitative content analysis revealed informative, minimally informative, and self-interest campaign promotion themes. Informative tweets involved individuals and organizations who would mention and give further context and information about the #DontFryDay campaign. Subthemes of the informative theme were sun safety, contextual, and epidemiologic information. Minimally informative tweets used the hashtag (#DontFryDay) and other types of hashtags but did not give any further context or original material in the tweets. Self-interest campaign promotion involved businesses, firms, and medical practices that would utilize and promote the campaign to boost their own ventures.
Conclusions: These analyses demonstrate the large potential reach of social media public health campaigns. However, limitations of such campaigns were also identified, for example, the relatively homogeneous groups actively engaged in the campaign. This study contributes to the understanding of the types of accounts and messages engaged in social media campaigns utilizing a hashtag, providing insight into the messages and participants that are effective and those that are not to achieve campaign goals. Further research on the potential impact of social media on health behaviors and outcomes is necessary to ensure wide-reaching implications.
Background: Reproducible research is a foundational component for scientific advancements, yet little is known regarding the extent of reproducible research within the dermatology literature.
Objective: This study aimed to determine the quality and transparency of the literature in dermatology journals by evaluating for the presence of 8 indicators of reproducible and transparent research practices.
Methods: By implementing a cross-sectional study design, we conducted an advanced search of publications in dermatology journals from the National Library of Medicine catalog. Our search included articles published between January 1, 2014, and December 31, 2018. After generating a list of eligible dermatology publications, we then searched for full text PDF versions by using Open Access Button, Google Scholar, and PubMed. Publications were analyzed for 8 indicators of reproducibility and transparency—availability of materials, data, analysis scripts, protocol, preregistration, conflict of interest statement, funding statement, and open access—using a pilot-tested Google Form.
Results: After exclusion, 127 studies with empirical data were included in our analysis. Certain indicators were more poorly reported than others. We found that most publications (113, 88.9%) did not provide unmodified, raw data used to make computations, 124 (97.6%) failed to make the complete protocol available, and 126 (99.2%) did not include step-by-step analysis scripts.
Conclusions: Our sample of studies published in dermatology journals do not appear to include sufficient detail to be accurately and successfully reproduced in their entirety. Solutions to increase the quality, reproducibility, and transparency of dermatology research are warranted. More robust reporting of key methodological details, open data sharing, and stricter standards journals impose on authors regarding disclosure of study materials might help to better the climate of reproducible research in dermatology.
Background: Almost one-third of US adults (29%) have a tattoo, and almost half (47%) of millennials reported having a tattoo. With more people getting tattoos, there is an increased risk of infectious diseases, skin infections, and allergic reactions. Tattoo artists can influence these health risks with their standards of practice, tattoo inks, and sterilization techniques. Although tattoos are becoming mainstream, it was unclear if tattoo artists would be a hard-to-reach population. Using social media sites represents a promising method for recruiting tattoo artists for Web-based survey studies. Objective: The aim of this study was to evaluate various Web-based platforms and traditional methods for recruiting tattoo artists into a descriptive Web-based survey study. Methods: Recruitment occurred via Facebook ads , Instagram, Twitter, website, Web-based advertisement, emails, and postcards mailed to tattoo shops. Results: Recruitment methods resulted in 2332 respondents, of which 1845 answered question 1, “Are you a tattoo artist?” Only 1571 were tattoo artists. Facebook ads recruited the most study participants. Facebook accounted for 1228 (1228/1571, 78.17%) respondents who were tattoo artists. This number surpassed the next leading category of HTTP Referer unknown, which had 268 (268/1571, 17.06%). The Tattoo Survey 2015 website recruited 45 (45/1571, 2.86%) tattoo artists, whereas other Web-based sources contributed to the recruitment of 28 (28/1571, 1.78%) tattoo artists. Twitter and email had the lowest response rate with only 0.06% (1/1571) each. Conclusions: Social media sites enhanced survey participation, making it easier to reach tattoo artists nationwide. Of the recruitment methods used, Facebook ads were the most effective option, both for cost and recruitment rates. This study’s findings extend those of the previous research studies that demonstrated the timeliness, ease, and effectiveness of using Facebook ads for recruitment.
