***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to determine if a teledermatology consult system , using store- and -forward digital imaging technology , results in patients achieving a shorter time from referral date to date of initial definitive intervention when compared to a traditional referral process . Patients being referred to the dermatology consult service from the primary care clinics at the Durham VA Medical Center were r and omized to either a teledermatology consultation or usual care .  A usual care consultation consisted of a text-based electronic consult request . A teledermatology consultation included digital images and a st and ardized history , in addition to the text-based electronic consult .  Time to initial definitive intervention was defined as the time between referral date and the date the patient was scheduled for a clinic visit for those patients that the consultant requested a clinic-based evaluation , or the time between referral date and the date the consult was answered by the consultant if a clinic visit was not required . Patients in the teledermatology arm of the study reached a time to initial definitive intervention significantly sooner than did those patients r and omized to usual care ( median 41 days versus 127 days , p = 0.0001 , log-rank test ) . Additionally , 18.5 % of patients in the teledermatology arm avoided the need for a dermatology clinic-based visit compared to zero patients avoiding a dermatology clinic visit in the usual care arm of the study ( p < 0.001 , z-test ) . Teledermatology consult systems can result in significantly shorter times to initial definitive intervention for patients compared to traditional consult modalities , and , in some cases , the need for a clinic-based visit can be avoided The diagnostic accuracy of realtime teledermatology was measured using two different video cameras . One camera was a relatively low-cost , single-chip device camera 1 , while the other was a more expensive , three-chip camera camera 2 . The diagnosis obtained via the videolink was compared with the diagnosis made in person . Sixty-five new patients referred to a dermatology clinic were examined using camera 1 followed by a st and ard face-to-face consultation on the same day . A further 65 patients were examined using camera 2 and the same procedure implemented . Seventy-six per cent of conditions were correctly diagnosed by telemedicine using camera 2 compared with 62 using camera 1 . A working differential diagnosis was obtained in 12 of cases using camera 2 compared with 14 using camera 1 . The percentage of ` no diagnosis ` , wrong and missed diagnoses was halved using camera 2 compared with camera 1 . These results suggest that the performance of the more expensive camera was superior for realtime teledermatology OBJECTIVES To determine the reliability of videoconferencing technology in evaluating skin tumors , the impact of the technology on the clinicians ' degree of suspicion that a skin tumor is malignant , and the recommendation to do a biopsy . MATERIAL S AND METHODS Four skin cancer screenings were conducted at rural health care facilities in eastern North Carolina that were connected to East Carolina University School of Medicine . A dermatologist saw the patients in person at the local facility , and the same patient was seen by a dermatologist via a T-1 connection to Greenville , North Carolina . RESULTS The two physicians were in absolute agreement on 59 % of the 107 skin tumors evaluated . There were five lesions identified by the on-site dermatologist as a probable or definite malignancy . The degree of concern about a lesion being malignant and the decision whether to do a biopsy were not significantly different , as shown by kappa analysis . CONCLUSION The concern about the malignancy of a particular skin lesion and the recommendation whether to do a biopsy were not significantly affected by telemedicine technology BACKGROUND The Israel Defense Forces implemented a pilot teledermatology service in primary clinics . OBJECTIVES To assess user satisfaction and clinical short-term effectiveness of a computerized store and forward teledermatology service in urban and rural units . METHODS A multi-center prospect i ve uncontrolled cohort pilot trial was conducted for a period of 6 months . Primary care physicians referred patients to a board-certified dermatologist using text email accompanied by digital photographs .  