Dysmorphology Core Status Report February 2015 KENNETH LYONS JONES, MD DEPARTMENT OF PEDIATRICS UNIVERSITY OF CALIFORNIA, SAN DIEGO

AIMS To assure consistency as well as accuracy in recognition of Fetal Alcohol Spectrum Disorders (FASD) at all CIFASD project sites throughout the world To develop a training DVD that could be used to teach physicians and other health care professionals with little or no experience in diagnosis of FASD to correctly identify the characteristic structural features of FAS through a physical examination and to successfully diagnose or rule out this disorder on that basis To develop a methodology whereby long-distance consultation can be provided to physicians and other healthcare providers in outlying areas throughout the world

Consistency and Accuracy in Recognition of FASD Overall the Dysmorphology Core has performed 3780 standardized physical examinations on 2615 unique subjects at consortium sites throughout the world 202 of those children have been examined since April 2014 That included 44 children in Atlanta; 29 children in Los Angeles; 94 children in Minneapolis; 29 children in San Diego; 3 children in Khmelnytsky and 3 children in Rivne in Ukraine

Training DVD We have developed a 15 minute DVD of a child with FAS This careful examination focuses on minor malformations in structural development characteristic of FAS Can be used on a recurring basis in teaching and clinical practice as a diagnostic tool

Training DVD

Methodology for long-distance consultation Two phased approach Remote physicians have the capability to film the physical exam and securely transmit them via the internet to Dr. Jones for review and schedule a consultation Remote physicians have the capability to perform the clinical examination and consultation with Dr. Jones during a live session at the remote site

Methodology for long-distance consultation Phase I: We established a collaboration with Dr. Jeffrey Wozniak at the University of Minnesota Services that use existing internet and network infrastructure Project provided handheld camera for taking images Physicians film the physical exam and securely transmit them via the internet to Dr. Jones for review and schedule a consultation For the consultation, the remote clinicians look at the participant documents and video at their site and Dr. Jones looks at same information on the secure repository at his site Dr. Jones provides feedback on capture images, text and completes the consultation with the remote physicians using secure imaging software

Methodology for long-distance consultation Phase II: Proceed at University of Minnesota with real-time consultations The transportable exam station (TES) equipment will be sent to University of Minnesota in March Clinical and support staff will be trained on equipment utilizing the software and other documentation implemented in Phase I Physicians will perform the clinical examination and consultation with Dr. Jones during a live session at the clinic sites The portable equipment can be used at various sites served by clinical staff working with Dr. Wozniak Pictures show what is included in the case: laptop, camera, stethoscope and cables

Transportable Exam Station (TES)

Considerations Sites can choose to stop with Phase I consultations and have improved clinical evaluations and save time in determining next steps for patients and their families In most circumstances existing internet and network services are sufficient to support both phases of long-distance consultation Sites can use existing clinical systems and behavioral imaging software for consultations The portable equipment save facilities costs required to support more permanent telemedicine physician carts The TES unit costs $65K for associated hardware and software

Considerations Project provides handbook, training materials and technical support for site implementation for chosen sites This methodology can be used again and again allowing for site specific service differences The portable equipment can be used at remote sites without internet connection and then uploaded at the center site after actual clinical exam is performed