***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 recently published the results of a r and omised controlled trial of a  nurse telephone consultation service in primary care out of hours.1 The new service , operating at evenings and weekends , significantly reduced  general practitioners ’ workload and was at least as safe as the existing out of hours service . Contacts diminish sharply after about 10 pm,2 and , anecdotally , a higher proportion of night calls necessitate consultation with a general practitioner . We report here a parallel trial aim ed at establishing whether  nurse telephone consultation was equally effective in managing workload at night Abstract Objective : To evaluate the effects of secondary prevention clinics run by nurses in general practice on the health of patients with coronary heart disease . Design : R and omised controlled trial of clinics over one year with assessment by self completed postal question naires and audit of medical records at the start and end of the trial . Setting : R and om sample of 19 general practice s in northeast Scotl and . Subjects : 1173 patients ( 685 men and 488 women ) under 80 years with working diagnoses of coronary heart disease who did not have terminal illness or dementia and were not housebound . Intervention : Clinic staff promoted medical and lifestyle aspects of secondary prevention and offered regular follow up . Main outcome measures : Health status measured by the SF-36 question naire , chest pain by the angina type specification , and anxiety and depression by the hospital anxiety and depression scale . Use of health services before and during the study . Results : There were significant improvements in six of eight health status domains ( all functioning scales , pain , and general health ) among patients attending the clinic . Role limitations attributed to physical problems improved most ( adjusted difference 8.52 , 95 % confidence interval 4.16 to 12.9 ) . Fewer patients reported worsening chest pain ( odds ratio 0.59 , 95 % confidence interval 0.37 to 0.94 ) . There were no significant effects on anxiety or depression . Fewer intervention group patients required hospital admissions ( 0.64 , 0.48 to 0.86 ) , but general practitioner consultation rates did not alter . Conclusions : Within their first year secondary prevention clinics improved patients ' health and reduced hospital admissions . Key messages Nurse led clinics in general practice were used to promote secondary prevention to patients with coronary heart disease Within the first year the health of patients invited to the clinics improved Most benefit was in functional status , but chest pain improved too There was no effects on anxiety or depression There were significant reductions in hospital admissions in the first Health visitors were employed specifically to care for two years for a r and om sample of patients in general practice who were aged over 70 . Independent assessment s made at the beginning and end of the study showed that the health visitor in an urban practice had some impact on her caseload of patients ; she provided more services for them , their mortality was reduced , and their quality of life improved , though the last measure just failed to be statistically significant . The health visitor working in a rural practice had no such effect BACKGROUND We set out to investigate whether community nurses could be trained in problem-solving therapy and , once trained , how effective they would be in treating emotional disorders in primary care . METHOD Seventy patients with an emotional disorder in primary care were r and omly allocated to receive either problem-solving therapy from a trained community nurse or treatment as usual from their general practitioner .  Interview and self-rated assessment s of clinical and economic outcome were made pretreatment , at eight weeks and at 26 weeks after treatment . RESULTS There was no difference in clinical outcome between patients who received problem-solving treatment and patients who received the general practitioner 's usual treatment . However , patients who received problem-solving treatment had fewer disability days and fewer days off work . The health care cost of problem-solving was greater than that of the general practitioner 's usual treatment but this was more than offset by savings in the cost of days off work . CONCLUSIONS Problem-solving treatment can be given by trained community nurses . The clinical effectiveness and cost-benefit of the treatment will depend on the selection of appropriate patients OBJECTIVE To evaluate the effect of a nurse-based intervention for patients with high total cholesterol ( TC ) levels in a community practice . DESIGN Clinical trial without a control followed by a nonr and omized control trial . SETTING Suburban primary care practice . PATIENTS White patients with TC higher than 6.21 mmol/L ( 240 mg/dL ) . In the initial trial , 82 patients with a mean TC level of 6.80 mmol/L ( 263 mg/dL ) . Fifty-three preponderantly female patients in the nonr and omized control trial with a mean TC level of 6.83 mmol/L ( 264 mg/dL ) .  