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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.
Near-data processing in database systems on native computational storage under HTAP workloads
(2022)
Today’s Hybrid Transactional and Analytical Processing (HTAP) systems, tackle the ever-growing data in combination with a mixture of transactional and analytical workloads. While optimizing for aspects such as data freshness and performance isolation, they build on the traditional data-to-code principle and may trigger massive cold data transfers that impair the overall performance and scalability. Firstly, in this paper we show that Near-Data Processing (NDP) naturally fits in the HTAP design space. Secondly, we propose an NDP database architecture, allowing transactionally consistent in-situ executions of analytical operations in HTAP settings. We evaluate the proposed architecture in state-of-the-art key/value-stores and multi-versioned DBMS. In contrast to traditional setups, our approach yields robust, resource- and cost-effcient performance.
nKV in action: accelerating KVstores on native computational storage with NearData processing
(2020)
Massive data transfers in modern data intensive systems resulting from low data-locality and data-to-code system design hurt their performance and scalability. Near-data processing (NDP) designs represent a feasible solution, which although not new, has yet to see widespread use.
In this paper we demonstrate various NDP alternatives in nKV, which is a key/value store utilizing native computational storage and near-data processing. We showcase the execution of classical operations (GET, SCAN) and complex graph-processing algorithms (Betweenness Centrality) in-situ, with 1.4x-2.7x better performance due to NDP. nKV runs on real hardware - the COSMOS+ platform.
Massive data transfers in modern data-intensive systems resulting from low data-locality and data-to-code system design hurt their performance and scalability. Near-Data processing (NDP) and a shift to code-to-data designs may represent a viable solution as packaging combinations of storage and compute elements on the same device has become feasible. The shift towards NDP system architectures calls for revision of established principles. Abstractions such as data formats and layouts typically spread multiple layers in traditional DBMS, the way they are processed is encapsulated within these layers of abstraction. The NDP-style processing requires an explicit definition of cross-layer data formats and accessors to ensure in-situ executions optimally utilizing the properties of the underlying NDP storage and compute elements. In this paper, we make the case for such data format definitions and investigate the performance benefits under RocksDB and the COSMOS hardware platform.
Background
Although teledermatology has been proven internationally to be an effective and safe addition to the care of patients in primary care, there are few pilot projects implementing teledermatology in routine outpatient care in Germany. The aim of this cluster randomized controlled trial was to evaluate whether referrals to dermatologists are reduced by implementing a store-and-forward teleconsultation system in general practitioner practices.
Methods
Eight counties were cluster randomized to the intervention and control conditions. During the 1-year intervention period between July 2018 and June 2019, 46 general practitioner practices in the 4 intervention counties implemented a store-and-forward teledermatology system with Patient Data Management System interoperability. It allowed practice teams to initiate teleconsultations for patients with dermatologic complaints. In the four control counties, treatment as usual was performed. As primary outcome, number of referrals was calculated from routine health care data. Poisson regression was used to compare referral rates between the intervention practices and 342 control practices.
Results
The primary analysis revealed no significant difference in referral rates (relative risk = 1.02; 95% confidence interval = 0.911–1.141; p = .74). Secondary analyses accounting for sociodemographic and practice characteristics but omitting county pairing resulted in significant differences of referral rates between intervention practices and control practices. Matched county pair, general practitioner age, patient age, and patient sex distribution in the practices were significantly related to referral rates.
Conclusions
While a store-and-forward teleconsultation system was successfully implemented in the German primary health care setting, the intervention's effect was superimposed by regional factors. Such regional factors should be considered in future teledermatology research.