Diagnosis , therapy and management were sent back to the referring PCP . Patients were asked to evaluate the level of the CSAFTD service , effect of the service on accessibility to dermatologists , respect for privacy , availability of drugs , health improvement and overall satisfaction . PCPs assessed the quality of the teledermatology consultations they received , the contribution to their knowledge , and their overall satisfaction . RESULTS Tele-diagnosis alone was possible for 95 % ( n=413 ) of 435 CSAFTD referrals ; 22 % ( n=95 ) of referrals also required face-to-face consultation , Satisfaction with CSAFTD was high among patients in both rural and urban clinics , with significantly higher scores in rural units . Rural patients rated the level of service , accessibility and overall satisfaction higher than did urban patients . PCPs were satisfied with the quality of the service and its contribution to their knowledge . Rural physicians rated level of service and overall satisfaction higher than did urban physicians . Tele-referrals were completed more efficiently than referral for face-to-face appointments . CONCLUSIONS CSAFTD provided efficient , high quality medical service to rural and urban military clinics in the IDF OBJECTIVE To determine the effect of de grade d digital image resolution ( as viewed on a monitor ) on the accuracy and confidence of dermatologic interpretation . MATERIAL S AND METHODS Eight dermatologists interpreted 180 clinical cases divided into three Logical Competitor Sets ( LCS ) ( pigmented lesions , non-pigmented lesions , and inflammatory dermatoses ) . Each case was digitized at three different resolutions . The images were r and omized and divided into ( 9 ) 60-image sessions . The physicians were completely blinded concerning the image resolution . After 60 seconds per image , the viewer recorded a diagnosis and level of confidence . The result ant ROC curves compared the effect of LCS , level of clinical difficulty , and resolution of the digital image . One-way analysis of variance ( ANOVA ) compared the curves . RESULTS The areas beneath the ROC curves did not demonstrate any consistently significant difference between the digital image resolutions for all LCS and levels of difficulty . The only significant effect observed was amongst pigmented lesions ( LCS-A ) where the ROC curve area was significantly smaller in the easy images at high resolution compared to low and medium resolutions . For all other ROC curve comparisons within LCS-A , at all other levels of difficulty , as well as within the other LCS at all levels of difficulty , none of the differences was significant . CONCLUSION A 720 x 500 pixel image can be considered equivalent to a 1490 x 1000 pixel image for most store- and -forward teledermatology consultations Background Increasing use of teledermatology should be based on demonstration of favourable accuracy and cost – benefit analysis for the different methods of use of this technique Teledermatology consultations were organized between two health centres and two hospitals in Northern Irel and using low-cost videoconferencing equipment . A prospect i ve study of patient satisfaction was carried out . Following each teleconsultation , patients were asked to complete a question naire assessing their satisfaction with the service . Over 22 months , 334 patients were seen by a dermatologist over the video-link , and 292 patients 87 completed the 16-item question naire . Patients reported universal satisfaction with the technical aspects of teledermatology . The quality of both the audio and the display was highly acceptable to patients . Personal experiences of the teledermatology consultation  were also favourable : 85 felt comfortable using the video-link . The benefits of teledermatology were generally recognized : 88 of patients thought that a teleconsultation could save time . Patients found the  teledermatology consultation  to be as acceptable as the conventional dermatology consultation . These findings suggest overall patient satisfaction with realtime teledermatology We studied the perceptions of general practitioners ( GPs ) towards teledermatology , before and after its introduction into eight general practice s for the purpose s of a r and omized controlled trial . A postal question naire was distributed before the trial and again one year later . Thirty-six of the 42 GPs responded on each occasion ( a response rate of 86 % ) . In the second survey , only 21 % of respondents indicated that they were satisfied with teledermatology  in their practice , while 47 % said that they were dissatisfied . Thirty-one per cent said that they felt confident about diagnosis and management of care through teledermatology , and 28 % reported that they were unconfident . Only 23 % of respondents said that they would consider using a  telemedicine system  in the future , while 34 % said they would not ( 43 % were unsure ) . There were no significant findings to suggest that the GPs ' perceptions changed over time . Less favourable responses to telemedicine were found than has been observed in previous studies , which suggests that the model of telemedicine described in this study would not be widely acceptable to GPs We carried out a pilot study on the feasibility and accuracy of store- and -forward  teledermatology  based on patient-provided images and history as a triage tool for outpatient consultation . Patients referred by their general practitioner provided a history and images via the Internet . The information was review ed by one of 12  teledermatologists  and the patient then visited a different dermatologist in person within two days . Three independent dermatologists compared the remote and in-person diagnoses in r and om order to determine diagnostic agreement . Broader agreement was also measured , by comparing the main disease