INTERVENTION Counseling by office nurses using the Eating Pattern Assessment Tool and h and outs with br and -specific food advice . In the initial study , patients attended up to 5 nurse counseling visits . In a follow-up study , intervention patients attending 2 or more counseling sessions were matched with other patients in the practice . MAIN OUTCOME MEASURES Eating Pattern Assessment Tool scores in the initial study and TC levels in both trials . RESULTS Mean Eating Pattern Assessment Tool scores at baseline in both studies demonstrated that intervention patients were already following a diet consistent with the National Cholesterol Education Program Step I Diet . In the initial study , mean TC levels of the patients declined 2 % ( P < .05 ) and mean Eating Pattern Assessment Tool score improved from 23.4 to 20.4 ( P < .001 ) . In the follow-up study , the mean TC level of all patients improved significantly ( P = .002 ) . However , the improvement of the intervention patients was no better than that of the comparison patients . CONCLUSION The nurse counseling intervention was not effective in patients already following a Step I Diet Practice nurses are playing an increasingly prominent role in preventive care , including the provision of anti-smoking advice during routine health checks . A r and omized controlled trial was design ed to assess the effectiveness of anti-smoking advice provided by nurses in helping smokers to stop smoking . A total of 14,830 patients aged 16 - 65 years from 11 general practice s completed a brief question naire on general health , including smoking status , at surgery attendance . The doctor identified 4330 smokers and r and omly allocated 4210 to control or intervention groups . The doctor asked those in the intervention group to make an appointment with the practice nurse for a health check . The attendance rate at the health check was 26 % . Smokers were sent follow-up question naires at one month and one year , and those who did not respond to two reminders were assumed to have continued to smoke . There was no significant difference in reported cessation between the intervention and control groups at one month or one year . However , there was a significant difference in the proportion of patients who reported giving up within one month and who had not lapsed by one year--0.9 % in controls and 3.6 % in the intervention group ( P less than 0.01 ) . Nevertheless , the effect of the nurse intervention itself may be small as the sustained cessation rate in attenders was only 42.4 % higher than in non-attenders . The deception rate in reporting cessation , as measured by urinary cotinine , was of the order of 25 % Objective To examine the impact on general practitioners ' workload of adding  nurse practitioners to the general practice team . Design R and omised controlled trial with measurements before and after the introduction of nurse practitioners . Setting 34 general practice s in a southern region of the Netherl and s. Participants 48 general practitioners . Intervention  Five nurses were r and omly allocated to general practitioners to undertake specific elements of care according to agreed guidelines . The control group received no nurse . Main outcome measures Objective workload , derived from 28 day diaries , included the number of contacts per day for each of three conditions ( chronic obstructive pulmonary disease or asthma , dementia , cancer ) , by type of consultation ( in practice , telephone , home visit ) , and by time of day ( surgery hours , out of hours ) . Subjective workload was measured by using a vali date d question naire . Outcomes were measured six months before and 18 months after the intervention . Results The number of contacts during surgery hours increased in the intervention group compared with the control group ( P < 0.06 ) , particularly for patients with chronic obstructive pulmonary disease or asthma ( P < 0.01 ) . The number of consultations out of hours declined slightly in the intervention group compared with the control group , but this difference did not reach significance . No significant changes became apparent in subjective workload . Conclusion Adding  nurse practitioners  to general practice teams did not reduce the workload of general practitioners , at least in the short term . This implies that nurse practitioners are used as supplements , rather than substitutes , for care given by general practitioners OBJECTIVE To compare the effects of three brief methods of reducing alcohol consumption among family practice patients . DESIGN Patients r and omly assigned to one of three interventions were assessed initially and at 3- , 6- , and 12-month follow-up appointments . SETTING Family practice clinic composed of 12 primary care physicians seeing approximately 6000 adults monthly in a small urban community , population 40,000 . PARTICIPANTS Through a screening question naire , 134 men and 131 women were identified as hazardous drinkers ( five or more drinks at least once monthly ) during an 11-month screening of 1420 patients . Of 265 patients approached , 180 agreed to participate and 159 ( 83 men and 76 women ) actually participated in the study . INTERVENTIONS Three interventions were studied : brief physician advice ( 5 minutes ) , two 30-minute sessions with a physician using cognitive behavioural strategies or two 30-minute sessions with a nurse practitioner