***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 This pilot study compared data obtained using traditional methods of visual dental screenings in a school setting with data obtained using an intraoral camera and transmitted to a distant location via telehealth technology . METHODS For the study , 137 schoolchildren were screened using traditional methods . Two months later , 32 children were r and omly selected and rescreened in a single day using the intraoral camera and the telehealth system . The measurement indices used were deft/DMFT . RESULTS A comparison revealed no significant difference in the data collected by the two screening methods . The percentage agreement between the methods ranged from 89 % to 100 % . CONCLUSION In under-serviced or remote areas , the telehealth system may allow for accurate identification of oral conditions and act as a means of consultation at a distance between specialists , general dental practitioners , dental hygienists and individual patients 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 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 Objective . Investigate the hypothesis that telemedicine , in the form of real-time audiovisual transmission , would permit accurate assessment of illness severity and allow improved triage for transport . Methods . A prospect i ve study comparing assessment s of patients examined conventionally ( in person ) and remotely by a telemedicine link .  Fifteen patients ( 3 months to 14 years of age ) admitted to our emergency department were evaluated as if for transport . Patients were evaluated simultaneously by a physically present pediatric emergency room physician and by a pediatric critical care physician linked to the examining room by a broadb and audiovisual link . Each physician completed a patient assessment question naire independently . The sensitivity and specificity of the patient assessment by the audiovisually linked physician were calculated . Results . Sensitivity , ie , the ability of the remote , audiovisually connected telemedicine physician to detect abnormal findings , is 87.5 % . Specificity , the ability of the remote physician to detect normal findings , is 93 % . It is likely that sensitivity would be markedly improved with addition of an electronic stethoscope . Conclusion . This study demonstrates that pediatric patients may be assessed accurately with a broadcast- quality real-time audiovisual system . Such a system may have dramatic implication s for providing pediatric specialty and subspecialty care in underserved areas PURPOSE The digital images of the optic disk from a portable fundus camera were evaluated for suitability in teleophthalmologic screening for glaucoma . METHODS Fifty-one eyes of 27 consecutive patients from our glaucoma clinic were dilated and photographed with a Zeiss FF retinal camera ( Carl Zeiss , Oberkochen , Germany ) and a portable Nidek NM-100 ( Nidek , Tokyo , Japan ) fundus camera . Digital images from the portable fundus camera were digitized , compressed and stored in a Fujix DF-10 M ( Fuji , Tokyo , Japan ) digitizer . Lossy compressed digital images and photographs from the Zeiss camera were presented separately in r and om order to three ophthalmologists for estimation of vertical cup : disk ratios ( VCDR ) and to evaluate image quality as good , acceptable , or unacceptable for screening glaucoma . Gold st and ard VCDRs were measured from monoscopic photographic slides obtained using the Zeiss camera by a fourth ophthalmologist . RESULTS Measurement of agreement ( Kappa values ) between estimated VCDR of digital images and photographs by the three ophthalmologists were 0.52 , 0.38 , and 0.50 respectively . Agreement between gold st and ard and estimated VCDR from photographs were 0.87 , 0.45 , and 0.84 respectively ( specificity between 79 % and 97 % , sensitivity between 70 % and 95 % ) . Kappa values obtained between gold st and ard and estimated VCDR from digital images were 0.52 , 0.49 , and 0.49 , respectively ( specificity between 68 % and 79 % , sensitivity between 67 % and 87 % . CONCLUSION Moderate to good agreement indicates that the digital images from the portable fundus camera may be suitable for optic disk assessment in the current configuration . This easy to use Nidek h and -held camera could be a viable instrument for teleophthalmology if a better digitizing system is incorporated to improve the quality of the images BACKGROUND This report is a supplement to an earlier evidence report ,  Telemedicine for the Medicare Population , which was intended to help policymakers weigh the evidence relevant to coverage of telemedicine services under Medicare . That report focused on telemedicine programs and clinical setting s that had been used with or were likely to be applied to Medicare beneficiaries . While we prepared that report , it became apparent that there are also telemedicine studies among non-Medicare beneficiaries -- e.g . , children and pregnant women -- that could inform policymakers and provide more comprehensive evidence of the state of the science regarding telemedicine applications . In addition , the first evidence report only partially included a class of telemedicine applications ( called self-monitoring/testing telemedicine ) in which the beneficiary used a home computer  or modern-driven telephone system  to either report information or access information and support from Internet re sources and indirectly interact with a clinician . Self-monitoring/testing applications in the first report required direct interaction with a clinician . The goal of this report is to systematic ally review the evidence in the clinical areas of pediatric and obstetric telemedicine as well as home-based telemedicine where there is indirect involvement of the health care professional . ( In this report , we will refer to the latter as clinician-indirect home telemedicine . ) Specifically , the report summarizes scientific evidence on the diagnostic accuracy , access , clinical outcomes , satisfaction , and cost-effectiveness of services provided by telemedicine technologies for these patient groups . It also identifies gaps in the evidence and makes recommendations for evaluating telemedicine services for these population s in the future . The evidence is clustered according to three categories of telemedicine service defined in our original report : store- and -forward , self-monitoring/testing , and clinician-interactive services . The three clinical practice areas review ed in this report are defined as follows . The term pediatric applies to any telemedicine study in which the sample consisted wholly or partially of persons aged 18 or younger , including studies with neonatal sample s. The term obstetric applies to any telemedicine study in which the sample consisted entirely of women seeking pregnancy-related