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Overview of international teledermatology.

Pan Afr Med J · 2010 · PMC3063501 · PMID 21436946

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showed a trendno p-value reported
Five hospitals submitted cases for more than four years; however, their activity data showed a trend in declining referral rates over the four-year period, which may represent successful knowledge transfer.

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Quoted from the open-access full text in Europe PMC under the licence the publisher applied. The sentence is reproduced exactly as published; the emphasis is ours.