***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 In a retrospective review , the  telemedical management of 65 out patients from a r and omized controlled trial ( RCT ) of telemedicine for non-urgent referrals to a consultant neurologist was compared with the management of 76 patients seen face to face in the same trial , with that of 150 out patients seen in the neurology clinics of district general hospitals and with that of 102 neurological out patients seen by general physicians . Outcome measures were the numbers of investigations and of patient review s. The  telemedicine group did not differ significantly from the 150 patients seen face to face by neurologists in hospital clinics in terms of either the number of investigations or the number of review s they received . Patients from the RCT seen face to face had significantly fewer investigations but a similar number of review s to the other 150 patients seen face to face by neurologists ( the disparity in the number of investigations may explain the negative result for telemedicine in that RCT ) . Patients with neurological symptoms assessed by general physicians had significantly more investigations and were review ed significantly more often than all the other groups . Patients from the RCT seen by telemedicine were not managed significantly differently from those seen face to face by neurologists in hospital clinics but had significantly fewer investigations and follow-ups than those patients managed by general physicians . The results suggest that management of new neurological out patients by neurologists using telemedicine is similar to that by neurologists using a face-to-face consultation , and is more efficient than management by general physicians OBJECTIVE To study the validity and feasibility of transferring images of cutaneous biopsy specimens via e-mail to remote physicians active in dermatopathology for teleconsultation . DESIGN Twenty skin specimens previously diagnosed at the Department of Dermatology , University of Graz , Austria , were subsequently sent for teleconsultation using the store- and -forward method . For each case , 3 or 4 images at different magnifications were sent by e-mail to 16 colleagues ( 11 dermatopathologists and 5 pathologists ) in 15 centers in 6 different countries . Six weeks later each observer received the hematoxylin-eosin-stained specimens to render a conventional diagnosis . SETTING Dermatopathology and pathology units within institutional and private setting s. MATERIAL Twenty small skin biopsy specimens of cutaneous diseases were selected r and omly from a study set of 80 . MAIN OUTCOME MEASURE Concordance between telepathologic diagnoses and conventional histopathologic diagnoses of 20 skin specimens . RESULTS On average , 78 % of the telediagnoses were correct ( range , 60%-95 % ) , whereas 85 % of the conventional diagnoses were correct ( range , 60%-95 % ) . A perfect diagnostic concordance was obtained in 7 ( 35 % ) of 20 cases , and a significant difference was identified in only 1 case . CONCLUSIONS Results suggest that telepathology performed by physicians active in dermatopathology may serve as a reliable technique for the diagnosis of cutaneous diseases when experts in dermatopathology are not available locally . Furthermore , teledermatopathology is attractive because it provides an opportunity to obtain timely consultation on difficult cases PURPOSE To evaluate the use of remote reading of digital retinal photographs in the diagnosis of  severe ( referral-warranted ) retinopathy of prematurity ( ROP ) during longitudinal screening for ROP . STUDY DESIGN Prospect i ve , longitudinal cohort study . SUBJECTS Forty-four consecutive premature infants at risk for ROP . METHODS All infants were examined longitudinally , over a series of examinations , by indirect ophthalmoscopy ( gold st and ard ) and digital photography using the RetCam-120 Digital Retinal Camera ( Massie Research Laboratories Inc. , Dublin , CA ) equipped with an ROP lens . Images were stored and read remotely by a masked reader . Referral-warranted ROP was defined as ROP in zone 1 , the presence of plus disease or the presence of any stage 3 ROP . We determined whether and when referral-warranted ROP was diagnosed for each eye , of each infant , on each examination , during the course of each of the infant 's screening . RESULTS Severe ( referral-warranted ) ROP was diagnosed in 23 eyes by indirect ophthalmoscopy during their series of examinations . Digital photography had a sensitivity of 100 % and a specificity of 96 % in detecting referral-warranted ROP . The positive predictive value of digital photography was 92 % , and the negative predictive value was 100 % . In 87 % of eyes , referral-warranted ROP was diagnosed by digital photography before or at the same time as indirect ophthalmoscopy . CONCLUSIONS Longitudinal remote reading of digital photographs using the RetCam-120 system has excellent specificity and sensitivity in detecting referral-warranted ROP . This pilot study has shown that remote reading of digital photographs has promise for telemedicine strategies in ROP screening OBJECTIVE To evaluate the reliability of strabismus assessment using telemedicine ( TM ) technology . DESIGN Two prospect i ve interobserver agreement studies . One study compared the agreement between a st and ard and a TM examination , whereas the other assessed agreement between two independent st and ard examinations . PARTICIPANTS Strabismus patients over 4 years of age examined at a remote community clinic and patients assessed in a strabismologist 's urban practice . METHODS Forty-two patients were examined in person by a pediatric ophthalmologist at the remote community and independently by a pediatric ophthalmology fellow by means of TM ( TM-st and ard study ) . The TM examination was performed with the help of a qualified ophthalmic assistant at the remote telecommunication center using a Power Cam 100 camera , a Picture Tel Concorde 4500 teleconferencing system , and a 224 kilobyte b and width . For comparison , independent in person examinations were performed on 43 patients by both examiners ( st and ard-st and ard study ) . Agreement was measured using unweighted