care . The term clinician-indirect home telemedicine applies to home-based telemedicine ( called self-monitoring/testing in our original report ) where a telemedicine application used in the home has only indirect involvement by the health care professional . Interactive home telemedicine was applied in this report to all patient population s. KEY QUESTIONS The key questions that served as a guide for review ing the literature in the evaluation of pediatric , obstetric , and clinician-indirect  home telemedicine applications were derived by consensus among the evidence - review team based on the analytic framework established for the original evidence report . For the current report , the questions were applied to studies in all three practice areas as a whole group within each of the three categories of telemedicine services : store- and -forward ; self-monitoring/testing ; and clinician-interactive . The specific key questions were : 1 . Does telemedicine result in comparable diagnosis and appropriateness of recommendations for management ? 2 . Does the availability of telemedicine provide comparable access to care ? 3 . Does telemedicine result in comparable health outcomes ? 4 . Does telemedicine result in comparable patient or clinician satisfaction with care ? 5 . Does telemedicine result in comparable costs of care and /or cost-effectiveness ? METHODS We search ed for peer- review ed literature using several bibliographic data bases . In addition , we conducted h and search es of leading telemedicine journals and identified key papers from the reference lists of journal articles . For our original evidence report on telemedicine for the Medicare population , we design ed a search to find any publications about telemedicine and used it to search the MEDLINE , CINAHL , and HealthSTAR data bases for all years the data bases were available . Through this process , we captured studies of pediatric , obstetric , and clinician-indirect home telemedicine ; however , they were excluded from the original report since they were outside its scope . For this supplemental report , we review ed our original search results and identified studies relevant to this report . We identified additional studies from the reference lists of included papers and from h and search ing two peer- review ed telemedicine publications , the Journal of Telemedicine and Telecare and Telemedicine Journal . We critically appraised the included studies for each study area and key question and discussed the strengths and limitations of the most important studies at weekly meetings of the research team . We also developed recommendations for research to address telemedicine knowledge gaps . To match these gaps with the capabilities of specific research methods , we classified the telemedicine services according to the type of evidence that would be needed to determine whether the specific goals of covering such services had been met . We emphasized the relationship between the type and level of evidence found in the systematic review of effectiveness and the types of studies that might be funded to address the gaps in knowledge in this growing field of research . FINDINGS We identified a total of 28 eligible studies . In the new clinical areas , we found few studies in store- and -forward telemedicine . There is some evidence of comparable diagnosis and management decisions made using store- and -forward telemedicine from the areas of pediatric dental screening , pediatric ophthalmology , and neonatalogy . In self-monitoring/testing telemedicine for the areas of pediatrics , obstetrics , and clinician-indirect home telemedicine , there is evidence that access to care can be improved when patients and families have the opportunity to receive telehealth care at home rather than in-person care in a clinic or hospital . Access is particularly enhanced when the telehealth system enables timely communication between patients or families and care providers that allows self-management and necessary adjustments that may prevent hospitalization . There is some evidence that this form of telemedicine improves health outcomes , but the study sample sizes are usually small , and even when they are not , the treatment effects are small . There is also some evidence for the efficacy of clinician-interactive telemedicine , but the studies do not clearly define which technologies provide benefit or cost-efficiency . Some promising areas for diagnosis include emergency medicine , psychiatry , and cardiology . Most of the studies measuring access to care provide evidence that it is improved . Although none of these studies were r and omized controlled trials , they provide some evidence of access improvement over prior conditions . Clinician-interactive telemedicine was the only area for which any cost studies were found . The three cost studies did not adequately demonstrate that telemedicine reduces costs of care ( except comparing only selected costs ) . No study addressed cost-effectiveness . CONCLUSIONS This supplemental report covering the areas of pediatrics , obstetrics , and indirect-clinician home telemedicine echoes the findings of our initial report for the Medicare domain , which is that while the use of telemedicine is small but growing , the evidence for its efficacy is incomplete . Many of the studies are small and /or method ologically limited , so it can not be determined whether telemedicine is efficacious . Future studies should focus on the use of telemedicine in conditions where burden of illness and /or barriers to access for care are significant . Use of recent innovations in the design of r and omized controlled trials for emerging technologies would lead to higher quality studies . Journals publishing telemedicine evaluation studies must set high st and ards for method ologic quality so that evidence reports need not rely on studies with marginal method ologies OBJECTIVE To report a pilot study of telemedical direct ophthalmoscopy in the diagnosis of acquired immune deficiency syndrome (AIDS)-related retinopathy in a human immunodeficiency virus (HIV)-positive population and in the diagnosis of glaucoma , cataract , and retinopathy in 
    Output:
    
The strongest evidence for the efficacy of  telemedicine  for diagnostic and management decisions came from the specialties of psychiatry and dermatology .
There was also reasonable evidence that general medical history and physical examinations performed via telemedicine had relatively good sensitivity and specificity .
Other specialties in which some evidence for efficacy existed were cardiology and certain areas of ophthalmology .
Despite the widespread use of telemedicine in most major medical specialties , there is strong evidence in only a few of them that the diagnostic and management decisions provided by telemedicine are comparable to face-to-face care