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Background: Internationally, teledermatology has proven to be a viable alternative to conventional physical referrals. Travel cost and referral times are reduced while patient safety is preserved. Especially patients from rural areas benefit from this healthcare innovation. Despite these established facts and positive experiences from EU neighboring countries like the Netherlands or the United Kingdom, Germany has not yet implemented store-and-forward teledermatology in routine care.
Methods: The TeleDerm study will implement and evaluate store-and-forward teledermatology in 50 general practitioner (GP) practices as an alternative to conventional referrals. TeleDerm aims to confirm that the possibility of store-and-forward teledermatology in GP practices is going to lead to a 15% (n = 260) reduction in referrals in the intervention arm. The study uses a cluster-randomized controlled trial design. Randomization is planned for the cluster “county”. The main observational unit is the GP practice. Poisson distribution of referrals is assumed. The evaluation of secondary outcomes like acceptance, enablers and barriers uses a mixed methods design with questionnaires and interviews.
Discussion: Due to the heterogeneity of GP practice organization, patient management software, information technology service providers, GP personal technical affinity and training, we expect several challenges in implementing teledermatology in German GP routine care. Therefore, we plan to recruit 30% more GPs than required by the power calculation. The implementation design and accompanying evaluation is expected to deliver vital insights into the specifics of implementing telemedicine in German routine care.
Modern persistent Key/Value stores are designed to meet the demand for high transactional throughput and high data ingestion rates. Still, they rely on backwards-compatible storage stack and abstractions to ease space management, foster seamless proliferation and system integration. Their dependence on the traditional I/O stack has negative impact on performance, causes unacceptably high write-amplification, and limits the storage longevity.
In the present paper we present NoFTL KV, an approach that results in a lean I/O stack, integrating physical storage management natively in the Key/Value store. NoFTL-KV eliminates backwards compatibility, allowing the Key/Value store to directly consume the characteristics of modern storage technologies. NoFTLKV is implemented under RocksDB. The performance evaluation under LinkBench shows that NoFTL-KV improves transactional throughput by 33%, while response times improve up to 2.3x. Furthermore, NoFTL KV reduces write-amplification 19x and improves storage longevity by imately the same factor.