***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: BACKGROUND Accurate diagnosis and management of pigmented lesions is critical because of the morbidity and mortality associated with melanoma . OBJECTIVE We sought to compare accuracy of store- and -forward teledermatology for pigmented neoplasms with st and ard , in-person clinic dermatology . METHODS We conducted a repeated measures equivalence trial involving veterans with pigmented skin neoplasms . Each lesion was evaluated by a clinic dermatologist and a teledermatologist ; both generated a primary diagnosis , up to two differential diagnoses , and a management plan . The primary outcome was aggregated diagnostic accuracy ( match of any chosen diagnosis with histopathology ) . We also compared the severity of inappropriately managed lesions and , for teledermatology , evaluated the incremental change in accuracy when polarized light dermatoscopy or contact immersion dermatoscopy images were viewed . RESULTS We enrolled 542 patients with pigmented lesions , most were male ( 96 % ) and Caucasian ( 97 % ) . The aggregated diagnostic accuracy rates for teledermatology ( macro images , polarized light dermatoscopy , and contact immersion dermatoscopy ) were not equivalent ( 95 % confidence interval for difference within + /-10 % ) and were inferior ( 95 % confidence interval lower bound < 10 % ) to clinic dermatology . In general , the addition of dermatoscopic images did not significantly change teledermatology  diagnostic accuracy rates . In contrast to diagnostic accuracy , rates of appropriate management plans for teledermatology were superior and /or equivalent to clinic dermatology ( all image types : all lesions , and benign lesions ) . However , for the subgroup of malignant lesions ( n = 124 ) , the rate of appropriate management was significantly worse for teledermatology than for clinic dermatology ( all image types ) . Up to 7 of 36 index melanomas would have been mismanaged via teledermatology . LIMITATIONS Nondiverse study population and relatively small number of melanomas were limitations . CONCLUSIONS In general , the diagnostic accuracy of  teledermatology  was inferior whereas management was equivalent to clinic dermatology . However , for the important subgroup of malignant pigmented lesions , both diagnostic and management accuracy of teledermatology  was generally inferior to clinic dermatology and up to 7 of 36 index melanomas would have been mismanaged via teledermatology . Teledermatology and teledermatoscopy should be used with caution for patients with suspected malignant pigmented lesions 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 Teledermatology studies have examined diagnostic concordance between live-interactive ( LI ) and in-person examinations ( IP ) ; and between store- and -forward ( SF ) and IP examinations . However , no studies have looked simultaneously across all three care delivery modalities , and few have measured management concordance and diagnostic confidence of the dermatologist . The purpose of this study was to compare LI and SF modalities with IP with respect to diagnostic and management concordance and to compare physician diagnostic confidence across the three modalities . Four dermatologists , in r and om rotation among all three care modalities , examined 110 new patients .  Confidence was rated on a Likert scale from 1 to 5 ( 5 = total confidence ; 1 = no confidence ) . Identical diagnoses were given to the patient by examiners from all three examination modalities in 70/110 patients ( 64 % ) . More identical diagnoses were given for IP and LI examinations than for IP and SF examinations ( 80 % vs. 73 % ) ; however , the difference was not statistically significant ( p = 0.13 ) . The highest self-reported confidence rating was given for 87 % of IP examinations , 59 % for LI , and 54 % for SF . Diagnostic confidence ratings for SF and LI were not significantly different from each other ( p = 0.50 ) ; however , diagnostic confidence ratings for LI and SF were both statistically lower than IP ( p < 0.0001 ) . Dermatologists were more confident with IP examination than either form of teledermatology . The percent of diagnostic and management agreement among IP , LI , and SF modalities was high Results from phase 1 of the UK Multicentre Teledermatology Trial demonstrated the diagnostic accuracy of realtime teledermatology using low-cost equipment . Phase 2 of the trial aim ed to assess its effectiveness as a management tool for dermatological disease . Teledermatology consultations were organized between two health centres and two hospitals in Northern Irel and using low-cost videoconferencing equipment . For 205 patients seen by a dermatologist over the video-link a diagnosis and management plan were recorded . A subsequent face-to-face consultation was arranged on the same day to confirm the diagnosis and treatment regime . A comparison of these management plans revealed that the same plan was recommended in 64 % of cases ; the teledermatologist was unable to advocate a suitable management plan in 19 % of cases ; a suboptimal treatment plan was suggested by the teledermatologist in 6 % of cases ; and in 11 % of cases , the teledermatologist suggested an inappropriate treatment plan . These findings indicate that appropriate