groups into which the two diagnoses fell . The teledermatologists indicated whether an in-person consultation or further investigations were necessary . There were 105 eligible patients , aged four months to 72 years , who were willing to participate . For the 96 cases included in the analysis , complete diagnostic agreement was found in 41 % ( n= 39 ) , partial diagnostic agreement in 10 % ( n= 10 ) and no agreement in 49 % ( n= 47 ) . There was disease group agreement in 66 % of cases ( n= 63 ) . Nearly a quarter ( 23 % ) of participating patients could have safely been managed without an in-person visit to a dermatologist OBJECTIVE This report describes the design , development , and technical evaluation of a teledermatology system utilizing digital images and electronic forms captured through , stored on , and viewed through a common web server in an urban capitated delivery system . MATERIAL S AND METHODS The authors design ed a system whereby a primary care physician was able to seek a dermatologic consultation  electronically , provide the specialist with digital images acquired according to a st and ardized protocol , and review the specialist response within 2 business days of the request . The setting s were two primary care practice s in eastern Massachusetts that were affiliated with a large integrated delivery system . Technical evaluation of the effectiveness of the system involved 18 patients . Main outcome measures included physician and patient satisfaction and comfort and efficiency of care delivery . RESULTS In 15 cases , the consultant dermatologist was comfortable in providing definitive diagnosis and treatment recommendations . In 3 cases , additional information ( laboratory studies or more history ) was requested . There were no instances where the dermatologist felt that a face-to-face visit was necessary . CONCLUSIONS This novel approach shows promise for the delivery of specialist expertise via the internet . Cost-effectiveness studies may be necessary for more widespread implementation OBJECTIVE To determine the relative efficacy of store- and -forward teledermatology vs face-to-face dermatology consultations in triage decisions about the need for a biopsy of neoplastic skin changes . DESIGN Prospect i ve study of consecutive patients judged by an internist to require dermatologic consultation for a skin growth . SETTING Private primary care and dermatology practice s and an academic dermatology practice . PATIENTS Patients requiring dermatology consultation for evaluation of skin growths . Patients were seen by a single primary care physician between July 10 , 1998 , and August 4 , 2000 . INTERVENTION Digital photographs of skin growths were obtained by the primary care physician and evaluated by a teledermatologist . The patient was then seen face-to-face by a dermatologist . A biopsy was performed if either dermatologist favored biopsy . MAIN OUTCOME MEASURES Decisions to perform a biopsy . Agreement between the dermatologists was assessed . RESULTS Of the 49 patients with evaluable photographs , the face-to-face dermatologist and teledermatologist recommended a biopsy for the same 26 patients , yielding a sensitivity of the teledermatologist of 1.00 ( 95 % confidence interval [ CI ] , 0.87 - 1.00 ) and a specificity of 1.00 ( 95 % CI , 0.85 - 1.00 ) . The agreement between the dermatologists ( kappa ) was 1.00 ( 95 % CI , 0.72 - 1.00 ) . CONCLUSION Store- and -forward teledermatology may provide an accurate and cost-effective method of determining whether skin growths in patients presenting to primary care physicians should undergo biopsy A r and omized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology  compared with conventional outpatient dermatology care for patients from urban and rural areas . One urban and one rural health centre were linked to a regional hospital in Northern Irel and by ISDN at 128 kbit/s . Over two years , 274 patients required a hospital outpatient dermatology referral - 126 patients ( 46 % ) were r and omized to a telemedicine consultation and 148 ( 54 % ) to a conventional hospital outpatient consultation .  Of those seen by telemedicine , 61 % were registered with an urban practice , compared with 71 % of those seen conventionally . The clinical outcomes of the two types of consultation were similar - almost half the patients were managed after a single consultation with the dermatologist . The observed marginal cost per patient of the initial  realtime teledermatology consultation  was 52.85 for those in urban areas and 59.93 per patient for those from rural areas . The observed marginal cost of the initial conventional consultation  was 47.13 for urban patients and 48. 
    Output:
    
Diagnostic accuracy was the most often used outcome measure and was found in phase I , II and IV .
Compared with other specialties in telemedicine ( i.e. telesurgery , telepaediatrics ) , teledermatology seems to be a mature application .
However , more evaluation studies with a focus on clinical outcomes such as preventable referrals or time to recovery are needed to prove that teledermatology indeed is a promising and cost-saving technology