Summary An in vivo screen was performed in search of chemicals capable of enhancing neuron formation in the hippocampus of adult mice. Eight of 1,000 small molecules tested enhanced neuron formation in the subgranular zone of the dentate gyrus. Among these was an aminopropyl carbazole, designated P7C3, endowed with favorable pharmacological properties. In vivo studies gave evidence that P7C3 exerts its pro-neurogenic activity by protecting newborn neurons from apoptosis. Mice missing the gene encoding neuronal PAS domain protein 3 (NPAS3) are devoid of hippocampal neurogenesis and display malformation and electrophysiological dysfunction of the dentate gyrus. Prolonged administration of P7C3 to npas3-/- mice corrected these deficits by normalizing levels of apoptosis of newborn hippocampal neurons. Prolonged administration of P7C3 to aged rats also enhanced neurogenesis in the dentate gyrus, impeded neuron death, and preserved cognitive capacity as a function of terminal aging.

IMPORTANCE External store-and-forward (SAF) teledermatology systems operate separately from the primary health record and have many limitations, including care fragmentation, inadequate communication among clinicians, and privacy and security concerns, among others. Development of internal SAF workflows within existing electronic health records (EHRs) should be the standard for large health care organizations for delivering high-quality dermatologic care, improving access, and capturing other telemedicine benchmark data. Epic EHR software (Epic Systems Corporation) is currently one of the most widely used EHR system in the United States, and development of a successful SAF workflow within it is needed.OBJECTIVES To develop an SAF teledermatology workflow within the Epic system, the existing EHR system of Parkland Health and Hospital System (Dallas, Texas), assess its effectiveness in improving access to care, and validate its reliability; and to evaluate the system's ability to capture meaningful outcomes. DESIGN, SETTING, AND PARTICIPANTS Electronic consults were independently evaluated by 2 board-certified dermatologists, who provided diagnoses and treatment plans to primary care physicians (PCPs). Results were compared with in-person referrals from May to December 2013 from the same clinic (a community outpatient clinic in a safety-net public hospital system). Patients were those 18 years or older with dermatologic complaints who would have otherwise been referred to dermatology clinic. MAIN OUTCOMES AND MEASURESMedian time to evaluation; percentage of patients evaluated by a dermatologist through either teledermatology or in-person compared with the previous year.RESULTS Seventy-nine teledermatology consults were placed by 6 PCPs from an outpatient clinic between May and December 2014; 57 (74%) were female and their mean (SD) age was 47.0 (12.4) years. Teledermatology reduced median time to evaluation from 70.0 days (interquartile range [IQR], 33.25-83.0 days) to 0.5 days (IQR, 0.172-0.94 days) and median time to treatment from 73.5 to 3.0 days compared with in-person dermatology visits. Overall, a greater percentage of patients (120 of 144 [83.3%]) were evaluated by a dermatologist through either teledermatology or in-person during the 2014 study period compared with the previous year (111 of 173 [64.2%]). Primary care physicians followed management recommendations 93% of the time.CONCLUSIONS AND RELEVANCE Epic-based SAF teledermatology can improve access to dermatologic care in a public safety-net hospital setting. We hope that the system will serve as a model for other health care organizations wanting to create SAF teledermatology workflows within the Epic EHR system.

scale) as reported by both physicians and patients, and the skin domains of both the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT; 0-4 scale for 47 items [maximum score, 188]) and Lee Symptom Scale (LSS; 0-4 scale for 5 categories [maximum score, 20]) as reported by patients. Results |The cohort consisted of 7 patients with NoGVHDP−, 9 with NoGVHDP+, 9 with ET, 8 with ST, and 13 with ET/ST. Clinical Severity Score responses were available for 34 patients (28 adult and 6 pediatric), FACT-BMT responses for 31 adults, and LSS responses for 34 adults (Tables 1 and 2). 3 Patients with ET/ST reported the greatest clinical severity (mean, 7.0/10) on CSS, the most skin bother (mean, 3.6/4) on FACT-BMT, and the highest total LSS (14.0/20). Using the CSS, physicians overall rated patients with skin of color to be less severely affected than patients rated themselves (mean, 2.8/10 vs 3.7/10). In particular, self-rated severity of NoGVHDP+ was higher than the physician-rated severity (mean, 2.4/10 vs 0.1/10). Despite having no active cGVHD, the NoGVHDP+ group self-rated their skin disease as more severe than patients with ST (mean, 2.4/10 vs 1.1/10).The total FACT-BMT scores were similar among patients with NoGVHDP+ (mean, 101.0/188) and those with ST (mean, 108.0/188). Similarly, in all LSS categories (color, rash, thickness, sores, and itch), patients with ET were more bothered by their disease than patients with ST (mean, 13/20 vs 5.4/20).

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