Skin cancer is a growing public health problem. Early and accurate detection is important, since prognosis and cost of treatment are highly dependent on cancer stage at detection. However, access to specialized health care professionals is not always straightforward, and population screening programs are unlikely to become implemented. Furthermore, there is a wide margin for improving the efficiency of skin cancer diagnostics. Specifically, the diagnostic accuracy of general practitioners and family physicians in differentiating benign and malignant skin tumors is relatively low. Both access to care and diagnostic accuracy fuel interest in developing smartphone apps equipped with algorithms for image analyses of suspicious lesions to detect skin cancer. Based on a recent review, seven smartphone apps claim to perform image analysis for skin cancer detection, but as of October 2018, only three seemed to be active. These apps have been criticized in the past due to their lack of diagnostic accuracy. Here, we review the development of the SkinVision smartphone app, which has more than 900,000 users worldwide. The latest version of the SkinVision app (October 2018) has a 95% sensitivity (78% specificity) for detection of skin cancer. The current accuracy of the algorithm may warrant the use of this app as an aid by lay users or general practitioners. Nonetheless, for mobile health apps to become broadly accepted, further research is needed on their health impact on the health system and the user population. Ultimately, mobile health apps could become a powerful tool to reduce health care costs related to skin cancer management and minimize the morbidity of skin cancer in the population.
Background: Teledermatology (TD) is one of the applications of electronic health and telemedicine that involves the use of information and communication technologies (ICTs) for the care of skin diseases. Previous studies on TD indicate that it seems to be effective in diagnosing early malignant pathologies, such as melanoma, and in reducing waiting lists by prioritizing urgent cases of pathology. Despite these advantages, the implementation of TD is still low in many areas. Objective: Most previous studies on TD have focused on analyzing the results of TD use. However, to completely understand TD, it is necessary to consider the determinants of its use. This study analyzes the factors that motivate medical professionals to use TD in their clinical practice. Methods: A survey that targeted a total population of 743 medical professionals from health care institutions in Andalusia (Spain) was used. The study sample comprised 223 doctors (87 dermatologists and 136 primary care physicians). Results: Using an extended Technology Acceptance Model and microdata for the 223 physicians, a cluster analysis (of the user’s ICT profile) and binary logistic regression analysis were conducted. This analysis demonstrated the presence of 3 clusters in the sample with respect to the use of technology (cluster 1: advanced use of ICTs; cluster 2: moderate use of ICTs; and cluster 3: scarce use of ICTs). The analysis performed confirmed the model’s goodness of fit, which allowed 69% of the variable’s variance to be explained. The outcomes revealed that the factors that were most important when implementing a TD system were the user’s ICT profile (P=.048), system efficiency (P<.001), and preference of the subjects involved (P=.008; P<.005). The quality of the assistance, the difficulties arising from the use of technology (information security and confidentiality), or interests of the administration were not decisive factors for the implementation of TD. Subsequently, we performed a logistic regression analysis, separating primary care doctors from dermatologists. For the former, the determining factors were the ICT profile and the efficiency of the system, whereas, among dermatologists, only the preference of each individual was considered to be a determining factor. Conclusions: The use of TD should be accompanied by a comprehensive program of validation and evaluation. These results show that determinants of TD implementation differ depending on the subjects involved. Therefore, it is essential to perform studies before the implementation of a TD system to identify and influence the aforementioned predictive factors.
Background: Skin cancer is the most common type of cancer in the United States. Rates of melanoma, a malignant form of skin cancer, are on the rise and are high among people under 30 years of age. Objective: This study aims to explore factors related to sun protection and tanning behavior and examine the influence of social media use and health information-seeking behaviors (HISB) on sun protection actions among a group of college students. Methods: In this cross-sectional study, students (N=258) at a large public university completed a survey that included questions on sun safety and tanning attitudes and behaviors, as well as HISB. A sun protection behavior score was created on the basis of behaviors related to seeking shade, using sunscreen, tanning booth and bed use, and the number of lifetime blistering sunburns. Multivariate logistic regression analyses were performed to assess associations between high and low sun protection behavior and sun safety and tanning attitudes and HISB. Results: The majority of participants were females (164/258, 63.8%), 31.0% (80/258) were white, and the mean age was 20.3 (SD 4.1) years. Females (odds ratio [OR] 0.42, 95% CI 0.22-0.81) and believers that suntan improves appearance (OR 0.25, 95% CI 0.10-0.66) were less likely to have “high” sun protection behaviors. Conclusions: The cultural belief that having a suntan improves appearance, especially among female college students, results in low sun protection behaviors. Interventions can be developed to improve skin cancer-related HISB among college students with the aim of developing better cognizance of skin cancer and sun protection behaviors.
