***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: We carried out a pilot study comparing satisfaction levels between psychiatric patients seen face to face ( FTF )  and those seen via  videoconference .  Patients who consented were r and omly assigned to one of two groups . One group received services in person ( FTF from the visiting psychiatrist ) while the other was seen using videoconferencing at 128 kbit/s . One psychiatrist provided all the FTF and videoconferencing assessment and follow-up visits .  A total of 24 subjects were recruited . Three of the subjects ( 13 % ) did not attend their appointments and two subjects in each group were lost to follow-up . Thus there were nine in the FTF group and eight in the videoconferencing group . The two groups were similar in most respects . Patient satisfaction with the services was assessed using the Client Satisfaction Question naire ( CSQ-8 ) , completed four months after the initial consultation . The mean scores were 25.3 in the FTF group and 21.6 in the videoconferencing group . Although there was a trend in favour of the FTF service , the difference was not significant . Patient satisfaction is only one component of evaluation . The efficacy of telepsychiatry must also be measured relative to that of conventional , FTF care before policy makers can decide how extensively telepsychiatry should be implemented Background Evidence -based practice s design ed for large urban clinics are not necessarily portable into smaller isolated clinics . Implementing practice -based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists . Objective The purpose of the Telemedicine Enhanced Antidepressant Management ( TEAM ) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists . Design Matched sites were r and omized to the intervention or usual care . Participants Small VA Community-based outpatient clinics with no on-site psychiatrists , but access to telepsychiatrists .  In 2003–2004 , 395 primary care patients with PHQ9 depression severity scores ≥12 were enrolled , and followed for 12 months . Patients with serious mental illness and current substance dependence were excluded .  Measures Medication adherence , treatment response , remission , health status , health-related quality of life , and treatment satisfaction . Results The sample comprised mostly elderly , white , males with substantial physical and behavioral health comorbidity . At baseline , subjects had moderate depression severity (  Hopkins Symptom Checklist , SCL-20 = 1.8 ) , 3.7 prior depression episodes , and 67 % had received prior depression treatment . Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 ( odds ratio [ OR ] = 2.1 , p = .04 ) and 12 months ( OR = 2.7 , p = .01 ) . Intervention patients were more likely to respond by 6 months ( OR = 2.0 , p = .02 ) , and remit by 12 months ( OR = 2.4 , p = .02 ) . Intervention patients reported larger gains in mental health status and health-related quality of life , and reported higher satisfaction . Conclusions Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies BACKGROUND Mental illness has become a significant worldwide health issue in recent years . There is presently insufficient evidence to definitively determine the clinical effectiveness and cost-effectiveness of different health care models . The objective of this study was to evaluate the effectiveness of videoconferencing in mental illness . DATA SOURCES Literature search es were performed in Medline , EMBASE , PsycINFO , Centre for Review s and Dissemination , and The Cochrane Library Controlled Trial Registry data bases ( 1997-May 2008 ) . A search of the following terms was used : e-health , mental disorders ( MeSH term ) , mental health ( MeSH term ) , mental health services ( MeSH term ) , telecare , teleconsultation , telehome , telemedical , telemedicine , telemental , telepsychiatric , telepsychiatry , televideo , videoconference , and videophone . STUDY SELECTION Type of disease , interventions , and clinical outcomes or patient satisfaction were identified . Exclusion criteria included studies that did not analyze intervention outcomes and studies with a sample size of fewer than 10 cases . Peer review and quality assessment according to Cochrane recommendations were required for inclusion . DATA EXTRACTION / SYNTHESIS Of 620 identified articles , 10 r and omized controlled trials are included ( 1,054 patients with various mental disorders ) . There were no statistically significant differences between study groups for symptoms , quality of life , and patient satisfaction . CONCLUSIONS There is insufficient scientific evidence regarding the effectiveness of telepsychiatry in the management of mental illness , and more research is needed to further evaluate its efficiency . However , there is a strong hypothesis that videoconference-based treatment obtains the same results as face-to-face therapy and that telepsychiatry is a useful alternative when face-to-face therapy is not possible