clinical management was possible in approximately two-thirds of dermatology consultations via the video-link 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 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 We compared the clinical outcomes after store- and -forward teledermatology with those following conventional clinic-based consultation . Subjects were r and omized to either  usual care ( a conventional clinic-based dermatology appointment ) or a store- and -forward teledermatology consultation . All subjects received baseline digital imaging and re-imaging was performed four months later . A total of 776 subjects were approached for inclusion , and a total of 508 image sets were review ed , 236 in usual care and 272 in teledermatology . The image sets from both study arms were used to make clinical outcome assessment s between baseline and four months . A dermatologist who was blinded to the r and omization rated the clinical outcomes using a three-point clinical course rating scale ( 1 = improved , 2 = no change , 3 = worse ) . In the usual care group , 65 % were rated as ' improved ' , 32 % were rated as ' no change ' and 3 % were rated as ' worse ' . For teledermatology , 64 % were rated as ' improved ' , 33 % as ' no change ' and 4 % as ' worse ' . The results of the study indicate that store- and -forward teledermatology consultations produce similar clinical outcomes when compared with conventional clinic-based consultations The aim of this study was to assess satisfaction with and acceptance of a store and forward teledermatology consult system among patients , referring primary -care clinicians , and consultant dermatologists . As part of a r and omized clinical trial that compared the clinical and economic outcomes of store and forward teledermatology to a conventional referral process , we conducted satisfaction assessment s among participating patients , referring primary -care clinicians , and consultant dermatologists . Survey questions included issues related to the timeliness of each consult process , the confidence participants displayed in each consult modality , and assessment s of overall satisfaction and preferences . A majority of referring clinicians ( 92 % ) and dermatologist consultants ( 75 % ) reported overall satisfaction with the teledermatology consult process . Ninety-five percent of referring clinicians reported that teledermatology result ed in more timely referrals for their patients . This finding was vali date d by the observation that teledermatology patients reached a point of initial intervention significantly sooner than did patients in usual care ( 41 days versus 127 days , p = 0.0001 ) .  Teledermatology patients reported satisfaction with the outcome of their teledermatology consultation  82 % of the time . However , patients did not express a clear preference for a consult method . A total of 41.5 % of patients preferred  teledermatology  , 36.5 % preferred usual care , and 22 % were neutral . Our study showed a high level of satisfaction among all users of a store- and -forward teledermatology consult system , and , in some cases , our survey results could be vali date d with observed clinical outcomes 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 BACKGROUND Recent studies demonstrating accuracy of teledermatology and teledermoscopy in the evaluation of  pigmented skin lesions ( PSL ) have been performed only on PSL previously selected by face-to-face examination . OBJECTIVES The objective was to investigate the feasibility of teledermatology for the management of individuals exhibiting multiple PSL with a two-step procedure . MATERIAL S AND METHODS In the first step , remote consultants selected clinical ly equivocal lesions evaluating a teletransmitted clinical image of patients ' backs . In the second step ,  dermoscopic images of selected lesions were evaluated . Management recommendations of both steps were compared with face-to-face . RESULTS For a total of 465 PSL in 18 patients , the agreement between the face-to-face and the two remote experts result ed moderate ( κ value , 0.530–0.565 ) in the first step and substantial ( κ value , 0.681–0.703 ) in the second step . CONCLUSIONS Although there are limitations of this pilot experience ( population and technical restrictions ) , our results provide preliminary evidence that a two-step teledermatologic approach may be feasible in managing individuals with multiple PSL 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 biops 
    Output:
    
RESULTS Of 78 included studies , approximately two-thirds comparing teledermatology and clinic dermatology  found better diagnostic accuracy with clinic dermatology .
Diagnostic concordance of store and forward with clinic dermatology was good ; concordance rates for live interactive and clinic dermatology were higher , but based on fewer patients .
Overall rates of management accuracy were equivalent , but teledermatology and teledermatoscopy were inferior to clinic dermatology for malignant lesions .
Management concordance was fair to excellent .
There was insufficient evidence to evaluate clinical course outcomes .
Patient satisfaction and preferences were comparable .
Teledermatology  reduced time to treatment and clinic visits and was cost-effective if certain assumptions were met .