Background: Teledermatology provides timely access to consultative dermatology services while reducing the need for travel among patients in rural and underserviced areas. However, knowledge about the potential benefits of such a service in urban areas is limited. Objective: This study aimed to determine the impact of a geographically unrestricted, intrainstitutional, secure, email teledermatology service for dermatology. Methods: We employed a mixed-methods approach using chart review, surveys, and semistructured interviews from the Canada Health Infoway Benefits Evaluation Framework. Patient charts were reviewed for demographics, clinical characteristics, and outcomes. Electronic and paper surveys were sent to patients and providers to quantify aspects of the service, such as satisfaction and usability, on a Likert scale. Semistructured interviews of referring providers and a convenience sample of academic consultant dermatologists who were considering teledermatology for their practice were conducted. Interviews were transcribed and analyzed using manual coding and thematic analysis by both the primary author and a second independent reviewer. All results were concurrently triangulated in an overarching analysis. Results: A total of 76 consultations were reviewed over a period of 18 months, of which 84% were completely managed without an in-person visit. Only 6% of rashes required a subsequent in-person visit to a dermatologist for management, compared to 41% of lesions. In addition, 28% (21/76) of patients responded to the survey. Patients “strongly agreed” to use the service again, were satisfied with the management of their skin issue, and thought the service saved them time. In general, providers who answered the electronic survey “strongly agreed” that the service demonstrated quality, timeliness, and an educational benefit, but increased their administrative time. A total of 9 interviews of 5 referring providers and 4 dermatologists were completed. Triangulation of all study components supported the hypothesis that teledermatology benefits providers, patients, and the health care system. Conclusions: Intrainstitutional teledermatology has high satisfaction among patients and providers and saves patients time, even when there are no geographic or systemic barriers to access. This service may be most effective when targeted at rashes rather than lesions. Additional research on the cost-effectiveness and educational benefits of this service is warranted.
Background: Despite their elevated melanoma risk, young-onset melanoma patients and their families exhibit low rates of engagement in skin cancer surveillance and sun protection behaviors. Interventions that improve skin cancer surveillance (total cutaneous exam [TCE] and skin self-exam [SSE]) and prevention (sun protection) practices among young-onset patients and their family members would likely have an impact on skin cancer morbidity and mortality; however, such interventions are lacking. Objective: The objective of our study was to examine the development, feasibility, and preliminary impact of a family-focused Facebook intervention to increase engagement in TCE, SSE, and sun protection among young-onset melanoma patients and their families. Methods: In this study, 48 young-onset melanoma patients and their 40 family members completed measures of knowledge; beliefs; and TCE, SSE, and sun protection intentions before and 1 month after participating in 1 of 5 separate “secret” (ie, private) Facebook groups. The intervention content consisted of daily postings about skin cancer, skin cancer risk factors, TCE, SSE, and sun protection. Results: Patient and family member participation rates differed by recruitment setting, with acceptance rates ranging from 24.6% to 39.0% among families recruited from a cancer center setting and from 12.7% to 61.5% among families recruited from a state registry. Among the 5 consecutive groups conducted, engagement, as measured by comments and likes in response to postings, increased across the groups. In addition, participants positively evaluated the intervention content and approach. Preliminary analyses indicated increases in TCE, SSE, and sun protection intentions. Conclusions: Our family-focused Facebook intervention showed promise as a potentially feasible and efficacious method to increase sun protection and skin cancer surveillance among individuals at increased risk for melanoma.
