***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 Tele-echocardiography has the potential to bring real-time diagnoses to neonatal facilities without in-house pediatric cardiologists . Many neonates in rural areas , smaller cities , and community hospitals do not have immediate access to pediatric sonographers or echocardiogram interpretation by pediatric cardiologists . This can result in suboptimal echocardiogram quality , delay in initiation of medical intervention , unnecessary patient transport , and increased medical expenditures . Telemedicine has been used with increased frequency to improve efficiency of pediatric cardiology care in hospitals that are not served by pediatric cardiologists . Initial reports suggest that telecardiology is accurate , improves patient care , is cost-effective , enhances echocardiogram quality , and prevents unnecessary transports of neonates in locations that are not served by pediatric cardiologists . OBJECTIVE We report the largest series to evaluate the impact of telemedicine on delivery of pediatric cardiac care in community hospitals . We hypothesized that live telemedicine guidance and interpretation of neonatal echocardiograms from community hospitals is accurate , improves patient care , enhances sonographer proficiency , allows for more efficient physician time management , increases patient referrals , and does not result in increased utilization of echocardiography . METHODS Using desktop videoconferencing computers , pediatric cardiologists guided and interpreted pediatric echocardiograms from 2 community hospital nurseries 15 miles from a tertiary care center . Studies were transmitted in real-time using the H.320 videoconferencing protocol over 3 integrated services digital network lines ( 384 kilobits per second ) . This result ed in a frame rate of 23 to 30 frames per second . Sonographers who primarily scanned adult patients but had received additional training in echocardiography of infants performed the echocardiograms . Additional views were suggested as deemed necessary by the interpreting physician , and interpretations were made during the videoconference . The results of the echocardiogram and recommendations for patient care were communicated to the referring physician over the telemedicine system . Analyses of accuracy , patient treatment , echocardiogram quality , time to diagnosis , pediatric cardiologist practice time management , patient referral patterns , and echocardiography utilization were conducted prospect ively . RESULTS A total of 500 studies in 364 patients were transmitted during a 30-month period . The most common indication for echocardiography was to rule out congenital heart disease ( 208 of 500 studies ) . Signs and symptoms that prompted this concern included cyanosis , murmur , tachypnea , genetic syndrome , arrhythmia , abnormal fetal echocardiogram , and maternal diabetes . Other indications included suspected  patent ductus arteriosus ( PDA ; 182 of 500 studies ) , intracardiac clot or catheter position , persistent pulmonary hypertension , and hemodynamic instability . Cardiac diagnoses included complex congenital heart disease ( n = 16 ) , noncritical heart disease ( n = 107 ) , and PDA ( n = 86 ) . Additional diagnoses included persistent pulmonary hypertension ( n = 12 ) , septal hypertrophy ( n = 18 ) , right atrial mass/clot/vegetation ( n = 11 ) , and decreased cardiac function ( n = 6 ) . An umbilical venous catheter was visualized in the left atrium in 9 % ( 45 of 500 ) of all studies . No significant abnormalities were found in 244 studies . Major diagnoses were confirmed by subsequent review of videotape in all studies . Comparison of final videotape interpretation to initial telemedicine diagnosis result ed in 1 minor diagnostic change ( membranous versus inlet ventricular septal defect ) . Echocardiograms were performed in subsequent visits in 264 patients . The diagnosis was altered in 3 patients . Telemedicine had an immediate impact on patient care in 151 transmissions . The most common interventions were indomethacin treatment for PDA ( n = 76 ) , retraction of umbilical venous catheters from the left atrium ( n = 45 ) , inotropic or anticongestive therapy ( n = 19 ) , anticoagulation ( n = 8) , and prostagl and in infusion ( n = 8) . Nineteen patients were transported to our hospital because of the telemedicine diagnosis . Inpatient or outpatient cardiology follow-up was recommended in an additional 131 studies and did not result in any change in the initial management . The most common diagnoses in these patients were ventricular septal defect ( n = 56 ) , atrial septal defect ( n = 21 ) , septal hypertrophy ( n = 9 ) , intracardiac thrombosis ( n = 8) , and pulmonary valve stenosis ( n = 4 ) . We speculate that the immediate availability of an echocardiographic diagnosis likely prevented unnecessary transport in 14 cases . Recommendations for additional views or adjustment of echocardiography machine setting s were made in 95 % of transmissions . Real-time guidance was especially helpful in suprasternal notch and subcostal sagittal imaging . Depth , color Doppler sector size , and color Doppler scale were frequently adjusted from routine adult setting s during the teleconference . The average time from request for echocardiogram to completion of the videoconference was 28 + /- 14 minutes . This was significantly shorter than the waiting time ( 12 + /- 16 hours ) for the videotape to be delivered by courier . Telemedicine eliminated the need for consultation in 194 cases and allowed the cardiologist to delay the visit until the end of the day in an additional 26 cases . This result ed in average time savings of 4.2 person-hours/wk based on travel and consultation time . Utilization of echocardiography  was similar before ( 35 of 1000 births ) and after ( 33 of 1000 to 43 of 1000 ) telemedicine installation . The percentage of neonatal echocardiograms that were interpreted by our practice increased from 63 % to 81 % at 1 hospital and from 0 % to 100 % at the other hospital . CONCLUSION Real-time transmission of neonatal echocardiograms from community hospitals over 3 integrated services digital network lines is accurate and has the potential to improve patient care , enhance echocardiogram quality , aid sonographer education , and have a positive impact on referral patterns and time management without increasing the utilization of echocardiography BACKGROUND Case management is believed to promote continuity of care and decrease hospitalization rates , although few controlled trials have tested this approach . OBJECTIVE To assess the effectiveness of a st and ardized telephonic case-management intervention in decreasing re source use in patients with chronic heart failure . METHODS A r and omized controlled clinical trial was used to assess the effect of telephonic case management on re source use .  Patients were identified at hospitalization and assigned to receive 6 months of intervention ( n = 130 ) or usual care ( n = 228 ) based on the group to which their physician was r and omized .  Hospitalization rates , readmission rates , hospital days , days to first rehospitalization , multiple readmissions , emergency department visits , inpatient costs , outpatient re source use , and patient satisfaction were measured at 3 and 6 months . RESULTS The heart failure hospitalization rate was 45.7 % lower in the intervention group at 3 months ( P = .03 ) and 47.8 % lower at 6 months ( P = .01 ) . Heart failure hospital days ( P = .03 ) and multiple readmissions ( P = .03 ) were significantly lower in the intervention group at 6 months . Inpatient heart failure costs were 45.5 % lower at 6 months ( P = .04 ) . A cost saving was realized even after intervention costs were deducted . There was no evidence of cost shifting to the outpatient setting . Patient satisfaction with care was higher in the intervention group . CONCLUSIONS The reduction in hospitalizations , costs , and other re source use achieved using st and ardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches Education programs for intensive insulin therapy were found to be valuable in improving glycemic control , but , due to low prevalence of type 1 diabetes in children and adolescents , access to those programs varies considerably in rural areas . We report on a telemedical care program that overcomes geographical isolation of patients on intensive insulin therapy . Sixty-one children and adolescents under the age of 26 participated in a telemedical care program . They stored daily information on blood glucose , injected insulin , meals and exercise  in a glucosemeter with electronic memory and transferred the data via modem go a remote diabetes center outside of the region . By individual telephone consultations from home , they review ed the data with a diabetologist at the diabetes center and adjusted their intensive insulin therapy in order to achieve predefined treatment goals . Patients were trained for 19 ( 6 - 48 ) weeks in the program and measured blood glucose 4.9 ( 1.7 - 4.9 ) times daily . Compared to the run-in-period , mean blood glucose had decreased ( 167 to 158 mg/dL , p < 0.01 ) , st and ard deviation of blood glucose had decreased ( 81 to 70 mg/dL , p < 0.001 ) , and frequency of hypoglycemia had decreased ( 5.2 to 3.3 in 4 weeks , p = 0.01 ) at the end of the program . The proportion of blood glucose values within the target range ( 80 - 180 mg/dL ) had increased ( 47 - 55 % , p < 0.001 ) . HbAlc was reduced by 0.4 % ( -3.8 to + 2.2 % , p < 0.05 ) . Telemedical care for intensive insulin therapy is safe , can improve glycemic control , and reduce the number of hypoglycemias in children and adolescents with type 1 diabetes In 1987 we established a  realtime echocardiography service  by  telemedicine  from the paediatric cardiology department of a tertiary-care hospital in Halifax . The service was initially provided to a single regional hospital but was exp and ed to six regional hospitals in the three Canadian Maritime Provinces . The system used a dialup broadb and video-transmission service provided by the telephone companies . Records of all transmissions were kept prospect ively and review ed to January 1997 . A total of 324 transmissions were made . During 1995- 96 there were 135 studies : 69 51 were urgent examinations of newborn children and 30 22 were urgent examinations of older children ; repeat studies and postoperative checks usually for pericardial effusion accounted for the other 36 studies 27 . The images were of broadcast quality except in five cases where problems with transmission or poor sedation occurred . A comparison of 26 transmitted studies with repeat , in person ' studies showed no important discrepancies in diagnosis . During the two-year study period , the cost of the network equipment leasing costs and telecommunications costs was C 90,000 . Use of the telemedicine network saved unnecessary patient transfer in 31 cases . The cost of the transportation avoided was C 100,000-C 118,000 . This review confirms our preliminary findings that broadb and echocardiography transmission provides a service comparable in availability and accuracy to that provided in our paediatric cardiology division Background .The high cost of caring for patients with congestive heart failure ( CHF ) results primarily from frequent hospital readmissions for exacerbations . Home nurse visits after discharge can reduce readmissions , but the intervention costs are high . Objectives .To compare the effectiveness of three hospital discharge care models for reducing CHF-related readmission charges : 1 ) home telecare delivered via a 2-way video-conference device with an integrated electronic stethoscope ; 2 ) nurse telephone calls ; and 3 ) usual outpatient care . Research Design . One-year r and omized trial . Subjects . English-speaking patients 40 years of age and older with a primary hospital admission diagnosis of CHF . Measures .Our primary outcome was CHF-related readmission charges during a 6-month period after r and omization . Secondary outcomes included all-cause readmissions , emergency department ( ED ) visits , and associated charges . Results .Thirty-seven subjects were r and omized : 13 to home telecare , 12 each telephone care and 12 to usual care .  Mean CHF-related readmission charges were 86 % lower in the telecare group ( $ 5850 , SD $ 21,094 ) and 84 % lower in the telephone group ( $ 7320 , SD $ 24,440 ) than in the usual care group ( $ 44,479 , SD $ 121,214 ) . However , the between-group difference was not statistically significant . Both intervention groups had significantly fewer CHF-related ED visits ( P = 0.0342 ) and charges ( P = 0.0487 ) than the usual care group . Trends favoring both interventions were noted for all other utilization outcomes . Conclusions .Substantial reductions in hospital readmissions , emergency visits , and cost of care for patients with CHF might be achieved by widespread deployment of distance technologies to provide posthospitalization monitoring . Home telecare may not offer incremental benefit beyond telephone follow-up and is more expensive OBJECTIVE Echocardiography is an important tool in the diagnosis and management of critically ill neonates . The authors hypoth 
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A central finding was that telehealth studies to date have not used socioeconomic indicators consistently .
However , specific telehealth applications have been shown to offer significant socio-economic benefit , to patients and families , health-care providers and the health-care system .
The main benefits identified were : increased access to health services , cost-effectiveness , enhanced educational opportunities , improved health outcomes , better quality of care , better quality of life and enhanced social support .