***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: Objective To investigate whether an internet based , nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinical ly manifest vascular disease . Design Prospect i ve r and omised controlled trial . Setting Multicentre trial in secondary and tertiary healthcare setting . Participants 330 patients with a recent clinical manifestation of atherosclerosis in the coronary , cerebral , or peripheral arteries and with at least two treatable risk factors not at goal . Intervention Personalised website with an overview and actual status of patients ’ risk factors and mail communication via the website with a nurse practitioner for 12 months ; the intervention combined self management support , monitoring of disease control , and drug treatment . Main outcome measures The primary endpoint was the relative change in Framingham heart risk score after 1 year . Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor . Results Participants ’ mean age was 59.9 ( SD 8.4 ) years , and most patients ( n=246 ; 75 % ) were male . After 1 year , the relative change in Framingham heart risk score of the intervention group compared with the usual care group was −14 % ( 95 % confidence interval −25 % to −2 % ) . At baseline , the Framingham heart risk score was higher in the intervention group than in the usual care group ( 16.1 ( SD 10.6 ) v 14.0 ( 10.5 ) ) , so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score . This produced a relative change of −12 % ( −22 % to −3 % ) in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and −8 % ( −18 % to 2 % ) adjusted for the baseline score . Of the individual risk factors , a difference between groups was observed in low density lipoprotein cholesterol ( −0.3 , −0.5 to −0.1 , mmol/L ) and smoking ( −7.7 % , −14.9 % to −0.4 % ) . Some other risk factors tended to improve ( body mass index , triglycerides , systolic blood pressure , renal function ) or tended to worsen ( glucose concentration , albuminuria ) . Conclusion An internet based , nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease . Trial registration Clinical trials NCT00785031 BACKGROUND This article is the result of a debate at the European Journal of Orthodontics Open Session in 2013 in Reykjavik , Icel and . OBJECTIVE The aim of this article is to highlight some of the strengths and weakness of clinical orthodontic research , with particular emphasis on r and omized controlled trials ( RCT ) . The ultimate aim of improving clinical orthodontic research in general . DESIGN This article is organized into two sections with arguments for and against RCTs . The background s to evidence -based evaluation and the level or quality of evidence in trials are discussed . The article emphasises what makes high quality clinical research , and gives practical advice including examples of tips and potential pitfalls for those undertaking clinical research . RESULTS AND CONCLUSION The overriding message is constructive and it is hoped that the article serves as an aid in evaluating , design ing , conducting , and reporting clinical research AIMS To describe and compare the outcomes of a nurse practitioner-managed cardiac surgery follow-up model of care with the st and ard model of primary care provider follow-up for coronary artery bypass graft surgery patients . BACKGROUND Advances in healthcare have had a favourable impact on length of stay following cardiac surgery ; however , the shorter length of stay has not been accompanied by enhanced support to bridge the gap between acute care and the community setting . DESIGN Prospect i ve ( 2009 - 2010 ) r and omized study . METHODS Elective cardiac surgery patients ( N = 200 ) were r and omly assigned to the nurse practitioner follow-up intervention or to the st and ard model of follow-up care . The main outcomes were health-related quality of life , patient satisfaction , symptoms , and health re source use . Outcome data were elicited via telephone interviews at 2 and 6 weeks postdischarge . RESULTS Baseline differences between the two groups were non-significant ; however , at 2 weeks postdischarge , the intervention group reported significantly fewer symptoms and higher physical functioning status . At 2 and 6 weeks postdischarge , the intervention group was significantly more satisfied with the amount of help , as well as the quality of the services received . Differences in healthcare re source use were not statistically significant . CONCLUSION This evidence suggests that the nurse practitioner-managed model of follow-up care effectively bridges the gap between institutional and primary care in the cardiac surgery population BACKGROUND High dem and for acute care nurse practitioners ( ACNPs ) in Canadian postoperative cardiac surgery setting s has outpaced method ologically rigorous research to support the role . PURPOSE To compare the effectiveness of ACNP-led care to hospitalist-led care in a postoperative cardiac surgery unit in a Canadian , university-affiliated , tertiary care hospital . METHODS Patients scheduled for urgent or elective coronary artery bypass and /or valvular surgery were r and omly assigned to either  ACNP-led ( n=22 ) or hospitalist-led ( n=81 ) postoperative care  . Both ACNPs and hospitalists worked in collaboration with a cardiac surgeon . Outcome variables included length of hospital stay , hospital readmission rate , postoperative complications , adherence to follow-up appointments , attendance at cardiac rehabilitation and both patient and health care team satisfaction . RESULTS Baseline demographic characteristics were similar between groups except more patients in the ACNP-led group had had surgery on an urgent basis ( p < or = 0.01 ) , and had undergone more complicated surgical procedures ( p < or = 0.01 ) . After discharge , more patients in the hospitalist-led group had visited their family doctor within a week ( p < or = 0.02 ) and measures of satisfaction relating to teaching , answering questions , listening and pain management were higher in the ACNP-led group . CONCLUSION / IMPLICATION S Although challenges in recruitment yielded a lower than anticipated sample size , this study contributes to our knowledge of the ACNP role in postoperative cardiac surgery . Our findings provide support for the ACNP role in this setting as patients who received care from an ACNP had similar outcomes to hospitalist-led care and reported greater satisfaction in some measures of care Objective To assess the cost-effectiveness of an internet-based , nurse-led vascular risk factor management programme in addition to usual care compared with usual care alone in patients with a clinical manifestation of a vascular disease . Design Cost-effectiveness analysis alongside a r and omised controlled trial ( the Internet-based vascular Risk factor Intervention and Self-management ( IRIS ) study ) . Setting Multicentre trial in a secondary and tertiary healthcare setting . Participants 330 patients with a recent clinical manifestation of atherosclerosis in the coronary , cerebral , or peripheral arteries and with ≥2 treatable vascular risk factors not at goal . Intervention The intervention consisted of a personalised website with an overview and actual status of patients ’ vascular risk factors , and mail communication with a nurse practitioner via the website for 12 months . The intervention combined self-management support , monitoring of disease control and pharmacotherapy . Main outcome measures Societal costs , quality -adjusted life-years ( QALYs ) and incremental cost-effectiveness . Results Patients experienced equal health benefits , that is , 0.86 vs 0.85 QALY ( intervention vs usual care ) at 1 year . Adjusting for baseline differences , the incremental QALY difference was −0.014 ( 95 % CI −0.034 to 0.007 ) . The intervention was associated with lower total costs ( € 4859 vs € 5078 , difference € 219 , 95 % CI −€2301 to € 1825 ) . The probability that the intervention is cost-effective at a threshold value of € 20 000/QALY , is 65 % . At mean annual cost of € 220 per patient , the intervention is relatively cheap . Conclusions An internet-based , nurse-led intervention in addition to usual care to improve vascular risk factors in patients with a clinical manifestation of a vascular disease does not result in a QALY gain at 1 year , but has a small effect on vascular risk factors and is associated with lower costs . Trial registration number NCT00785031 This study reports results of the 2-year follow-up phase of a r and omized study comparing outcomes of patients assigned to a nurse practitioner or a physician primary care practice .  In the sample of 406 adults , no differences were found between the groups in health status , disease-specific physiologic measures , satisfaction or use of specialist , emergency room or inpatient services . Physician patients averaged more primary care visits than nurse practitioner patients . The results are consistent with the 6-month findings and with a growing body of evidence that the quality of primary care delivered by nurse practitioners is equivalent to that by physicians Increasing dem and to deliver and document therapeutic and preventive care sharpens the need for disease management strategies that accomplish these goals efficiently while preserving quality of care . The purpose of this study was to compare selected outcomes for a new chronic disease management program involving a nurse practitioner - physician team with those of an existing model of care . One hundred fifty-seven patients with hypertension and diabetes mellitus were r and omly assigned to their primary care physician and a nurse practitioner or their primary care physician alone  . Costs for personnel directly involved in patient management , calculated from hourly rates and encounter time with patients , and pre- and post- study glycosylated hemoglobin ( HbA1c ) , high-density lipoprotein cholesterol ( HDL-c ) , satisfaction with care and health-related quality of life ( HRQoL ) were assessed . Although 1-year costs for personnel were higher in the team-treated group , participants experienced significant improvements in mean HbA1c ( − 0.7 % , p = 0.02 ) and HDL-c ( + 2.6 mg dL − 1 , p = 0.02 ) . Additionally , satisfaction with care improved significantly for team-treated subjects in several sub-scales whereas the mean change over time in HRQoL did not differ significantly between groups . This study demonstrates the value of a complementary team approach to chronic disease management in improving patient-derived and clinical outcomes at modest incremental costs BACKGROUND Telemonitoring has been advocated as a way of decreasing costs and improving outcomes , but no study has looked at true Medicare payments and 30-day readmission rates in a r and omized group of well treated patients . OBJECTIVE The aim of this work was to analyze Medicare cl aims data to identify effects of home telemonitoring on medical costs , 30-day rehospitalization , mortality , and health-related quality of life . METHODS A total of 204 subjects were r and omized to usual-care and monitored groups and evaluated with the SF-36 and Minnesota Living With Heart Failure Question naire ( MLHF ) . Hospitalizations , Medicare payments , and mortality were also assessed . Monitored subjects transmitted weight , blood pressure , and heart rate , which were monitored by an experienced heart failure nurse practitioner . RESULTS Subjects were followed for 802 ± 430 days ; 75 subjects in the usual-care group ( 316 hospitalizations ) and 81 in the monitored group ( 327 hospitalizations ) were hospitalized at least once ( P = .51 ) . There were no differences in Medicare payments for inpatient or emergency department visits , and length of stay was not different between groups . There was no difference in 30-day readmissions ( P = .627 ) or mortality ( P = .575 ) . Scores for SF-36 and MLHF improved ( P < .001 ) over time , but there were no differences between groups . The percentage of patients readmitted within 30 days was lower with telemonitoring for the 1st year , but this did not persist . CONCLUSIONS Telemonitoring did not result in lower total costs , decreased hospitalizations , improved symptoms , or improved mortality . A decrease in 30-day readmission rates for the 1st year did not result in decreased total cost or better outcomes Low levels of statin adherence may compromise treatment outcomes . The aim of this study was to investigate whether nurse-led cardiovascular risk-factor counseling could improve statin adherence and lipid levels without increasing patients ' anxiety .  Patients with indications for statin therapy for primary or secondary prevention of cardiovascular disease were r and omly assigned to receive routine care or extended care ( EC ) at baseline and at months 3 , 9 , and 18 . Patients in the EC group received a personalized risk-factor passport , showing modifiable and unmodifiable individual risk factors and a graphical presentation of their calculated absolute 10-year cardiovascular disease risk as well as the target risk that could be reached if all modifiable risk factors were optimally treated . Lipid levels were assessed at each visit . Carotid intima-media thickness was measured at baseline and at month 18 . Adherence , anxiety , quality of life , symptoms , and smoking status were assessed using a self-administered question naire at each visit . A total of 201 patients were included in the study .  Statin adherence was significantly higher ( p < 0.01 ) and anxiety was significantly lower ( p < 0.01 ) in the EC 
    Output:
    
There was no statistical difference between nurse practitioner-led care and usual care for 30-day readmissions , health related quality of life and length of stay .
IMPACT Low to moderate quality evidence was identified with no statistically significant associated outcomes of care .