kappa ( k ) for categorical data , the intraclass correlation coefficient ( ICC ) for continuous data , and percent agreement . The odds of disagreement with TM  ( comparing the TM-st and ard versus st and ard-st and ard studies ) was assessed with logistic regression analysis . MAIN OUTCOME MEASURES Three parameters were assessed : ( 1 ) category of strabismus , determined by observation without cover test ; ( 2 ) angle of deviation at 0.33 and 6.0 m ; and ( 3 ) ocular muscle action . RESULTS Agreement on the category of strabismus was good ( k > 0.61 ) other than for vertical deviations . However , there was good to excellent agreement between TM and st and ard examinations on the vertical ( ICC = 0.78 ) and horizontal ( ICC = 0.79 ) angles of deviation with 6-m fixation with the cover test . Muscle ratings agreed within one point for the lateral , superior , and inferior rectus muscle actions in more than 90 % of the eyes examined . Although good agreement was observed in the TM-st and ard study , it was inferior to the agreement in the st and ard-st and ard study . Examination by TM increased the odds of disagreement compared with examination in person by twofold to threefold . CONCLUSIONS Strabismus examination can be performed with a good level of reliability with the use of medium b and width video teleconferencing equipment . However , reduced reliability has been noted in the detection of  small vertical deviations by inspection and in evaluating oblique muscle actions BACKGROUND Outcomes related to chronic heart failure ( HF ) remain relatively poor , despite advances in pharmacological therapy and medical and nursing care . Experts agree that outpatient care may be among the factors that affect HF outcomes . We hypothesized that the method by which outpatient care is delivered may affect outcomes in this patient population . METHODS A prospect i ve , r and omized design was used to compare HF outcomes from 216 patients r and omized to 1 of 2 home health care delivery methods for 3 months after discharge . Care was delivered by the home nurse visit ( HNV ) or the nurse telemanagement ( NTM ) method . In the latter , patients used transtelephonic home monitoring devices to measure their weight , blood pressure , heart rate , and oxygen saturation . These data were transmitted daily to a secure Internet site . An advanced- practice nurse worked collaboratively with a cardiologist and subsequently treated patients via the telephone . Both delivery methods used the same HF-specific clinical guidelines to direct care . Outcomes include HF readmissions and length of stay , anxiety , depression , self-efficacy , and quality of life . Data were primarily tested using a 2-group analysis of variance ( ANOVA ) . We used a repeated- measures ANOVA to conduct preintervention-postintervention analyses . RESULTS After 3 months , patients in the  NTM group ( n = 108 ; mean + /- SD age , 62.9 + /- 13.2 years ; 83 % African American ; 64 % female ) had fewer HF readmissions ( 13 vs 24 ; P</=.001 ) with shorter lengths of stay ( 49.5 vs 105.0 days ; P</=.001 ) compared with the HNV group ( n = 108 ; mean + /- SD age , 63.2 + /- 12.6 years ; 89 % African American ; 62 % female ) . Hospitalization charges at 3 months were less in the NTM group compared with the HNV group ( $ 65 023 vs $ 177 365 ; P</=.02 ) . At 6 and 12 months , cumulative readmission charges in the NTM group were also less ( $ 223 638 vs $ 500 343 [ P<.03 ] and $ 541 378 vs $ 677 710 [ P</=.16 ] , respectively ) compared with the HNV group . Quality of life was significantly improved for both groups when we compared postintervention and preintervention scores . CONCLUSION The adaptation of state-of-the-art computerized technology to closely monitor patients with HF with advanced- practice nurse care under the guidance of a cardiologist significantly improves HF management while reducing the cost of care This study compared health-related outcomes , during a 1-year period , for two groups of frail elders-one that received care coordination via distance monitoring ( home-telehealth )  and one that received no intervention . A case-control design was employed . The  home telehealth intervention group was made up of 111 male veterans who were enrolled in a Veterans Health Administration project . The control group consisted of 115 men who were referred from either senior service agencies or hospital rehabilitation programs , but did not receive home-telehealth . Subjects in both groups had primary diagnoses of hypertension , diabetes , respiratory disease , or heart disease . The two groups were similar in terms of age , race , marital status , and independence in instrumental activities of daily living ( IADL ) at baseline . A paired t-test was used to study the before-after ( baseline to 12-month follow-up ) improvements in the outcome measures within each group . Regression models were used to compare the outcome improvements between the two groups . Over 1 year , the intervention group improved 2.2 points more in IADL , 14.4 points more in FIM motor scores , and 2.7 points more in FIM cognitive scores than the control group ( p < 0.0001 ) . This evidence supports the use of a specific home-telehealth strategy for care coordination to improve functional independence in non-institutionalized veterans with chronic disease . A r and omized controlled trial should be employed to confirm these findings OBJECTIVE To test the hypothesis that telemedicine for new patient referrals to neurological out patients is as efficient and acceptable as conventional face to face consultation . METHODS A r and omised controlled trial between two groups : face to face ( FF ) and telemedicine ( TM ) . This study was carried out between a neurological centre and outlying clinics at two distant hospitals linked by identical medium cost commercial interactive video conferencing equipment with ISDN lines transmitting information at 384 kbits/s . The same two neurologists carried out both 
    Output:
    
Studies of office/hospital-based telemedicine suggest that telemedicine is most effective for verbal interactions , e.g. videoconferencing for diagnosis and treatment in specialties like neurology and psychiatry .