Therapist adherence to a manualized cognitive-behavioral anger management group treatment ( AMT ) was compared between therapy delivered via videoconference ( VC ) and the traditional in-person modality , using data from a large , r and omized controlled trial comparing the effectiveness of AMT  for veterans with combat-related posttraumatic stress disorder . Therapist adherence was rated for the presence or absence of process and content treatment elements . Secondary analyses were conducted using a repeated measures ANOVA . Overall adherence to the protocol was excellent ( M = 96 % , SD = 1 % ) . Findings indicate that therapist adherence to AMT is similar across delivery modalities and VC is a viable service delivery strategy that does not compromise a therapist 's ability to effectively structure sessions and manage patient care We compared the efficacy of telepsychiatry and same-room treatment of combat-related post-traumatic stress disorder ( PTSD ) using cognitive behavioural therapy in 14 weekly , 90-min treatment sessions . Of 97 patients referred for study participation , 38 were r and omized ( 17 into telepsychiatry , 21 into same-room ) , and approximately 25 ( the number differed by instrument ) had at least one post-baseline assessment . Measures of clinical and process outcomes were examined . No group differences were found on clinical outcomes at three-month follow-up . Satisfaction with treatment ratings was similar in both groups , with ' strong satisfaction ' indicated by veterans in both modalities . Attendance and drop-out were similar in the two groups . The same-room group reported more comfort in talking with their therapist at post-treatment and had better treatment adherence . The results provide preliminary support for the use of telepsychiatry in the treatment of PTSD to improve access to care Little is known about whether the recommendations made during telepsychiatry are actually implemented . We review ed 100 telepsychiatry consultations , chosen r and omly from a paediatric telepsychiatry programme serving rural communities in Ontario . Treatment recommendations had been made for each case review ed and up to nine recommendations had been made for a single case . Twenty-seven percent of recommendations revolved around monitoring ( 10 % ) , changing ( 9 % ) , starting ( 4 % ) , continuing ( 3 % ) and stopping ( 1 % ) medication . Case managers associated with 54 of the cases were interviewed to determine whether the recommendations had been implemented and to examine the barriers and facilitators to implementation . The results indicated that cooperation of both child and parent , clear communication of recommendations , involvement of the school and local health providers , stability of the agencies and availability of services were key components in the successful implementation of recommendations . The matter of technology or technological difficulties acting as a barrier to telepsychiatric consultations was not mentioned by case managers , suggesting that it was not a problem We used a PC-based videoconferencing system to conduct child psychiatry assessment s. The telecommunications link was six digital lines , giving a total b and width of 336 kbit s. Twenty-three patients aged 4 - 16 years , accompanied by their parents , completed two psychiatric assessment s , one via videoconferencing and another face to face FTF . The order of assessment s was r and omized . Question naires were used to record the diagnosis , treatment recommendations and the psychiatrists ' , patients ' and their parents ' satisfaction with each assessment . An independent evaluator concluded that in 22 cases 96 the diagnosis and treatment recommendations made via the videoconferencing system were the same as those made FTF . The psychiatrists stated that videoconferencing assessment s were an adequate alternative to FTF assessment s and did not interfere with diagnosis . However , the responses from the psychiatrist satisfaction question naire showed that they preferred FTF assessment s. No significant difference was found in the patients ' or parents ' satisfaction responses after the two types of assessment . The majority of children 82 liked ' using the telepsychiatry system and six 26 preferred it to a FTF assessment . Most parents 91 indicated that they would prefer to use the videoconferencing system than to travel a long distance to see a psychiatrist in person To investigate whether forensic evaluations can be performed reliably using telemedicine , we compared the results on a st and ard competency assessment instrument using telemedicine ( TM ) and live interviews ( LI ) . Two board-certified forensic psychiatrists used the Georgia Court Competency Test ( GCCT ) to evaluate 21 forensic psychiatric in patients . Half of the patients were r and omly assigned to a telemedicine interview  and half were assigned to a live interview .  