Background: The overall distribution of all skin and wound problems experienced by residents in skilled nursing facilities, with respect to the location on the body, is poorly understood. Previous studies focused largely on one disease type, rather than all possible skin lesions. Hence, the relative distribution of skin and wound problems as mapped on the body has not previously been reported. In addition, existing data come mainly from clinical studies and voluntarily reported statistics; unbiased real-world evidence is lacking. Objective: The aim of this study was to understand the type and location of skin and wound lesions found in skilled nursing facilities and to map these on the body. Methods: Data from 23,453 wounds were used to generate heat maps to identify the most common areas of skin and wound lesions, as well as the most common wound types at different body locations. Results: The most common wound types were abrasion (8792/23,453, 37.49%), pressure ulcers (4089/23,453, 17.43%), surgical wounds (3107/23,453, 13.25%), skin tears (2206/23,453, 9.41%), and moisture-associated skin damage (959/23,453, 4.09%). The most common skin and wound locations were the coccyx (962/23,453, 4.10%), right (853/23,453, 3.64%) and left (841/23,453, 3.59%) forearms, and sacrum (818/23,453, 3.49%). Conclusions: Here, we present the body location hot spots of skin and wound lesions experienced by residents of skilled nursing facilities. In addition, the relative prevalence of these conditions is presented. We believe that identifying areas on the body prone to preventable wounds can help direct actions by care workers and improve the quality of care for skilled nursing residents. This study represents an example of how analysis of specialized electronic medical records can be used to generate insights to educate and inform facility managers where to focus their efforts to prevent these injuries from occurring, not only from retrospective database analysis but also in near real time.
Background: Social media is increasingly used as a source of health information and is useful for information exchange and patient support. Objective: The aim of this study is to describe the Facebook groups and pages that are available for melanoma patients. Methods: A systematic search of Facebook groups and pages was performed using the word “melanoma.” The first 50 pages found in the search, sorted by most relevant, were analyzed for several characteristics, namely page name, category, verification status, number of likes, number of followers, visitor posts per week, page posts per week, ability to donate, date of inception, and for-profit or nonprofit. The first 50 groups found in the search, sorted by most relevant, were analyzed for name, category, number of members, and privacy setting. Results: There were 669 pages and 568 groups related to melanoma found on Facebook. The first 50 pages had a combined total of 266,709 likes and 257,183 followers and, of these, 30% (15/50) were verified by Facebook. Within the analyzed Facebook pages, the average number of visitor posts per week was 0.48, the average number of posts by the page per week was 5.6, and the most common page categories were community and nonprofit. Of the 50 groups analyzed, 18 were public and 32 were private (closed). The total number of combined group members in all 50 groups was found to be 23,047 and 52% (26/50) of the groups were categorized as support. Conclusions: Melanoma pages and groups on Facebook reach a large portion of the population. To provide resources for the population of patients diagnosed with malignant melanoma and ensure that proper information is distributed, physicians and health care organizations may consider using Facebook as a platform to support and educate patients with melanoma.
Background: Clinical practice guidelines are evidence based recommendations used by dermatologists to improve patient care. These guidelines provide the physician with an assessment of the benefits an...
Background: Clinical practice guidelines are evidence based recommendations used by dermatologists to improve patient care. These guidelines provide the physician with an assessment of the benefits and harms of a treatment and its alternatives. Therefore, it is essential that the clinical practice guidelines be based on the strongest available evidence. Numerous studies in a variety of different fields of medicine have demonstrated that recommendations supported by weak evidence are a common theme in clinical practice guidelines. A clinical guideline based solely on weak evidence has the capability to reduce the quality of care provided by dermatologists. Objective: Our primary objective is to evaluate the levels of evidence supporting the recommendations constituting the American Academy of Dermatology clinical practice guidelines. Methods: Using a cross-sectional study design, investigators SM and RO located all current clinical practice guidelines from the American Academy of Dermatology website on June 10, 2017 and December 11, 2019. Each recommendation and its corresponding evidence rating were extracted in a duplicate and blinded fashion. A consensus meeting was planned a priori to resolve disagreements in extractions or stratifications. Results: Six clinical guidelines and their subsections were screened and 899 recommendations were identified. Our final data included 841 recommendations, as 58 of the recommendations contained no level of evidence and were excluded from calculations. The majority of the recommendations were supported by a moderate level of evidence and therefore received a B rating (346/841, 41.1%). Roughly one-third of the recommendations were supported by a strong level of evidence and were given an A rating (307/841, 36.5%). The clinical practice guideline with the highest overall strength of evidence was regarding the treatment of acne, which had 17 of 35 (48.6%) recommendations supported by strong evidence and only two (2/35, 5.7%) supported by weak evidence. The clinical practice guideline with the least amount of recommendations supported by strong evidence was melanoma (13/63, 20.6%). Conclusions: Clinical practice guidelines that lack strong supporting evidence could negatively affect patient care, and dermatologists should be mindful that not all recommendations are supported by the strongest level of evidence. Increased quantity and quality of research needs to be performed in the field of dermatology to improve the evidence supporting the American Academy of Dermatology clinical practice guidelines.