using identical strategies . MAIN OUTCOME MEASURES Quantity and frequency ( QF ) of drinking were used to assess reduction in hazardous drinking and problems related to drinking over 12 months of follow up . RESULTS No statistical difference between groups was found . The QF of monthly drinking was reduced overall by 66 % ( among men ) and 74 % ( among women ) for those reporting at least one hazardous drinking day weekly at assessment ( N = 96 ) . Men reported drinking significantly more than women . CONCLUSIONS These results indicated that offering brief , specific advice can motivate patients to reduce their alcohol intake . There was no difference in effect between brief advice from their own physician or brief intervention by a physician or a nurse Abstract Objective : To determine the effectiveness of health checks , performed by nurses in primary care , in reducing risk factors for cardiovascular disease and cancer . Design : R and omised controlled trial . Setting : Five urban general practice s in Bedfordshire . Subjects : 2205 men and women who were r and omly allocated a first health check in 1989 - 90 and a re-examination in 1992 - 3 ( the intervention group ) ; 1916 men and women who were r and omly allocated an initial health check in 1992 - 3 ( the control group ) . All subjects were aged 35 - 64 at recruitment in 1989 . Main outcome measures : Serum total cholesterol concentration , blood pressure , body mass index , and smoking prevalence ( with biochemical validation of cessation ) ; self reported dietary , exercise , and alcohol habits . Results : Mean serum total cholesterol was 3.1 % lower in the intervention group than controls ( difference 0.19 mmol/l ( 95 % confidence interval 0.12 to 0.26 ) ; in women it was 4.5 % lower ( P<0.0001 ) and in men 1.6 % ( P<0.05 ) , a significant difference between the sexes ( P<0.01 ) . Self reported saturated fat intake was also significantly lower in the intervention group . Systolic and diastolic blood pressures and body mass index were respectively 1.9 % , 1.9 % , and 1.4 % lower in the intervention group ( P<0.005 in all cases ) . There was a 3.9 % ( 2.4 to 5.3 ) difference in the percentage of subjects with a cholesterol concentration > /=8 mmol/l , but no significant differences in the number with diastolic blood pressure > /=100 mm Hg or body mass index > /=30 kg/m2 . There was no significant difference between the two groups in prevalence of smoking or excessive alcohol use . Annual rechecks were no more effective than a single recheck at three years , but health checks led to a significant increase in visits to the nurse according to patients ' degree of cardiovascular risk . Conclusions : The benefits of health checks were sustained over three years . The main effects were to promote dietary change and reduce cholesterol concentrations ; small differences in blood pressure may have been attributable to accommodation to measurement . The benefits of systematic health promotion in primary care are real , but must be weighed against the costs in relation to other priorities . Key messages Key messages There is little effect on smoking or alcohol use , and more targeted approaches to modifying these behaviours may be appropriate Systematic implementation of health checks might lead to a reduction in risk of myocardial infa rct ion among those who attend of about 5 - 15 % ; men , who are at higher risk , show less change than women Health checks consume substantial re sources , and their effect is attenuated by non-attendance The benefits of health promotion through primary care must be weighed against their costs and in relation to other The Oxford and Collaborators Health CHECK Trial ( OXCHECK ) was a r and omized controlled trial of the effectiveness of  nurse-administered health checks in the general practice setting . It was design ed primarily to influence risk factors for cardiovascular disease and cancer . The fourth and final year has now been completed , and the data analysis on over 8,100 health checks is under way . The 
    Output:
    
Patient health outcomes were similar for nurses and doctors but patient satisfaction was higher with nurse-led care .
Nurses tended to provide longer consultations , give more information to patients and recall patients more frequently than did doctors .
The impact on physician workload and direct cost of care was variable .
In general , no appreciable differences were found between doctors and nurses in health outcomes for patients , process of care , re source utilisation or cost .
AUTHORS ' CONCLUSIONS The findings suggest that appropriately trained nurses can produce as high quality care as primary care doctors and achieve as good health outcomes for patients .
While doctor-nurse substitution has the potential to reduce doctors ' workload and direct healthcare costs , achieving such reductions depends on the particular context of care .
Doctors ' workload may remain unchanged either because nurses are deployed to meet previously unmet patient need or because nurses generate dem and for care where previously there was none .
Savings in cost depend on the magnitude of the salary differential between doctors and nurses , and may be offset by the lower productivity of nurses compared to doctors