Total scores on the GCCT were similar for both raters , indicating high levels of agreement between telemedicine and live interviews . Patient and provider satisfaction were measured and indicated that , although patients did not express a preference for a particular interview modality , providers reported greater satisfaction with live interviews . Findings suggest that one aspect of competency to st and trial can be reliably evaluated using telemedicine and that patients perceive telemedicine as an acceptable alternative to a st and ard live interview . The limited sample size precludes definite conclusions and further studies involving a larger forensic study population are warranted OBJECTIVE A major problem in the delivery of mental health services is the lack of availability of empirically supported treatment , particularly in rural areas . To date no studies have evaluated the administration of an empirically supported manual-based psychotherapy for a psychiatric condition via telemedicine . The aim of this study was to compare the relative efficacy and acceptability of a manual-based cognitive-behavioral therapy ( CBT ) for bulimia nervosa ( BN ) delivered in person to a comparable therapy delivered via telemedicine . METHOD One hundred twenty-eight adults meeting DSM-IV criteria for BN or eating disorder-not otherwise specified with binge eating or purging at least once per week were recruited through referrals from clinicians and media advertisements in the targeted geographical areas . Participants were r and omly assigned to receive 20 sessions of manual-based , CBT for BN over 16 weeks delivered either face-to-face ( FTF-CBT ) or via telemedicine ( TV-CBT ) by trained therapists . The primary outcome measures were binge eating and purging frequency as assessed by interview at the end of treatment , and again at 3- and 12-month follow-ups . Secondary outcome measures included other bulimic symptoms and changes in mood . RESULTS Retention in treatment was comparable for TV-CBT and FTF-CBT .  Abstinence rates at end-of-treatment were generally slightly higher for FTF-CBT compared with TV-CBT , but differences were not statistically significant . FTF-CBT patients also experienced significantly greater reductions in eating disordered cognitions and interview-assessed depression . However , the differences overall were few in number and of marginal clinical significance . CONCLUSIONS CBT for BN delivered via telemedicine was both acceptable to participants and roughly equivalent in outcome to therapy delivered in person Background Older adults who live in rural areas experience significant disparities in health status and access to mental health care . " Telepsychology , " ( also referred to as " telepsychiatry , " or " telemental health " ) represents a potential strategy towards addressing this longst and ing problem . Older adults may benefit from telepsychology due to its : ( 1 ) utility to address existing problematic access to care for rural residents ; ( 2 ) capacity to reduce stigma associated with traditional mental health care ; and ( 3 ) utility to overcome significant age-related problems in ambulation and transportation . Moreover , preliminary evidence indicates that telepsychiatry programs are often less expensive for patients , and reduce travel time , travel costs , and time off from work . Thus , telepsychology may provide a cost-efficient solution to access-to-care problems in rural areas . Methods We describe an ongoing four-year prospect i ve , r and omized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder , Behavioral Activation , delivered either via in-home videoconferencing technology ( " Telepsychology " ) or traditional face-to-face services ( " Same-Room " ) . Our hypothesis is that in-homeTelepsychology service delivery will be equally effective as the traditional mode ( Same-Room ) . Two-hundred twenty-four ( 224 ) male and female elderly participants will be administered protocol -driven individual Behavioral Activation therapy for depression over an 8-week period ; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains : ( 1 ) clinical outcomes ( symptom severity , social functioning ) ; ( 2 ) process variables ( patient satisfaction , treatment credibility , attendance , adherence , dropout ) ; and ( 3 ) economic outcomes ( cost and re source use ) . Discussion Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective as the traditional mode of service delivery , defined in terms of clinical , process , and economic outcomes , for elderly patients with depression residing in rural areas without adequate access to mental health services . Trial registration National Institutes of Health Clinical Trials Registry ( Clinical Trials.gov identifier # NCT0 
    Output:
    
Despite the method ological limitations and heterogeneity of the systematic review s , there appears to be good evidence of effectiveness ( reliability and improved outcomes ) and feasibility ( use , satisfaction , acceptability and cost ) for videoconference-based telepsychiatry internationally .